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Treatment for Attention Deficit Hyperactivity Disorder (ADHD)

ADHD TreatmentThe best treatment for adults with attention-deficit hyperactivity disorder (ADHD) is based on a multimodal, multidisciplinary approach, which includes medication and psychotherapy (and/or ADHD coaching).

Specifically, medication reduces impulsivity, inattention, and hyperactivity. That is, ADHD medication helps you to focus, work, and learn. However, research has found that medication alone doesn’t address every symptom of ADHD. That’s because, as the common saying goes, “pills don’t teach you skills.”

So, while medication is critical in helping individuals with ADHD reduce symptoms, it doesn’t teach you the skills, systems, and tools necessary to succeed at your job, study for exams, regulate your emotions, run a household, build relationships, and build an intentional, fulfilling life.

Medication for ADHD

Stimulant medications are generally the first-line treatment for ADHD. That’s because they’re highly effective at reducing symptoms. They act quickly (within 20 to 45 minutes, depending on the specific medication). And most people experience few side effects.

A significant amount of research has demonstrated that when taken as directed by your psychiatrist or physician, stimulants are safe and effective in treating ADHD.

Stimulants include methylphenidate (Ritalin, Concerta, Metadate, Methylin) and amphetamines (Adderall, Dexedrine, Dextrostat). A 2018 review and meta-analysis found that the first choice for adults with ADHD is an amphetamine. Amphetamines were rated most efficacious by both clinicians and the individuals taking the medication, and they were the only medications with better acceptability than placebo.

The most common side effects of stimulants include: increased heart rate and blood pressure; decreased appetite (often low in the middle of the day and more normal by dinner time); sleep problems, such as insomnia; increased anxiety and/or irritability; and mild stomachaches and headaches. A rare side effect is motor tics.

You and your doctor can come up with a plan to manage and minimize bothersome side effects. For instance, sleep problems can be reduced by taking your medication earlier in the day, and taking a melatonin supplement before bed. You also might learn about and implement good sleep habits, and/or work with a therapist who specializes in cognitive behavioral therapy for insomnia.

Non-stimulants are another class of medications approved to treat ADHD. Your doctor might prescribe a non-stimulant medication if you experienced bothersome side effects with stimulants, or they weren’t effective for you. Doctors also might prescribe a non-stimulant if you have certain co-occurring conditions, such as heart problems.

Non-stimulants include Strattera (atomoxetine, a selective norepinephrine reuptake inhibitor) and Intuniv (guanfacine ER). Non-stimulants take longer to work than stimulants—it can take 4 to 8 weeks to experience the full benefits.

Some people may find they tolerate non-stimulant medication better. Unlike stimulants, non-stimulants don’t cause agitation or sleeplessness, and have a longer-lasting effect. The side effects of non-stimulant medications include: decreased appetite, upset stomach, nausea, dizziness, and mood swings.

Sometimes, doctors will prescribe antidepressants for ADHD, such as tricyclic antidepressants (e.g., desipramine, imipramine), and serotonin and norepinephrine reuptake inhibitors (e.g, venlafaxine). Selective serotonin reuptake inhibitors, which are frequently prescribed for reducing symptoms of depression, are ineffective for ADHD.

ADHD also commonly co-occurs with other disorders, such as mood disorders, anxiety disorders, and substance use disorders (SUD). Treatment typically starts by targeting the most severe disorder first (e.g., psychosis, bipolar disorder, severe depression, SUD).

For instance, if someone is struggling with bipolar depression, the doctor may prescribe medications to specifically treat those symptoms. After the person’s mood has stabilized or the depressive episode has remitted, the doctor might prescribe an ADHD medication (and the person continues taking both medications).

With co-occurring conditions, it’s also important to be careful about interactions between medications. For instance, both amphetamines (e.g., Adderall) and methamphetamines (e.g., Ritalin) don’t mix well with fluoxetine (Prozac). They can cause restlessness, racing thoughts, and an inability to sleep. Combining these ADHD medications with fluoxetine also boosts the risk of serotonin syndrome, a rare but very serious condition characterized by confusion, hallucinations, seizure, extreme changes in blood pressure, fever, blurred vision, tremor, vomiting, and more. In severe cases, serotonin syndrome can lead to coma or death.

Finding the right medication for you can take time, and is a process of trial and error. This is why it’s important to advocate for yourself when talking to your doctor. Voice any concerns you have about the medication you’re taking. Don’t hesitate to mention whether you think it’s working, and whether you’re experiencing side effects, because, again, you and your doctor can find ways to minimize those reactions.

