health

ADHD in adults is challenging but highly treatable

8 Comments
By Laura E Knouse

When I was a child in the 1980s, the people I knew with attention-deficit/hyperactivity disorder were hyperactive boys who went to the school nurse at lunchtime to get their medicine. Many people assumed that these boys would “grow out of” their symptoms as teenagers or adults.

For most of the 200-year-plus history of the condition we now know as ADHD, it was considered a childhood disorder. Specialists began to more widely recognize that ADHD can 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 effect their lives.

In the past 30 years, adult ADHD has gone from barely recognized to a well-established disorder with evidence-based treatment options. In my 20 years studying and treating ADHD in adults, it’s been exciting to witness and, in a small way, contribute to advances in evidence-based treatment for adult ADHD made by researchers around the world.

Living with ADHD

ADHD is a disorder with symptoms of inattention such as distractibility and disorganization. It can also include hyperactivity and impulsivity in some but not all individuals. ADHD begins in childhood and causes problems in school, work and in social relationships. One study estimates that about 3.4% of adults worldwide meet criteria for ADHD, and recognition of ADHD in girls and women has increased in recent years. Symptoms of ADHD run in families and are linked to the functioning of specific brain regions.

But the experience of ADHD isn’t entirely based in genetics. A person’s environment can influence how much ADHD causes problems in their daily life. Because ADHD symptoms overlap with those of other conditions such as depression and anxiety disorders, a careful, multistep professional evaluation is necessary to accurately diagnose it.

There is no question 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 supported reasons for optimism and hope about effective treatment for adult ADHD.

To date, the main strategies for managing ADHD in adults are medication and a type of therapy called cognitive behavioral therapy for adult ADHD. Current evidence points to medicine as 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.

Medication options

The medications most commonly used to treat ADHD are called stimulants.

It may seem strange that medications called stimulants are prescribed for a disorder that can involve hyperactivity. Stimulant medications for ADHD work by increasing the availability of the brain chemicals dopamine and norepinephrine in the regions of the brain associated with attention and self-regulation. Stimulant medications, when taken by mouth as prescribed, are relatively safe and unlikely to be addictive.

The two main types of stimulant medications 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 formulations – typically for around four to six hours – while Concerta and Vyvanse are designed to work up to about 12 hours.

Common side effects from stimulants may include reduced appetite and weight loss, as well as headaches or sleep problems if taken too close to bedtime. In addition, people with cardiac problems may not be prescribed these medications because they can cause slightly elevated heart rate and blood pressure.

Nonstimulant medications used to treat ADHD in adults include atomoxetine, which increases the brain neurotransmitter norepinephrine, and bupropion, an antidepressant drug sometimes used to treat ADHD that increases both dopamine and norepinephrine.

A recent analysis found that all four of these medication types reduced ADHD symptoms better than a placebo, or “sugar pill,” over about 12 weeks. Amphetamine-based medications worked the best overall for adults, and methylphenidate, bupropion and atomoxetine seemed to work slightly less well but with few differences among them. Unfortunately, very few studies have followed patients for longer periods of time, so it’s unclear whether these positive results persist.

Several studies using health care datasets offer intriguing information about the potential positive effects of medication for people in real-life settings. These studies found a relationship between prescriptions for ADHD medications and lower rates of depression, motor vehicle crashes, suicide-related events and negative events related to substance abuse. Although not definitive, this research points toward positive effects of ADHD medications beyond just reducing symptoms.

Medications are not the right choice for everyone. Some people have unpleasant side effects or find that the medications are not effective. Because 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 medication types and doses to find the one that provides the right balance of positive effects with minimal side effects. 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.

Specialized therapy for adult ADHD

Whereas medications treat ADHD “from the inside out,” specialized therapy for ADHD works “from the outside in” 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 interaction between their thoughts, feelings and actions and learn skills to cope with problems and meet important goals. There are different styles of cognitive behavioral therapy based on the problem that the client wants to work on. These treatments are evidence-based, while still tailored to each individual client.

Over the past two decades, researchers have begun to develop and test cognitive behavioral therapies specifically for adults with ADHD.

These specialized therapies help clients integrate organization and time-management skills into their lives. They also typically help people incorporate strategies to increase and maintain motivation to complete tasks and combat procrastination.

Most cognitive behavioral therapies teach clients to become aware of the effects of their thought patterns on emotions and actions so that nonhelpful thoughts can have less influence. Whereas therapy for depression and anxiety tends to focus on overly negative thinking, ADHD therapy sometimes targets overly positive or overly optimistic thinking that can sometimes get clients in trouble.

Reasons for 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 reductions in their ADHD symptoms and improvements in their functioning.

However, the effects tended to be smaller than those observed with medication. Cognitive behavioral therapy seemed to have stronger effects on inattentive symptoms than on hyperactive-impulsive ones, and effects did not depend on whether participants were already taking medication.

While cognitive behavioral therapy for adult ADHD appears to be a promising option for ADHD treatment, unfortunately, it can be difficult to find a therapist. Because therapy aimed at adult ADHD is relatively new, fewer clinicians have been trained in this approach. However, manuals for clinicians and workbooks for clients are available for those interested in this treatment option. And telehealth may make these treatments more accessible.

And as has been the case for other forms of cognitive behavioral therapy, e-Health interventions like app-delivered therapy could bring treatment directly into the daily lives of people with ADHD.

More targeted forms of ADHD therapy are on the horizon, including specific approaches for the needs of college students with ADHD.

