By Eric K. Mason
Lighthouse Human Services and Consulting
Counseling and Psychological Services in Bangkok, Thailand
Treatment of ADHD
There are a variety of approaches which are effective in the treatment of ADHD. These approaches include pharmacological, psychological, behavioral treatments, psychosocial, and academic. Often, parent training to teach parents how to manage children with ADHD is recommended, as well. Often a combination of all of the aforementioned approaches is the most effective method to ensure the best treatment outcomes.
Pharmacological treatments includes the use of stimulant medications, such as Ritalin, Dexedrine, Concerta, Adderall, and Metadate. Modafinil a stimulant medication used for the treatment of narcolepsy is sometimes used “off label” for ADHD. Stimulant medications appear to be the most effective medications for treating ADHD.
Other non-stimulant medications used to treat ADHD include anti-depressants, such as Wellbutrin and imipramine. A non-stimulant and non-antidepressant medication which has proven effective in treating ADHD is called Strattera. In addition, a blood pressure medication, known as Hypodine, has shown some effectiveness in improving ADHD symptoms. However, this medication is usually used in combination with one of the stimulant medications mentioned above.
Although the medications above are quite different in many ways (from stimulants to antidepressants to blood pressure medications), they share in common one way in which they affect the brain that provides relief from symptoms of ADHD—namely, stimulating or activating the frontal lobes of the brain. Other than having this in common, these medications affect the various neurotransmitters in the brain differently. For example, stimulants tend to have a greater effect on dopamine, while the non-stimulant medications increase norepinephrine levels. Both of these neurotransmitters have a stimulating effect on the brain which is why these medications are believed to reduce symptoms of ADHD. It is believe that the aforementioned blood pressure medication works by increasing blood flow to the frontal lobes, leading to an improvement in ADHD symptoms.
One of the most comprehensive studies of ADHD revealed that medications alone may be effective in reducing ADHD symptoms. That is, medications without the use of other treatment approaches, such as psychological or behavioral interventions, significantly reduce the symptoms of ADHD in 80% of people with ADHD, according to the study mentioned above. Although medications are often effective in reducing symptoms of ADHD, due to the complex nature of ADHD, it is advisable to combine treatment approaches, nevertheless. For example, the complexities of ADHD are evident as it pertains to the challenges those with ADHD face, such as poor school performance, emotional difficulties, social isolation, other mental disorders, as well family discord and parenting skill needs.
Although psychological treatments, such as psychotherapy and counseling, typically are not recommended as a standalone treatment for ADHD, they may be very effective in treating some aspects for ADHD, especially when incorporated as part of a comprehensive treatment approach. Psychotherapy may be used to address other concerns that may arise indirectly from ADHD, such as family conflict and poor self-esteem, as well as other disorders which may co-occur alongside ADHD (e.g., depression and anxiety disorders). Furthermore, psychologists and counselors often employ cognitive strategies, such as collaborative problem-solving techniques to address negative thoughts and perceptions which may be exacerbating ADHD and/or symptoms of other mental disorders.
Behavioral treatments are an essential part of a comprehensive approach to treating ADHD, as behavioral treatments are designed to reduce problematic behaviors associated with ADHD.
Behavioral approaches include positive reinforcement, token economies, and response-cost programs. In general, effective behavioral plans for symptoms of ADHD have the following common features: increased structure and support, reinforcement of appropriate behaviors, an immediate response, and a focus on rewards. Systematic behavior modification programs can help manage behaviors, particularly oppositional behaviors (Connors, 2009).
Psychosocial treatments essentially aim to improve the social skills of those with ADHD, especially with peers. Although most people with ADHD do not lack social skills, they may fail to apply appropriate social skills at the appropriate time. Psychosocial treatments tend to rely on cognitive and behavioral method to teach better social skills to those with ADHD. Additionally, social skills training may include practical tips, such as teaching the person with ADHD to pay attention to socials cues (e.g., body language, social context, or tone of voice), not just what the words that people use to communicate. Unfortunately, children and adolescents with ADHD may become socially isolated which, in turn, may lead to other issues, such as depression or substance abuse (Conners, 2009). Therefore, psychosocial treatments and social skills training are an important part of a comprehensive approach to the treatment of ADHD.
Academic interventions are designed to improve the odds of school success for those with ADHD. These interventions tend to practical solutions and involve teachers, school counselors, and parents—ensuring all those involved with the student with ADHD are on the same page and working together help the student by “evening the playing field.”
Academic interventions include specific recommendations for change. Modified instruction (e.g., increased hands-on), specialized instructions, and specific skill instruction (e.g., organization, time management) are all forms of academic intervention that can be very effective for youth ADHD (Conners, 2009).
Academic interventions are essential in improving organizational skills by practical applications, such as encouraging the student to use separate folders for each school subject, having teachers place the student’s homework in a specified homework folder each (which parents can check daily), explicit and step-by-step instructions, testing accommodations (such as allowing more time), as well assignment modifications (such as allowing the student to divide large assignment into multiple smaller assignments which would equate to the original assignment). These interventions are not intended to make school assignments and tests easier for students with ADHD, but rather serve to allow the student time to develop the necessary skills to cope with ADHD while also ensuring that the students receives an equal education to those without ADHD. In addition, these interventions may serve to prevent the student from becoming overly discouraged by school which, in turn, limits the probability of the student developing other problems, such as low self-esteem or depressive disorders (Conners, 2009).
Although medication alone may be effective in treating ADHD, a comprehensive assessment should be completed in order to decide the best treatment approach.