When I was a kid in the 1980s, the people I knew with Attention-Deficit/Hyperactivity Disorder were hyperactive boys who would go to the school nurse at lunchtime to get their medicine. Many assumed that these boys would “grow out” from their traits as teenagers or adults.
For the more than 200-year history of the condition we now know as ADHD, it was considered a childhood disorder. Experts began to recognize more widely that ADHD could also affect adults only in the 1990s, when scientific evidence showed that some people continue to experience ADHD symptoms into adulthood and that it can profoundly affect their lives. can affect.
Over the past 30 years, adult ADHD has barely been recognized as a well-established disorder with evidence-based treatment options. In my 20 years studying and treating ADHD in adults, it has been exciting to see and, in a small way, contribute to advances in evidence-based treatments for adult ADHD made by researchers around the world.
living with adhd
ADHD is a disorder characterized by inattentiveness such as distraction and disorganization. This may include hyperactivity and impulsivity in some but not all individuals. ADHD begins in childhood and causes problems in school, work, and social relationships. One study estimates that around 3.4% of adults worldwide meet the criteria for ADHD, and there has been an increase in recognition of ADHD among girls and women in recent years. Symptoms of ADHD tend to run in families and are linked to the functioning of specific brain regions.
But the experience of ADHD is not based solely on genetics. A person’s environment can affect how many problems ADHD causes in their daily lives. Because ADHD symptoms overlap with those of other conditions, such as depression and anxiety disorders, a careful, multi-step professional evaluation is necessary to make an accurate diagnosis.
There is no doubt that living with ADHD presents real and persistent challenges. But today adults with ADHD have greater access to information and more evidence-based treatment options. And there are scientifically backed reasons for optimism and hope about effective treatments for adult ADHD.
To date, the main strategies for managing ADHD in adults are medications and a type of therapy called cognitive behavioral therapy for adult ADHD. Current evidence points to it being more effective at reducing adult ADHD symptoms than therapy, but the research base for ADHD therapy is growing. And because they work in different ways, medication and therapy can be considered complementary tools in the adult ADHD toolbox.
The most commonly used drugs to treat ADHD are called stimulants.
It may seem strange that drugs called stimulants are prescribed for a disorder that may include hyperactivity. Stimulant medications for ADHD work by increasing the availability of the brain chemicals dopamine and norepinephrine in areas of the brain associated with attention and self-regulation. Stimulant drugs, when taken by mouth as prescribed, are relatively safe and are unlikely to be addictive.
The two main types of stimulant drugs are methylphenidate, sold under brand names such as Ritalin and Concerta, and stimulants in the amphetamine family such as lisdexamphetamine, which go by the brand names Adderall and Vyvanse. Ritalin and Adderall are shorter-acting formulas — usually for about four to six hours — while Concerta and Vyvanse are designed to work for about 12 hours.
Common side effects from stimulants can include reduced appetite and weight loss, as well as headaches or sleep problems if taken too close to bedtime. Also, people with cardiac problems cannot be prescribed these drugs as they can slightly increase the heart rate and blood pressure.
Nonstimulant medications used to treat ADHD in adults include atomoxetine, which increases the brain’s neurotransmitter norepinephrine, and bupropion, an antidepressant medication sometimes used to treat ADHD that reduces dopamine and norepinephrine. Increases both.
A recent analysis found that all four of these types of medication reduced ADHD symptoms more than a placebo, or “sugar pill,” in about 12 weeks. Amphetamine-based drugs worked best for adults, and methylphenidate, bupropion, and atomoxetine worked slightly less well, but they had some differences. Unfortunately, very few studies have followed patients for long periods of time, so it is unclear whether these positive results persist.
Several studies using health care datasets provide interesting information about the potential positive effects of medication for people in real-life settings. These studies found an association between prescription ADHD medications and lower rates of depression, motor vehicle accidents, incidents related to suicide, and negative events related to substance abuse. Although not definitive, this research points to positive effects of ADHD medications beyond simply reducing symptoms.
Medicines are not the right choice for everyone. Some people have unpleasant side effects or find that the medicines are not effective. Since there is no way yet to predict which medication will work for which patient, adults with ADHD should be prepared to work closely with their doctor to try different types of drugs and dosages. At least to provide the right balance of positive effects. Effect. The bottom line is that, although medications are not a perfect solution, medication is an important part of the treatment toolbox for many adults with ADHD.
Special Therapy for Adult ADHD
While medications treat ADHD “from the inside out,” special therapy for ADHD works “from the outside” by helping clients learn skills and structure their environments to reduce the negative impact of ADHD on their lives. .
In cognitive behavioral therapy, clients work with a therapist to understand the interactions between their thoughts, feelings, and actions and learn skills to deal with problems and accomplish important goals. There are different styles of cognitive behavioral therapy depending on the problem the client wants to work on. These treatments are evidence-based, while still being tailored to each individual client.
In the past two decades, researchers have begun to develop and test cognitive behavioral treatments specifically for adults with ADHD.
These special treatments help clients integrate organization and time-management skills into their lives. They typically help people incorporate strategies to increase and maintain motivation to complete tasks and deal with procrastination.
Most cognitive behavioral therapies teach clients to become aware of the effects of their thought patterns on feelings and actions so that non-helpful thoughts can have less impact. While therapy for depression and anxiety tends to focus on excessively negative thinking, ADHD therapy sometimes targets overly positive or overly optimistic thinking that can sometimes get clients into trouble.
because of optimism
In 2017, my students and I conducted a meta-analysis, a type of study that quantitatively summarizes the effects of multiple studies. Using data from 32 studies and up to 896 participants, we found that, on average, adults with ADHD who participated in cognitive behavioral therapy saw a reduction in their ADHD symptoms and an improvement in their functioning.
However, the effects were small compared to the effects seen with the drug. It appeared that cognitive behavioral therapy had a greater effect on inattentive symptoms than hyperactive-impulsive people, and the effects did not depend on whether the participants were already taking the drug.
While cognitive behavioral therapy for adult ADHD appears to be a promising alternative to ADHD treatment, unfortunately, it can be difficult to find a therapist. Because therapy aimed at adult ADHD is relatively new, fewer physicians have been trained in this approach. However, manuals for physicians and workbooks for clients are available for those interested in this treatment option. And telehealth could make these treatments more accessible.
And as has been the case with other forms of cognitive behavioral therapy, e-health interventions such as app-delivered therapy can bring treatment directly into the daily lives of people with ADHD.
More targeted forms of ADHD therapy are on the horizon, including specific approaches to the needs of college students with ADHD.