Learn more about the different ADHD medications in the table below:

Trade NameGeneric NameApproved Age
Adderall
Adderall XR
amphetamine
(extended release)
3 and older
Adzenys XR-ODTamphetamine extended release (bioequivalent to Adderall XR)6 and older
Concertamethylphenidate
(long acting)
6 and older
Daytrana (patch)methylphenidate6 and older
Dexedrine
Dextrostat
dextroamphetamine3 and older
Focalindexmethylphenidate6 and older
Metadate ER
Metadate CD
methylphenidate
(extended release)
6 and older
Ritalin
Ritalin SR
Ritalin LA
methylphenidate
(extended release)
(long acting)
6 and older
Stratteraatomextine6 and older
Tenex, Intuniv #guanfacine hydrochloride12 and older
Vyvanselisdexamfetamine6 and older
* – Because of its potential for serious side effects affecting the liver, Cylert should not ordinarily be considered as first-line drug therapy for ADHD.
# – Tenex is short-term preparation and Intuniv is the long-term preparation brand name

Watch Our Recommended Video on Medications for ADHD

Psychotherapy for ADHD

The therapy of choice for adult ADHD is cognitive behavioral therapy (CBT). There isn’t one specific type of CBT for managing ADHD. Therapists adapt CBT to each person’s individual needs. Essentially, most treatments have these qualities in common: They’re structured, goal oriented, skills based, and collaborative.

The first step typically focuses on psychoeducation, which means that the therapist will teach you about the symptoms of ADHD and how the ADHD brain works (and likely shatter common myths and stereotypes, such as ADHD has zero to do with laziness and absolutely is not a character flaw). Psychoeducation also is invaluable for loved ones. Learning accurate information about ADHD and how it affects you helps your loved one to better support you, and it improves the quality of the relationship.

In CBT, your therapist will help you address specific symptoms that are interfering with your daily functioning. This might include everything from learning to regulate your emotions to managing stress to reducing impulsive reactions to navigating challenges at work. Together, you and your therapist might focus on managing your time, getting organized, planning, and prioritizing, along with adopting healthy habits (e.g., sleep and exercise are critical).

You’ll focus on real-life tasks that give you trouble, such as paying bills and setting up a planner; and real-life situations, such as being assertive with your boss (versus being passive or aggressive in your communication).

In CBT, your therapist also will help you recognize, re-evaluate, and revise distorted thoughts and beliefs you hold about yourself, your capabilities, and your future. Many adults with ADHD become very self-critical and think thoughts such as: “I’m such a failure,” “I can’t do anything right,” “Why even try?” “I’m not smart enough,” “I can never go back to school,” “I could never ______.”

If you have a co-occurring disorder, working with a therapist is critical for reducing those symptoms, as well. For instance, if you have depression or anxiety, your therapist might use techniques from CBT, as well (CBT is highly effective for treating both depression and anxiety), or integrate other interventions.

Another effective approach in managing ADHD is coaching. ADHD coaching varies widely in who does the coaching and how it’s done. For instance, individuals have different credentials, and they might offer services face to face, by phone, or over email. It’s important that the coach you work with has graduated from a recognized training program specifically for ADHD coaching. For instance, the ADD Coach Academy is an ADHD coach training program fully accredited by the International Coach Federation (ICF) and the Professional Association of ADHD Coaches (PAAC), the governing bodies of the life coaching and ADHD coaching professions.

ADHD coaches help you gain a thorough understanding of how ADHD impacts your life, and identify solutions, strategies, and tools that work specifically for your needs, circumstances, and learning style. They also capitalize on your strengths and natural talents. They help you set up systems and structure to be successful and create a more satisfying life.

Learn more about finding the right ADHD coach for you at this link.

