Treatment For Attention-Deficit Hyperactivity Disorder (ADHD)

While ADHD is not something that can be or should be “treated”, there are strategies that can be implemented to manage it.

Effective management methods are important for targeting signs of ADHD that interfere with personal, social, academic, and occupational functioning across the lifespan, such as emotion dysregulation, mood swings, and executive dysfunction.

This article provides an overview of evidence-based pharmacological and non-pharmacological methods for ADHD.

Medication

Stimulant Medications

• Typically first-line treatments for ADHD.
• Examples include Ritalin (short-acting), Concerta (extended release), Adderall, Vyvanse, and Daytrana (skin patch).
• Benefits include enhanced concentration, reduced hyperactivity, improved organization, productivity, and impulse control. These medications function by increasing dopamine and norepinephrine in the brain.
• Selection depends on factors like desired speed of symptom relief, duration of effectiveness, delivery mode (tablet, patch, liquid), potential side effects, compliance likelihood, and abuse risks.

Non-Stimulant Medications

• Alternative or supplementary treatments.
• Atomoxetine (selective norepinephrine reuptake inhibitor), Guanfacine and Clonidine (activate alpha2 receptors), Viloxazine, and Bupropion (norepinephrine-dopamine reuptake inhibitor).
• Suitable when stimulants are ineffective or cause adverse effects, providing extended symptom coverage with lower abuse potential.

Before considering medication options, please discuss your options and the full side effects with a health professional. This article is meant only as a summary of medications and should not be taken as medical advice. 

Psychotherapy

Various types of therapy and support teach individuals with ADHD new skills to directly improve their psychological and behavioral regulation.

These interventions address aspects of impairment related to underlying ADHD neurobiology but not targeted by medication alone. Parent training is also included for managing children with ADHD.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) for ADHD may help identify and shift negative thinking patterns like “I just can’t focus, nothing will help,” which exacerbates ADHD struggles.

Reconstructing self-defeating thoughts builds confidence to apply new skills taught in CBT like:

• Organizational systems – planners, electronic alerts, labeling, file management
• Time management – breaking down tasks, scheduling focused work intervals
• Planning/prioritizing – short and long-term goal setting, task analysis
• Self-monitoring – focus rating scales, assessing own attention and performance
• Problem-solving – evaluating challenges systematically then developing action plans

Both individual and group CBT improve core symptoms, emotional regulation, productivity, motivation and life satisfaction in various ADHD populations.

A meta-analysis examining 28 studies indicates CBT effectively reduces both core ADHD symptoms (inattention, hyperactivity, impulsivity) and emotional symptoms like anxiety and depression in adults with ADHD.

Considerations:

• Can be time-consuming to implement organizational systems and new habits. Dropping out due to feeling overwhelmed is a risk.
• Focusing extensively on changing thoughts could increase masking behaviors or emotional inhibition. Assessing ongoing internal experiences is important.

Acceptance and Commitment Therapy

Acceptance and Commitment Therapy (ACT) is a branch of CBT that can be a valuable approach for individuals with ADHD. By learning to accept their thoughts and feelings without judgment, people with ADHD can reduce the emotional impact of their challenges.

ACT also teaches techniques to detach from unhelpful thoughts, stay present in the moment, and cultivate a sense of self that is separate from one’s diagnosis.

Additionally, by clarifying personal values and taking committed action towards goals aligned with those values, individuals with ADHD can improve their motivation, focus, and overall well-being.

Through the practice of self-compassion and mindfulness, ACT can help people with ADHD develop greater resilience and adaptability in the face of their unique challenges, ultimately leading to a more fulfilling life.

Dialectical Behavior Therapy

Dialectical behavior therapy (DBT) blends CBT with mindfulness exercises and emotional coping tactics from Zen Buddhist traditions using concepts of radical acceptance and tolerating distress.

DBT provides psychological skills training in four areas:

• Mindfulness – nonjudgmental focus on the present moment
• Distress tolerance – coping ahead and in the moment with strong emotions
• Emotion regulation – identifying and modifying reactions
• Interpersonal effectiveness – maintaining self-respect and relationships

Since ADHD can affect emotion regulation and impulsivity, DBT may be a helpful management option for individuals with ADHD.

Research indicates DBT improves ADHD symptoms along with emotional impulsivity and may be particularly helpful for adults with co-occurring mood disorders and suicidal ideation.

Considerations:

• Radical acceptance may excuse harmful behaviors without accountability. Needs balance with change.
• Mindfulness could enable avoidance of necessary life responsibilities/demands instead of building coping skills.

Behavior Therapy Techniques

Parents, teachers and medical providers can be trained to implement these strategies:

• Positive reinforcement and rewards to strengthen desired behaviors
• Appropriate negative consequences for problematic behaviors
• Removing triggers and tailored accommodations

Methods aim to motivate individuals with ADHD using frequent feedback matched to their struggles with delayed reinforcement from consequences as well as facilitating environmental supports.

Common behavior therapy programs include:

• Parent Training – Teaching parenting skills and behavior modification tailored to child/teen ADHD issues improves conduct across home and school settings. Particular focus on promoting consistency with discipline and social/academic development.
• Classroom Management – Trains teachers in providing structured limits, redirection of disruptive ADHD behaviors and reinforcement delivery through daily report cards tied to personalized behavioral goals students work towards.
• Child Skills Training – Direct coaching for kids/teens to boost organizational abilities, social skills pragmatics and self-control with bridging delays to reinforcement. Best results come from practicing these abilities across natural settings.

Considerations:

• Over-reliance on external reinforcement can prevent developing intrinsic motivation and discipline.
• Strict adherence to rewards/consequences often proves unrealistic long-term. Can’t control all environments.

