Treating ADHD: When Stimulant Medications Don't Work

Health Writer

Stimulant medications are often used to treat ADHD but it is estimated that between 10 percent and 20 percent of people with ADHD are not helped by these types of medications. Although that's great news for the 80 percent to 90 percent of people that find ADHD symptoms are significantly reduced with stimulant medication it leaves many people wondering what to do when stimulant medications don't work.

The American Academy of Pediatrics (AAP) agrees that medication is not right for every child. Some may experience side effects that prevent using them and others may have coexisting conditions that make using stimulant medication impossible. Additionally, family and cultural beliefs may prevent some from using medications. Doctors should take all these factors into consideration when not only determining whether medication is a viable treatment but in monitoring effectiveness.

Each person reacts to medication differently. While one type of stimulant medication, such as Ritalin will work well for one person, it may not be as effective for another. The AAP recommends that doctors try 2 to 3 different stimulant medications, and work closely with a patient to find the correct dosage, before deciding that stimulant medication does not work.

After several different medications are used without success, the AAP considers it a "treatment failure." There are a number of reasons for this:

The diagnosis of ADHD should be reevaluated. There are a number of physical illnesses which share symptoms of ADHD.  Over-stimulation in autism or Asperger's Syndrome can look like hyperactivity. Hearing or visual impairments can cause a child to not pay attention.   Learning disabilities can look like ADHD in the classroom and thyroid problems can cause problems with the ability to concentrate. Depression or anxiety also share symptoms of inattention or problems focusing.

There may be a coexisting condition. For some, ADHD medication doesn't work effectively because a second, or comorbid, condition is present. For example, if someone has both ADHD and depression, the stimulant medications may be helping symptoms of ADHD, such as hyperactivity or impulsiveness, but the depression could be causing problems focusing. Unless both conditions are identified and treated, all symptoms will not be properly treated.   In addition to checking to make sure the diagnosis of ADHD is correct, you, or your child, should also be evaluated for additional medical conditions.

Non-stimulant treatment can be considered. Some people cannot tolerate stimulant medications for a variety of reasons. The side effects may be severe or other medical conditions, such as heart disease or high blood pressure, or other medications interfere with the effectiveness of the medication. These problems may prevent someone from taking stimulant medication. Other non-stimulant medications, such as Strattera (Atomoxetine), Clonidine (Catapres) or Guanfacine (Tenex, Intuitiv) can be tried. Not all of these treatments are approved by the FDA for ADHD but have been found to work to reduce some of the symptoms of ADHD.

Behavior therapy alone may be effective. While a combination of stimulant medication and behavioral strategies have been found to be the most effective when treating ADHD, many people use only behavior strategies to manage symptoms of ADHD. Working with an behavioral therapist or an ADHD coach can help in developing and following specific strategies to help in problem areas.