Learn more: Psychotherapy and additional treatments for ADHD

Self-Help Strategies for ADHD

  • Learn all you can about ADHD. Whether you’re working with an ADHD-focused professional or not, try to stay up to date on the latest information about ADHD. Learn about the neurological underpinnings, and how symptoms manifest. Read blogs written by people with ADHD, watch videos (like these videos), and listen to ADHD-related podcasts. Attend conferences, such as the CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder) conference.
  • Exercise regularly. Participating in physical activities boosts your mood and energy, and shrinks stress and anxiety. It helps you think more clearly, improving working memory and executive function (which is involved in planning, prioritizing, and getting organized). According to Harvard psychiatrist John Ratey, “A bout of exercise is like taking a little bit of Prozac and a little bit of Ritalin.” The key is to make exercise fun for you. Do what you enjoy, whether that’s running, dancing, or taking a walk (while listening to a podcast or audiobook or your favorite playlist).
  • Get enough sleep. Sleep disturbances and sleep disorders tend to co-occur in adults with ADHD. But getting enough sleep is vital because it sharpens focus and attention. Sleep deprivation, on the other hand, exacerbates ADHD symptoms. Consider creating a calming bedtime routine, reducing stimulating activities, and being consistent about the time you go to bed, and the time you wake up. If you struggle with insomnia, cognitive behavioral therapy is highly effective (and the preferred approach over medication).
  • Rely on alarms and reminders. That is, don’t rely on your memory. Set alarms to alert you that it’s time to take your medication. Set alarms to remind you that it’s time to eat, since many ADHD medications minimize appetite. Set several alarms to tell you when it’s time to finish up a task (e.g., an alarm for 10 minutes and then 5 minutes before you need to stop; and then the moment you need to stop). This way you aren’t running late to an appointment or meeting.
  • Cut clutter. Be ruthless about getting rid of things. The less you have, the easier it is to get organized, and stay organized—and the easier it is to find exactly what you need.
  • Capitalize on your creativity. Individuals with ADHD are known for their tremendous creativity. Channel that creativity into coming up with strategies and shortcuts to help you navigate regular challenges, and make tedious tasks more bearable (e.g., turning laundry or cleaning into a game).
  • Set up systems and stations. This is key to simplifying your days, reducing stress, and becoming successful in all facets of your life. For instance, have a place for everything in your home. Have a small basket by the door for the items you need to actually get out the door, such as your keys, wallet, and phone. Have different zones in your home, such as a coffee zone in your kitchen, which includes your coffeemaker, mugs, and coffee; and a mailing zone in your home office, which includes cards, envelopes, stamps, pens, and tape. In other words, make your environment work for how you work. (You can find more tips in this piece, and in this piece.)
  • Surround yourself with supportive individuals. For instance, join an online forum for people with ADHD, or a group coaching program. Ask a close friend to serve as your accountability partner when you’re trying to accomplish certain tasks (e.g., you email them when you spend 20 minutes on your work report or writing project).

 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Cortese S., Adamo N., Del Giovane C., Mohr-Jensen C., Hayes A.J., Carucci S…Cipriani, A. (2018). Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: asystematic review and network meta-analysis. Lancet Psychiatry, 5 (9), 727–38.

Hallowell, E.M. & Ratey, J.J. (2011). Driven to Distraction (Revised): Recognizing and Coping with Attention Deficit Disorder. Anchor Press.

Kooij, J.J.S., Bijlenga, D., Salerno, L., Jaeschke, R., Bitter, I., Balázs, J…Asherson, P. (2019).  Updated European Consensus Statement on diagnosis and treatment of adult ADHD. European Psychiatry, 56, 14-34.

Miller, K., (2017, September 8). Exercise and the ADHD college student. Attention deficit disorder association. Retrieved from https://add.org/exercise-adhd-college-student.

Millichap, J.G. (2011). Attention Deficit Hyperactivity Disorder Handbook: A Physician’s Guide to ADHD (2nd ed.). New York: Springer.National Institute of Mental Health. (2019). Attention deficit hyperactivity disorder. Retrieved from https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml on April 27, 2019.

Nigg, J.T. (2017). Getting Ahead of ADHD: What Next-Generation Science Says about Treatments That Work—and How You Can Make Them Work for Your Child. New York: Guilford Press.

Sherman, C., Russell, R., Barrow, K., Williams, P. (2016). Challenge your thoughts, change your life. ADDitude magazine. Retrieved from https://www.additude.com/cognitive-behavioral-therapy-for-adhd.


Margarita Tartakovsky, M.S.

Margarita Tartakovsky, M.S. is an Associate Editor and regular contributor at Psych Central. Her Master's degree is in clinical psychology from Texas A&M University. In addition to writing about mental disorders, she blogs regularly about body and self-image issues on her Psych Central blog, Weightless.

APA Reference
Tartakovsky, M. (2019). Treatment for Attention Deficit Hyperactivity Disorder (ADHD). Psych Central. Retrieved on June 26, 2019, from https://psychcentral.com/adhd/treatment-for-attention-deficit-hyperactivity-disorder-adhd/
Scientifically Reviewed
Last updated: 25 Jun 2019
Last reviewed: By a member of our scientific advisory board on 25 Jun 2019
Published on Psych Central.com. All rights reserved.