Let’s Talk About ADHD Treatment
You or your child has been diagnosed with ADHD. Now what? We’ll answer your questions and help you see a clear path forward.by Holly Pevzner Health Writer
Getting treatment for ADHD requires using several strategies while working closely with healthcare providers, therapists, teachers, and family members. It also means adopting approaches such as school interventions, behavioral therapy, psychotherapy, coaching, and possibly medication. Perhaps most importantly, you’ll need to swap any notion of “cure” for the reality of ongoing management. Now for the encouraging news: With persistence, you’ll hit on the solution that works for you or your kiddo. The best place to start your journey? Right here.
Our Pro Panel
We went to some of the top ADHD experts to bring you the most up-to-date information possible.
Sharon Saline, Psy.D.
Licensed Clinical Psychologist and Author
What Your ADHD Child Wishes You Knew
Lenard A. Adler, M.D.
Psychiatrist and Director of the Adult ADHD Program
New York City
Rosemarie Manfredi, Psy.D.
Licensed Psychologist and Certified School Psychologist
Neurodevelopmental Assessment and Consulting, LLC
For those 6 years old and up, medication and behavioral therapy is often the go-to ADHD treatment combo to improve focus and other ADHD symptoms. Getting outside in nature and engaging in regular exercise can help to improve focus, as well, research has shown.
ADHD is a chronic neurodevelopmental (or neurobiologic) disorder. Essentially, this means that ADHD is a condition that affects how the brain functions. It’s thought that there may be less activity in some parts of the brain that are in charge of attention, but this in no way relates to intelligence. Other possible influencing factors: heredity; head injuries; being born premature or at a low birth weight; prenatal exposure to alcohol, nicotine, and/or lead.
Cured? No. A more apt way to look at it is this: ADHD can change over time. For instance, the hyperactivity seen in some children with ADHD often becomes restless in adulthood. Some individuals manage and adapt to their symptoms in adulthood, choosing to discontinue active treatment. Others use various treatments and supports throughout their lives.
For children under 6 years old, behavior therapy is the recommended treatment option for ADHD. But for older children and adults, behavior therapy used in combination with psychostimulant medications, such as Ritalin, Adderall, and Dexedrine, is considered the most effective treatment strategy. Stimulants have been shown to lessen ADHD symptoms in up to 80% of people who take them.
What Exactly Is ADHD Again?
It’s one of the most common neurodevelopmental disorders of childhood. More than 6 million children have been diagnosed with ADHD, according to a 2016 report from the Centers for Disease Control and Prevention (CDC). However, ADHD isn’t something you tend to outgrow. In fact, it can persist well into adulthood. Roughly 11 million people, or 5% of the adult population, have it, too.
How does it present? ADHD is marked by its key characteristics:
Inattention (wandering off task, loss of focus, disorganization)
Hyperactivity (being in constant motion)
Impulsivity (acting or speaking without thinking)
You don’t need to display this trifecta to have ADHD. You may just have one of these signs or symptoms, or a combo; most kids with ADHD show a combo of these symptoms.
How Should You Approach ADHD Treatment?
Like asthma or diabetes, ADHD is considered a chronic condition. That doesn’t necessarily mean it can’t be managed or that you or your child will be taking meds and going to therapy forever. It simply means that ADHD can’t be cured, but you most certainly can thrive with your diagnosis—once a treatment strategy is in place and working for you.
Depending on the age of diagnosis, most treatments involve the following:
Behavior therapy, including parent training
Individual and family counseling; an ADHD coach
School accommodations / special education services
A plan for long-term management
What Are ADHD Treatment Goals?
You can’t formulate an effective ADHD treatment plan if you don’t know what you’re working toward. That’s like going on a road trip with no directions or destination in mind!
Since Cure my ADHD is not a viable end-goal, you’ll need to tease out more attainable objectives by collaborating with a trained clinician.
To put together a child's treatment plan, for example, the American Academy of Pediatrics recommends starting with three target outcomes. What does success look like for your kiddo? To get there, think about what behaviors are the biggest roadblocks to your child’s success at home, school, and within your community. You want to focus on specific and realistic behavior changes that:
You can actually observe and measure
Your child will be able to accomplish
The goals you come up with may include things like:
Completing homework assignments
Decreasing arguments with siblings
Getting ready for school without supervision
Decrease disruptive behaviors, like throwing a tantrum when homework gets tough
While the AAP guide is clearly for kids, goal-setting for adults with ADHD is not that different. It’s just that with children, the focus is often on academic and social outcomes. For adults, goals generally address employment, financial, and relationship challenges.
