Attention deficit hyperactivity disorder (ADHD) affects millions of U.S. children and adults. In fact, it’s recognized as the most common neurodevelopmental disorder in children, and ADHD diagnosis in adults is on the rise. Characterized by symptoms such as inattention, hyperactivity and impulsivity, ADHD can have a significant impact on a person’s social, work and home life.
But what exactly is ADHD, and how is it treated? Continue reading to learn the causes and symptoms of ADHD, as well as common treatment options and how to find a doctor that’s right for you.
What Is ADHD?
ADHD is a neurodevelopmental disorder, characterized by differences in the development and function of the nervous system, which includes the spinal cord and brain.
More specifically, ADHD impacts the brain’s executive functions, which are a set of mental skills located in the frontal lobe of the brain, explains Billy Roberts, a licensed independent social worker, certified ADHD therapist and clinical director and founder of Focused Mind ADHD Counseling in Ohio.
Executive functions are a set of cognitive processes that are crucial for learning and development. They’re responsible for many tasks and functions, including:
Working memory (holding information in your mind with the purpose of completing a task)
While ADHD was initially identified as a neurodevelopmental disorder that affects children, it can affect adults as well—persisting through adult years in up to 65% of cases (yet experts note symptoms are frequently less severe). “Symptoms of ADHD do improve or resolve for some children, but for a large majority of individuals they do not,” says Jennifer Minami, M.D., an assistant professor of psychiatry at Loma Linda University School of Medicine in Redlands, California.
Adults with ADHD may experience some or all of the following symptoms:
Lack of attention to detail
Poor organizational skills
Inability to focus
Regularly losing belongings
Risk taking with little regard for personal safety or the safety of other people
While researchers don’t know for sure what causes ADHD, several factors may be at play. “We do know that it is a highly heritable condition, meaning that there is a significant genetic component to its cause,” says Dr. Minami. In other words, if you have a parent or sibling with ADHD, you are more likely to have it. There are also some well-known environmental causes of ADHD, such as low birth weight, premature birth and maternal stress and substance use during pregnancy, according to Dr. Minami.
Research shows that structural and functional differences in several regions of the brain may also contribute to ADHD. “There is a particular area of the frontal cortex called the prefrontal cortex, which is responsible for many important brain functions, that we see impaired in individuals with ADHD,” says Dr. Minami. “These include organization, impulse control and time management.”
Treatments for ADHD
ADHD is very treatable and a comprehensive treatment plan should be customized to an individual’s preferences, previous treatment history, cost and availability of specialized treatment providers, says Dr. Minami.
ADHD-focused therapies often center on an individual’s goals and are most effective when they build on a person’s unique strengths, adds Roberts. “For example some folks are wanting more skills for organization or time management, while others find that their confidence needs improvement,” he says.
Here are some of the most common treatments for ADHD.
Education and Support
One of the first treatment steps is to educate both the individual with ADHD and their family members, which may include caregivers and partners. Mental health professionals can guide individuals with ADHD and their loved ones through skills trainings, which may include stress management. “This helps reduce blame on the individual with ADHD for the interpersonal strain that is often caused by ADHD,” says Dr. Minami. “It also increases partnership in the treatment plan.”
Additionally, ADHD support groups can help people with ADHD and their family members connect with other people navigating similar circumstances and learn new ways to manage challenges presented by ADHD.
Stimulants are the most commonly prescribed type of medication for ADHD treatment and are generally considered more effective than non-stimulant medications. Stimulant medications including amphetamines (such as Adderall) and methylphenidates (such as Ritalin and Concerta) help decrease ADHD symptoms by stimulating parts of the brain (mainly the dopamine system) so they work more effectively together.
“In broad terms, stimulants cause an increase in the amount of two neurotransmitters—dopamine and norepinephrine—between cells in certain parts of the brain,” says Dr. Minami. Upping the levels of these neurotransmitters can increase a person’s attention and motivation while decreasing hyperactivity and distractibility.
Side effects of stimulant treatment include headache, decreased appetite, increased sweating, anxiety and difficulty falling asleep.
There is a common concern that ADHD treatment with stimulants can increase the risk of substance use disorders, but long-term studies show the opposite to be true, says Dr Minami. In fact, recent research suggests the use of stimulant or non-stimulant medication to treat ADHD does not increase the risk of substance use, but rather early treatment may reduce the likelihood of a person developing substance use disorders.