Other Interventions

Other non-pharmacological options for coping with ADHD impairment continue emerging, though more research is needed to confirm their efficacy and feasibility for widespread use.

• Mindfulness: Practices designed to enhance attention regulation and emotional stability. Mindfulness exercises encourage conscious choice-making, allowing individuals to respond thoughtfully rather than impulsively.
• Neurofeedback: Aims at self-regulation of brain activity, potentially leading to improved attention skills, though further evidence on long-term efficacy is required.
• Dietary Supplements: Potential interventions include omega-3 fatty acids, iron, zinc, and magnesium. However, further research is required for definitive efficacy.
• Physical Exercise: Aerobic exercise regularly boosts neurotransmitter production, aiding focus, cognitive flexibility, and emotional stability.
• Sleep Hygiene: Ensuring adequate sleep significantly improves treatment outcomes by boosting attention, memory, and emotional regulation.

Building Organizational Skills

Dr. Dawn-Elise Snipes explains how organizational skills can be helpful for managing ADHD symptoms like inattention, distractibility, and executive functioning challenges.

Some examples of helpful organizational strategy training include using checklists, setting up systems and designated homes for important items, and creating assignment templates or frameworks.

For instance, having a special box, basket, or “launch pad” area for keys, bags, phones and other essentials when entering the house can assist with memory, planning ahead, and losing track of items.

The rationale is that by building habits, routines, and structural supports, many common ADHD-related frustrations around organization, follow-through, and forgetfulness can be minimized. This, in turn, alleviates self-esteem issues and motivational problems and reduces family tensions.

Organizational skills training aims to set the person up for success instead of highlighting deficits. It provides the scaffolding and tools to bypass neurological weaknesses.

ADHD Support Groups

ADHD support groups connect individuals facing similar struggles, reducing isolation. Sharing personal experiences and successful strategies provides motivation and ideas for practical symptom management.

Groups foster accountability through encouragement and empathy from those managing the same disorder and understanding ADHD’s impact. This motivates persevering with management methods and builds self-compassion.

Finding and Evaluating ADHD Treatment Providers

• Seek professionals experienced in ADHD, such as psychiatrists, psychologists, therapists, or ADHD coaches.
• Consider practical issues, such as the provider’s specialty, experience, costs, insurance coverage, and approach to personalized care.
• Effective providers emphasize detailed initial assessments, ongoing monitoring, and communication.

Special Considerations across the lifespan

Unique factors shape ADHD management for people of different ages, supporting the need for specialized care across the lifespan tailored to each population’s needs:

• Preschoolers: Typically, medication is rarely prescribed due to diagnostic challenges distinguishing typical behavior from ADHD; parent training in behavioral strategies is prioritized.
• Adolescents: Management addresses complex academic demands, driving safety, and preventive measures for substance misuse and risk-taking behaviors.
• Adults: Often require updated screening, psychotherapy for coping skill deficits, couples counseling, job coaching, and tailored workplace accommodations. Medication management considers greater misuse risks.
• Older Adults: Careful differentiation from cognitive decline or other age-related changes. Medication adjustments are cautious due to higher susceptibility to side effects and drug interactions.

References

Abootorabi Kashani, P., Naderi, F., Safar Zadeh, S., Hafezi, F., & EftekharSaadi, Z. (2020). Comparison of the effect of dialectical behavior therapy and emotion regulation on distress tolerance and suicide ideation in symptoms of attention deficit/hyperactivity disorder in adolescents. Psychological Achievements, 27(2), 69-88.

Daley, D., van der Oord, S., Ferrin, M., Danckaerts, M., Doepfner, M., Cortese, S., & Sonuga-Barke, E. J. (2014). Behavioral interventions in attention-deficit/hyperactivity disorder: a meta-analysis of randomized controlled trials across multiple outcome domains. Journal of the American Academy of Child & Adolescent Psychiatry, 53(8), 835-847. https://doi.org/10.1016/j.jaac.2014.05.013

Kaplan, G., & Newcorn, J. H. (2011). Pharmacotherapy for child and adolescent attention-deficit hyperactivity disorder. Pediatric Clinics, 58(1), 99-120. https://doi.org/10.1016/j.pcl.2010.10.009

Liu, C. I., Hua, M. H., Lu, M. L., & Goh, K. K. (2023). Effectiveness of cognitive behavioural‐based interventions for adults with attention‐deficit/hyperactivity disorder extends beyond core symptoms: A meta‐analysis of randomized controlled trials. Psychology and Psychotherapy: Theory, Research and Practice. https://doi.org/10.1111/papt.12455

Neef, N. A., Perrin, C. J., & Madden, G. J. (2013). Understanding and treating attention-deficit/hyperactivity disorder. In G. J. Madden, W. V. Dube, T. D. Hackenberg, G. P. Hanley, & K. A. Lattal (Eds.), APA handbook of behavior analysis, Vol. 2. Translating principles into practice (pp. 387–404). American Psychological Association. https://doi.org/10.1037/13938-015

Pfiffner, L. J., & Haack, L. M. (2014). Behavior management for school-aged children with ADHD. Child and Adolescent Psychiatric Clinics of North America, 23(4), 731-746. https://doi.org/10.1016/j.chc.2014.05.014

Rooney, M., & Pfiffner, L. J. (2018). Attention-deficit/hyperactivity disorder. In J. N. Butcher & P. C. Kendall (Eds.), APA handbook of psychopathology: Child and adolescent psychopathology (pp. 417–445). American Psychological Association. https://doi.org/10.1037/0000065-019

Safren, S. A., Sprich, S., Mimiaga, M. J., Surman, C., Knouse, L., Groves, M., & Otto, M. W. (2010). Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. JAMA, 304(8), 875–880. https://doi.org/10.1001/jama.2010.1192