The Role of Medication in ADHD Treatment
Treatment for ADHD is often aimed at reducing symptoms, but that should not be the only criteria. The goal should be improved functioning in the real world, according to Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). This includes being self-sufficient, being able to cope with the demands of daily life, and having a better quality of life than one would have without treatment. Treatment for ADHD includes behavioral strategies, medication, parent training, and coaching.
According to ADHD Parents Medication Guide, medication "plays an important role in the treatment of children, adolescents and adults with ADHD…for most people with ADHD, medication dramatically reduces hyperactivity, improves attention and increases the ability to get along with others.” It also notes that children with ADHD who have other mental health conditions, such as depression and anxiety, were especially helped by having individual and family treatment as part of their treatment plan.
Medication does not cure ADHD. But it does help to reduce symptoms, when taken as prescribed.
How medication helps
Approximately 80 percent of people respond positively to stimulant medications according to CHADD. They work by affecting the neurotransmitters dopamine and norepinephrine, in the brain and enable networks of nerve cells in the brain to communicate more effectively with each other. Medications help most people with ADHD feel calmer and more able to focus and concentrate. They should not change a person’s personality, but might make them less hyperactive and more attentive.
Medications help increase attention span and focus, while reducing hyperactivity and impulsivity. Many people notice improvements in frustration tolerance and report that taking medication has led to improvements in relationships with parents, spouses, peers, and teachers.
Not everyone finds that medications work. Some find the benefits extraordinary, while some see modest improvements.
Types of medications for ADHD
The most common medications used to treat ADHD are psychostimulants, such as:
Methylphenidate (Ritalin, Concerta, Metadate, Daytrana, Methylin, Quillivant)
Amphetamines (Adderall, Eveko, Adzenys)
Dextroamphetamines (Dexedrine, ProCentra, Zenzedi)
Stimulant medications begin working 30 to 90 minutes after taking the medication. Short-acting medications last four to six hours. Many are available in extended release (XR, ER), lasting anywhere from six to 12 hours, depending on the medication and dosage.
There are also non-stimulant medications (atomoxetine, clonidine, guanfacine), which are approved by the FDA in the treatment of ADHD. Clonidine can be used in combination with stimulants to improve its effectiveness. Where stimulant medications are effective immediately and the effects last for a short period of time, these medications must be taken every day to be effective. But you or your child might not feel the full effect for three to four weeks.
Other medications include antidepressants, antihypertensive medications, and wake-promoting medications, such as those used to treat narcolepsy. These can be tried if psychostimulants or non-stimulant medications are not effective or not well tolerated.
Side effects of ADHD medications
The most common side effects of stimulant medications are reduced appetite and difficulty sleeping. These are usually short-term and frequently go away after a few weeks. Some people have headaches or stomachaches, but this also usually disappears after taking medication for a few weeks.
Height and weight should be monitored by your doctor. Stimulant use may be associated with a small reduction in growth. According to the Multimodal Treatment Study of ADHD, this may continue into adulthood.
Treatment for children under six years old
For children under the age of six, the American Academy of Pediatrics (AAP) recommends behavior therapy as the first line of treatment, before trying medication. The AAP found many preschool age children with moderate to severe dysfunction had improved symptoms with behavioral therapy alone. If no significant improvement is seen with behavior therapy, then methylphenidate can be prescribed.
For children older than six, medications combined with behavior therapy is recommended. Stimulant medications have shown the best results, but non-stimulants and clonidine will work if stimulants are not tolerated.
The long-term use of stimulant medication
The Multimodal Treatment Study of ADHD (MTA) followed up 579 children who were between ages of 7 and 10 in 1999, the first year of study. Participants were randomly assigned to four groups: medication, medication plus behavior therapy, behavior therapy only, or community care, which was care organized and overseen by parents. They were intensively treated for 14 months.
The study found that medication was most effective. After the 14 months, treatment continued or didn’t based on parents’ discretion, but researchers still followed up with participants periodically and the results were published every few years. The most recent update was in March 2017. This follow-up confirmed that reduced height, by an average of 2.36 centimeters (about one inch), was still present in those that took stimulants.
A previous follow up, in 2007, had found that medications seemed to lose their effectiveness around three years after starting them. The follow up in 2016 found that more than 60 percent of the participants continued to have ADHD symptoms, regardless of whether they used medication or not. The most recent, in March 2017, found that symptom severity was not any different in those who took medication and those who didn’t.
This made people wonder whether the treatment was worth it, or whether it was only effective for a short time. Dr. Steve Hinshaw, a professor of Psychology at the University of California, Berkeley, isn’t sure that the MTA shows that medication isn’t effective.
In an article published in Wire Cognitive Science, he states it could be that intensive treatment with medication wasn’t necessarily occurring throughout the years; that the monitoring by parents that was apparent during the initial phase of the study was not present after the initial 14 months; or that some people may experience a burnout of the dopamine receptors, and that would make medication less effective.
“When ADHD medication is working, many of the ADHD symptoms go away. It is not uncommon, though, for some symptoms to linger. Behavior treatments may help with the remaining symptoms,” according to ADHD Parents Medication Guide.
It remains true that medication is effective for many people. It is up to you and your doctor to monitor this effectiveness and continue to evaluate its benefits.