“Part of careful treatment and monitoring includes assessment for ongoing substance use disorders and misuse, and [the prescribing] of stimulants that are less prone to misuse,” adds Dr. Minami.
Experts also note due to the side effect of reduced appetite, individuals should also be screened for eating disorders before receiving a prescription.
Atomoxetine (Strattera) is a non-stimulant medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of ADHD in adults. As a selective norepinephrine reuptake inhibitor, this medication also boosts the amount of the neurotransmitters norepinephrine and dopamine in the brain.
Research shows atomoxetine can effectively improve ADHD symptoms in children and adults. Additionally, it may be a better choice for people who have coexisting psychiatric disorders—such as bipolar disorder, anxiety and depression—that do not respond well to stimulant medications. People who take atomoxetine may experience headaches, insomnia, decreased appetite, dry mouth and gastrointestinal side effects, such as abdominal pain and vomiting.
Another non-stimulant medication for ADHD treatment in adults and children is viloxazine (Qelbree), as well as clonidine and guanfacine.
Non-stimulant medication can take longer to reduce ADHD symptoms.
While Dr. Minami says non-stimulant medications are less effective at reducing the symptoms of ADHD, they can be a good choice in the following circumstances:
Stimulants did not significantly reduce symptoms
Stimulants caused side effects, such as weight loss or insomnia, that can’t be managed or tolerated
Providers or patients have concerns about substance use issues
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT)—a form of psychotherapy (or talk therapy)—is often used as an adjunct treatment option. It’s not shown to reduce ADHD symptoms as effectively as stimulants or non-stimulants, but CBT is considered an effective treatment for adults with ADHD, especially when used in conjunction with medication.
In CBT sessions, a mental health professional may help a person with ADHD manage difficulties with daily tasks that involve executive functioning—such as time management, short- and long-term planning and organization—as well as manage anxiety and boost self-esteem.
“Cognitive behavioral therapy can help individuals develop skills for improving organization and learning to overcome negative self-talk and anxiety, which can be common in adults with ADHD,” says Roberts.
Executive Function Coaching
Because people with ADHD tend to struggle with areas of executive functioning such as organization, planning ahead, focusing and remembering details, they may benefit from coaching focused on building executive skills. “As the demands for time management, organization and planning increase in academic and work settings, many individuals with ADHD benefit from having a coach who helps build and support executive functioning skills,” says Dr. Minami. Coaching may include work on self-regulation, well-being and personal and professional productivity.
Research suggests ADHD coaching—especially when used in tandem with medication—can effectively improve executive functioning.
Treatment for ADHD often includes the development of habits and routines that focus on sleep, self-care and overall health—all of which support brain functioning—according to Roberts.
Additionally, research suggests mindfulness practices, including meditation, can be an effective treatment approach for ADHD. “Mindfulness and meditation help individuals learn to raise their awareness of the present moment, including their thoughts and emotions,” says Roberts. “Practicing mindfulness and meditation can ultimately help improve focus and impulse control.”
How to Find a Doctor—and Treatment—for You
If you’re searching for a doctor that can help you with ADHD diagnosis and treatment, Roberts recommends looking for a specialist (such as a psychiatrist who specializes in the condition), since ADHD symptoms can overlap with the symptoms of several other conditions, including anxiety and depression. “It’s vital that a provider knows how ADHD impacts everyday life so that they can make a sound diagnosis and develop an effective treatment plan,” he says.
When vetting ADHD specialists, Dr. Minami suggests asking the following questions:
What is your training and experience in treating ADHD?
What kind of treatments for ADHD do you offer?
What does an evaluation for ADHD with you entail?
Before treatment begins, an ADHD specialist will conduct a comprehensive evaluation. This evaluation includes some or all of the following, according to Dr. Minami:
A thorough history of symptoms dating back to childhood
Insight about the individual from parents, teachers and/or partners
Medical and family history
An assessment for other psychiatric conditions
Because ADHD impacts individuals differently, Roberts says treatment plans are often holistic and customized. “Effective treatment for ADHD rarely depends on one aspect of treatment, but should focus on all the ways ADHD impacts life,” he says. So rather than narrow in on one type of treatment, Roberts says ADHD specialists typically combine different types of treatment, such as self-care, talk therapy, environmental modifications (like setting up a low-distraction office space or using a timer to alert a person when an activity is complete) and medication, if needed.
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