Whatever goals you zero in on will serve as your guiding star, helping you measure the efficacy of your strategy during this first leg of your treatment.
What’s Behavior Therapy For ADHD?
For children and adolescence, behavior therapy encompasses training kids themselves and their parents. The reason: Ultimately, therapy can’t work if it’s only about teaching a child to change and adapt.
Parents—you know, the folks reacting to the ADHD symptoms and in charge of household order—need to change and adapt along with their child. This approach is known as behavioral parent therapy.
Over the span of about 8 to 16 sessions, a trained parent therapist helps the adults in a child’s life learn to:
Encourage positive behaviors
Discourage negative behaviors
Improve parent-to-kid communication skills
Instill a consistent discipline strategy
While dubbed parent therapy, this method often involves working with parents and children together. The idea is to target specific actions and habits that are eating away at a child’s self-esteem, self-control, and overall behavior.
Throughout the process, parents practice the skills they’re learning at home, while the therapist checks in to monitor progress.
While there are different types of parent behavior therapy (like parent-child interaction therapy, parent management training, and positive parenting programs), essentially, all of it should include these tentpoles:
Use rewards to reinforce positive behavior: Think: sticker charts or special privileges, like an extra 30 minutes of screentime
Ignore negative behavior: Since children often use bad behavior to get attention, overlooking certain missteps can actually discourage the behavior.
Take away privileges: This is only advised if a negative behavior veers too serious to ignore.
Eliminate common triggers: If your child misbehaves when sitting next to a specific kiddo, move seats. If your child keeps grabbing your phone at home, place it in a drawer when you walk in the door. You get the idea.
When to Try Behavioral Therapy
While it’s never too late for behavior therapy, the best approach is to start as soon as an ADHD diagnosis is made.
If your child is under 12 with ADHD, the AAP strongly suggests that you attend parent behavior therapy training.
If your child with ADHD is between 4 and 5 years old, the AAP goes as far as dubbing this type of training the first-line treatment. Translation: Behavior training should for-sure be tried before even considering ADHD medication.
Why? Children with ADHD improve faster when behavioral therapy comes first. And they often respond to lower dose meds than what would normally be prescribed, according to a study in the Journal of Clinical Child & Adolescent Psychology. Sadly, however, research shows that only about 40% to 50% of families with young children with ADHD take part in these types of services.
By 8 to 10 years old, you child can likely benefit from visiting a therapist solo or with peers in a group session. Here, a trained therapist, such as a psychologist, licensed social worker or licensed counselor, works to help your kiddo to recognize symptoms and better manage his behavior by replacing problematic actions and reactions with healthier ones.
For instance, if your child is having a beast of a time staying on top of schoolwork, a therapist can teach him techniques to better manage his schedule and responsibilities. If your child is struggling to process social cues as many with ADHD do, and saying off-putting things that she thinks are funny, a therapist can help her better understand (and appropriately respond to) these types of situations.
While behavior therapy is effective and important, it’s not an overnight “fix.” Time, effort, and commitment is required for the process to work. The payoff, however, is powerful. And for many, it’s even more powerful when paired with medications. (More on that later.)
What Other Types of Therapy Help ADHD?
Several modes of therapy can provide the tools and support to live better with ADHD. Often, someone might benefit from more than one type simultaneously.
Those who have a child with ADHD might want to try:
Family therapy with a licensed mental health pro
A parenting group led by a trained mental health clinician or parenting specialist
Adults with ADHD can reap the rewards of:
Family or marriage counseling
Individual therapy or counseling that hones in on improving various behavioral and time management skills—and emotional issues entangled with a diagnosis, too.
What type of pro should you see for therapy? An ADHD coach, a mental health counselor, or a licensed therapist are a few options. And it’s not out of the realm for folks to work with a therapist and a coach simultaneously. Here are the basic differences:
ADHD coaching: Essentially, a coach (who’s not necessarily a mental health pro) helps adults or adolescents with ADHD recognize how their symptoms play out—and negatively impact—their everyday lives, concentrating on specific hiccups in time management, organization, goal-setting, and problem-solving. Their role is to hold you accountable, offer support and encouragement, and, most notably, to spur positive action. You can opt for in-person, online, by phone or even via e-mail help.
