Treatment of Adult Attention Deficit Hyperactivity Disorder

How can we help adults who are diagnosed with ADHD?

For many individuals, simply understanding that they have a condition which is causing them to struggle at home, work, or school can bring relief. These adults may have been frustrated by their inability to function effectively. Commonly, they blame themselves—thinking that they are lazy, incapable, or incompetent. One of the most damaging effects of having ADHD is its impact on self-esteem. Realizing that they were born with a life long neurodevelopmental condition is liberating.

Medications can help too. There are both stimulant and non-stimulant medications.  Typically, the longer acting preparations are recommended as they result in smoother improvement of symptoms.

Stimulant medications include methylphenidate and amphetamine compounds. Close to 80% of individuals respond well to these medications. We are still unsure exactly how these medications work for adults with ADHD—they appear to work on the neurochemical transmitters in the brain.  These medications can improve attentiveness, decrease distractibility, improve vigilance, and the ability to persist in low interest or low satisfaction tasks.

The most commonly prescribed medications are forms of methylphenidate (the trade name is Ritalin), which comes in both short acting and long acting forms. Common types of amphetamines are dextroamphetamine (Dexedrine) or amphetamine salts (Adderall). Unfortunately, it is very difficult to determine which medication will work well for a particular adult. Typically, prescribers will start at a low dose and move up in dose depending on response. Treatment has to be very individualized and can take some time to select the right medication at the right dose.

Like any medication, there can be side effects that need to be evaluated and monitored. Some individuals may have insomnia, headaches, weight loss, or increases in blood pressure or heart rate. They may not be suitable for some men and women. Individuals with a history of drug abuse or drug dependence may not do well with these medications.

Studies have shown that anywhere from 10-30% of adults with ADHD have problems with drug abuse or drug dependence. Some of these individuals may be likely to abuse stimulant medications.

Non-stimulant medications, such as Atomoxetine (Strattera) or Bupropion (Wellbutrin) are good alternatives for many adults for whom stimulant medications are not indicated. While stimulant medications work immediately, these non-stimulant medications may take several weeks before they take effect. Side effects can include dry mouth, insomnia, constipation, or nausea.

It is important to remember that while these medications may be helpful, they are rarely “magic wands” that make all ADHD problems disappear. There are also growing concerns that some young adults or college students may abuse stimulant medications, give them to friends, or sell them. Some adults may try to use them as a way of reducing their appetite, since weight loss can be a side effect. Providers that prescribe these medications are cautious and careful to insure that they are being used properly.

Cognitive-behavioral therapy can also help individuals with ADHD learn skills to help them with organization, planning, and life management. These approaches provide “coaching” in how to use technology to stay on time and remember appointments (putting appointments in your smart phone), developing strategies for completing low interest tasks, and enlisting the help and support of family and friends.

Husbands and wives of adults with ADHD often complain that their spouses are unreliable, disorganized, terrible listeners, and rarely complete tasks around the house! Frequently they feel that their ADHD partner is not trying hard enough. In these situations education about this condition can be very helpful. Gaining a better understanding of ADHD contributes to less blaming and shaming in families.

In addition to these traditional treatment approaches, there are alternative approaches that many adults consider. Biofeedback, diet, herbs, and meditation are used. Many of these approaches have not been studied as extensively as the traditional medical methods.

Have you been diagnosed with ADHD? What has helped you?