Cognitive-behavioral therapy: Here, a mental health professional helps individuals with ADHD focus on practical short- and long-term goals, such as organization, time management, and reigning in one’s reactiveness. However, they also help with the emotional load tied to years of dealing with ADHD, like feelings of inadequacy or general pessimism. In addition, many adults with ADHD are also dealing with a coexisting mental health issue, such as depression or anxiety, that CBT can help as well. Up to 53% of adults with ADHD also have depression, according to a 2017 report in the journal BMC Psychiatry.
How Can School Help With Treatment?
ADHD can impact nearly all aspects of a kid’s school day. (Heck, ADHD red flags often initially pop up at school.) So ADHD treatments need to carry over to the classroom in order to yield success.
That’s why adjusting a child’s school environment is a key part of any ADHD treatment plan, the AAP notes. (About 9 out of 10 kids get school support, such as school accommodations and in-class help, notes the Centers for Disease Control and Prevention.)
To get started, meet with your child’s teachers to offer your concerns and ask them to share what (learning and behavior) concerns they have regarding your child, too. From there, work together to explore some ways school can help, like:
Behavioral Classroom Management
Teachers implement a reward system or a daily report card to help encourage positive behaviors in the classroom. This strategy is recommended by the AAP and has been shown to work for students of all ages, according to a report in the Journal of Clinical Child & Adolescent Psychology.
Teachers, counselors, or school psychologists teach children a specific plan to manage their time and workload in a way that tamps down distractions and keeps school work organized.
Students with ADHD may qualify for classroom accommodations. These kiddos likely have what’s dubbed a 504 Plan, named after the Section 504 statute that notes schools cannot discriminate against children with disabilities. Here, kids may be able to, for example:
Use technology to assist in classroom tasks
Get extra time to complete tests and/or be allowed movement breaks throughout the day
Special Education Services
If your child’s ADHD interferes with her ability to learn and succeed in school—and your kiddo is in a public school—she may qualify for special education. For this to occur, a child must be evaluated by the school (you need to request this in writing) and receive an Individualized Education Plan (IEP).
An IEP and/or 504 Plan can include accommodations, like:
More time to finish assignments
Breaking assignments up into smaller parts
An IEP can also include modifications, like:
Different textbooks than schoolmates
Alternate test questions or test questions than schoolmates
Regardless of the specifics, all IEPs comprise details on:
Short-term benchmarks to achieve annual goals
How goals are measured
Which special education services will be offered and for how long
No matter what strategies are in place, it’s incredibly important for parents, teachers, and schools to work together to support a child’s treatment plan. When everyone is on the same page—and kids get mirroring messages and interventions in all areas of their lives—the more successful that kiddo is going to be.
And know this: Graduating from high school does not have to mean graduating from in-school ADHD support. But since a child’s IEP or 504 won’t simply carry over to university, you’ll very likely need to submit a written diagnosis from your child’s physician or psychologist that includes how her ADHD impacts various aspects of her learning. (Contact a college’s Office of Disability Services office for specific guidelines.) From there, your child will meet with her designated disability counselor to hammer out accommodations that can work in this new setting.
What Medications Treat Children and Adults With ADHD?
For many children and adults, medication is an essential part of ADHD treatment. This isn’t surprising, considering between 70% and 80% of children with ADHD have fewer symptoms when taking ADHD medication, according to the CDC.
While most studies focus on ADHD meds for children, generally speaking, the same drugs have been shown to be safe and effective in adults, too. Of course, it’s important to understand that whatever medication a person is on, no pill can be the end-all-be-all in treatments.
Alas, meds don’t teach organizational, planning, prioritizing, or self-monitoring skills. That know-how can only come from direct instruction. The medication’s job? To help folks better tap the skill garnered from said direct instruction.
With that, ADHD treatment guidelines put out by the AAP do not endorse medications for preschoolers. Instead, they stress behavioral therapy alone. For kids between 6 and 17, however, a combo of behavioral therapy and medication is recommended. And meds are considered the mainstay of ADHD treatment in adults, according to the journal American Family Physician.
Several FDA-approved medications treat ADHD in children and adults. They fall into two buckets:
Psychostimulants: This is the most effective and widely used type of ADHD medication. Despite the name, these fast-acting meds don’t actually increase stimulation. Rather, they have a calming effect by boosting levels of dopamine, a neurotransmitter associated with motivation, attention, and movement. These meds can take as little as 45 minutes to start working.
Commonly prescribed meds: These include methylphenidates, such as Ritalin and Concerta, and amphetamines, such as Adderall and Dexedrine.
Non-stimulants: Up to 30% of people don’t respond to stimulants, according to a report in Expert Review of Neurotherapeutics. For those folks, non-stimulants are the next choice. This class of meds is also an option for those who experience significant stimulant side effects or people who simply prefer to avoid stimulants. While non-stimulants can take about a week to start working, once they kick in, they can last up to 24 hours.
Commonly prescribed meds: Some popular options include Strattera, Intuniv, Tenex, and antidepressants such as Wellbutrin and Effexor.
What Are The Side Effects of ADHD Medications?
Side effects from ADHD meds are not uncommon, but they’re also often temporary. Healthcare providers often start with small doses, gradually increasing until benefits become more clear, just as side effects (if any) remain tolerable. If side effects do occur, a clinician will tinker with the type of medication, the dosing, and/or release formula (short- or long-lasting) to get it right.
Overall, stimulants have the potential for side effects, such as:
Minor growth delay
Moodiness and irritability
Raise blood pressure and heart rate
And some side effects associated with non-stimulants include:
Getting the Mix of Meds Right
Naturally, not all medications work the same for everyone. So even if, say, Ritalin is a perfect fit for your child’s classmate, it doesn’t mean your child will experience the same effect. That’s why it’s crucial to work with your healthcare provider to compare you or your child’s specific needs with the characteristics of the ADHD medications you’re considering, including weighing side effects. And know that tweaking drugs and dosages are par for the course. (Getting it 100% the first try is, well, almost impossible.)
To truly understand how well treatments are working, you’ve got to monitor their effectiveness over time. Your healthcare provider will likely advise you (and your child’s teachers, if applicable) to fill out behavior rating scales and to note any changes in your goals, plus any side effects. At the same time, you might be asked to keep tabs on your or your child’s weight, pulse, and blood pressure (for kids, height, too).
What About Alternative Therapies for ADHD?
Various so-called alternative therapies touted as ADHD treatments have little or no scientific backing. According to the AAP, these include:
Megavitamins and mineral supplements
Treatment for candida yeast infection
EEG biofeedback (training to increase brain-wave activity)
Applied kinesiology (realigning bones in the skull)
Reducing sugar consumption
Optometric vision training (asserts that faulty eye movement and sensitivities cause behavior problems)
Also noteworthy: Currently, there aren’t enough double-blind placebo-controlled studies to recommend ditching artificial food coloring or increasing polyunsaturated fatty acids supplementation for ADHD, so concludes research in the journal PLOSone.
Complementary approaches that are worth a shot, however, include:
Exercise: It drives the brain to release neurotransmitters, like dopamine, which helps bring on the feeling of calm. It also substantially—and consistently—benefits the executive functioning skills, attention, and behavior of kids with ADHD, found a 2019 report in the Journal of Clinical Medicine. Studies also support the impact exercise can have on adults with ADHD. For example, a report in the journal Medicine and Science in Sports and Exercise found that a mere 20 minutes of exercise can enhance motivation for cognitive tasks in adults with ADHD.
Getting outdoors: Both children and adults who spend time in nature seem to experience improved concentration and impulse control. In addition, children with ADHD who are hyperactive have less severe symptoms if they take their play to a wide-open natural environment, like a grassy field. As little as 20 minutes of outdoor time in an open, green space can potentially buy a child about two hours of ready-to-focus time later, experts report.
These diet tweaks: Since folks with ADHD are more likely to have allergies and food sensitivities, it may be wise to get tested if you notice that you or your child experiences behavior changes or amplified ADHD symptoms after eating a certain food. Simply eating a healthy balanced diet regularly throughout the day can also make a meaningful impact. That means not skipping meals, as hunger can lead to distraction, impulsiveness, and restlessness.
How Do ADHD Treatments Shift Over Time?
As we now know, ADHD is a chronic condition that doesn’t necessarily go away, but it very much can change over time—like, hyperactivity often lessens as kiddos mature, morphing into restlessness.
Another thing that can change? The way to approach treatment. For instance, with years of behavior training and organizational techniques as scaffolding, many adults consider tapering off medications.
To give this a proper go, however, it’s imperative that one recognizes exactly what the medicine does for their ADHD symptoms. Folks who have that awareness tend to be more adept at tapping into their learned coping strategies sans medicine.
That said, a significant number of people with ADHD do, in fact, continue various treatments and supports throughout their lives. After all, the big-picture ADHD goal should not be to get off meds (or even reduce the dose), but to struggle less and bolster quality of life.
For those who were diagnosed with ADHD as children, it’s very important to transition treatment into adult care. Essentially, this means finding a physician who treats adults and is comfortable prescribing ADHD medication if warranted. It’s a good idea to start this process about six months before finishing up with a pediatric clinician, who will very likely help you down this road.
Getting treatment for ADHD requires persistence, a willingness to explore new angles, a solid support network, and plenty of patience. But if you stay the course, you’ll find your challenges are eased and school, work, and relationships become a whole lot easier, in time.
- Guidelines for Treating Children: Pediatrics. (2019) “Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.” pediatrics.aappublications.org/content/144/4/e20192528
- Behavior Training Need-to-Know: ADDitude. (2019). “How Does Behavior Therapy Work?” additudemag.com/how-does-behavioral-therapy-parent-training-work/
- More on Parent Training: Centers for Disease Control and Prevention. (2020). “Parent Training in Behavior Management for ADHD.” cdc.gov/ncbddd/adhd/behavior-therapy.html
- Behavioral Interventions for Kids with ADHD: Child Mind Institute. (n.d.). “Behavioral Treatments for Kids With ADHD.” childmind.org/article/behavioral-treatments-kids-adhd/
- Treatment Stats for Children With ADHD: Centers for Disease Control and Prevention. (2016). “ADHD in Young Children.” cdc.gov/vitalsigns/adhd/infographic.html#graphic
- ADHD Coaching: Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). (2015). “ADHD Coaching of Adults.” chadd.org/wp-content/uploads/2018/04/coaching-adults.pdf
- Treatment for Concurrent ADHD Conditions: BMC Psychiatry. (2017).”Adult ADHD and comorbid disorders: clinical implications of a dimensional approach.” ncbi.nlm.nih.gov/pmc/articles/PMC5567978/
- Rewards Work for Kids with ADHD: Journal of Clinical Child & Adolescent Psychology. (2014). “Evidence-Based Psychosocial Treatments for Children and Adolescents with Attention-Deficit/Hyperactivity Disorder.” ncbi.nlm.nih.gov/pmc/articles/PMC4025987/
- ADHD Accommodations in College: ADDitude. (2020). “Yes, You Can Get ADHD Accommodations In College.” additudemag.com/yes-you-can-get-adhd-accommodations-in-college/
- ADHD Med Stats: Centers for Disease Control and Prevention. (2020). “Treatment of ADHD.” cdc.gov/ncbddd/adhd/treatment.html
- Managing of ADHD in Adults: American Family Physician. (2012). “Diagnosis and Management of Attention-Deficit/Hyperactivity Disorder in Adults.” aafp.org/afp/2012/0501/p890.html
- Info on Non-Stimulant Meds: Expert Review of Neurotherapeutics. (2007). “Pharmacotherapy of attention-deficit/hyperactivity disorder: nonstimulant medication approaches.” pubmed.ncbi.nlm.nih.gov/17286552/
- Side Effects of ADHD Meds: Child Mind Institute. (n.d.). “Side Effects of ADHD Medication.” childmind.org/article/side-effects-of-adhd-medication/
- Managing Meds: CHADD. (n.d.). “Medication Management.” chadd.org/for-adults/medication-management/
- Unproven ADHD Treatments: HealthyChildren.org. (2019). “Common ADHD Medications & Treatments for Children.” healthychildren.org/English/health-issues/conditions/adhd/Pages/Determining-ADHD-Medication-Treatments.aspx
- Green Space and ADHD: Applied Psychology: Health and Well-Being. (2011).“Could Exposure to Everyday Green Spaces Help Treat ADHD? Evidence from Children's Play Settings.” gwern.net/docs/nature/2011-taylor.pdf
- More on the Green Effect: ADDitude. (2017). “News on Green Therapy.” additudemag.com/news-green-therapy-alternative-adhd/