Dr Laura E Knouse** is a clinical psychologist **, University of Richmond.

The Conversation is an independent and nonprofit source of news, analysis and commentary from academic experts.

© The Conversation

©2022 GPlusMedia Inc.

8 Comments
Login to comment

I was the "Hyper active" boy I was also the "zombie" ( as mother put it) on Ritalin at one point.

But my mother (an actual mother not a parent having kids to then complain the government doesn't have free day care) decided she would rather have the crazy son than the drug controled zombie and this while also raising 3 other children.

I am still full on ADHD approaching my 60s and I am doing Ok the only problem are others unwilling to accept me as I am.

It is interesting to note if tomorrow I put on a dress makeup and said I was a woman suddenly everyone has to accommodate me and change things for my benefit.

And if there was a pill to change LGBTQ people into "straight" would we be advocating and actively pushing the meds on them.

I am not bipolar, schizophrenic, etc...

I am no danger to others or my self I just don't sit still or think like the rest , so therefore drugs me is the solution not for my benefit but because it is easier for society to do that to me than accommodate me.

Nearly 60 and still Drug free and doing fine.

1 ( +6 / -5 )

Hype! A good teacher with patience can handle learning disabilities with NO drugs.

Of course it doesn't make money for the pharmaceutical industry though.

Keep psych OUT of education, please.

-2 ( +4 / -6 )

BertieWooster

Today 08:35 am JST

Sorry this time don't blame the pharmaceutical companies.

It is 100% on society and especially parents and teachers today.

Class sizes are smaller than any time in the past, families have 2 children at the most but for some reason a single ADHD child in class or in the family is too much to handle to much disruption.

And both parents an teachers "demanded" something and the pharmaceutical companies obliged them.

My niece is also ADHD and my sister did not want here in drugs, but the school and government in Canada forced her on them, calling it negligence/abuse to not "treat" her with available meds!

So now during school months she is forces to take drugs and has lost appetite, weight, on breaks and summer holidays is the only time she is not on drugs as my sister and she herself don't like them.

She turns 18 this year and once that happens the government has no power over her and like me she will stop the drugs.

0 ( +4 / -4 )

Antiquesaving,

I sympathise. I've heard many similar stories.

My nephew was diagnosed with ADHD. His mum took him off ALL sugar and his behaviour changed 180 degrees overnight.

Drugs are NOT the solution and psych is completely clueless.

-2 ( +2 / -4 )

BertieWoosterToday  11:13 am JST

Antiquesaving,

I sympathise. I've heard many similar stories. 

My nephew was diagnosed with ADHD. His mum took him off ALL sugar and his behaviour changed 180 degrees overnight. 

Drugs are NOT the solution and psych is completely clueless.

This is stunning news sir. You should apply for a new company and sell foods, etc etc with no sugar.

Sugar certainly has energy issues and can set up a energy boost, crash cycle, but I hope you aren't saying that omitting sugar is the cure. There are different types of sugar, eg fruit, pastas, etc etc. Clearly you're referring to refined sugar, and pumping your kids with refined sugar and junk food is not healthy ADHD or no ADHD.

ADHD was first noticed as far back as the 1700s. well documented by a Scottish doctor, and I don't think refined sugar was the main cause then. You also need to explain by ADHD everyone just wants to pick out the over excitable kids but ADHD is a spectrum where a lot of ADHD kids have not attention and low energy and aren't hyper active. These kids are ADHD but are low energy low stimulus ADHD. I don't if you really are a professional and have a WIDE knowledge of ADHD but I think you need to understand the LOW attentive types of ADHD can benefit from some meds and they become more awake, more alert and are able to focus, and listen better. So there are two ends of the spectrum. Not just the media stereotype.

Patients who do not benefit from the meds are free to stop taking them, but if some patients benefit they can choose to continue. Nobody is forcing anyone to take these medicines.

4 ( +5 / -1 )

As this is supposedly a Japanese first paper, I'm going to talk the situation of medication for ADHD in Japan.

Ritalin is banned for the treatment of ADHD in Japan, and it is only allowed under a very restrictive license (almost no medical practitioner can actually prescribe it) to treat narcolepsy.

This is because an scandal that happened back in the 2007s about a 25 year old man that was using Ritalin and committed suicide. The media tried to link his suicide to the use of Ritalin, since apparently the hospital he was attending to was prescribing way more than necessary doses of Ritalin to him.

After this, and in typical Japanese Government manner, the Japanese government overreacted to this scandal by first, voiding the medical license of the hospital that did this, and then by basically making it imposible for medical practitioners to prescribe Ritalin.

Since Ritalin was the only available medication approved in Japan to treat ADHD, basically people with ADHD were left without any medication to treat ADHD for 6 years, until in 2013 Concerta was approved for use in ADHD.

Now, ADHD patients have to also go through extra hops and bureaucratic bs just to get Concerta.

First, their doctor has to be registered in the ADHD register system (yes, there is such a thing), and they need to take some government approver e-seminars in order to get registered in the system, and be able to prescribe Concerta.

But it doesn't end there, patients also have to be registered in the system (in other words, there is actually a national database right now which have all of the data of ADHD patients around the country), and starting 2020 with a new system, patients with ADHD are given basically an ADHD ID card, that they have to bring to his doctor every single time they need to get their prescription of Concerta.

One of the main symptoms of ADHD is Inattention, which means, ADHD patients are actually pretty prompt to forget to bring this card with them, which means that since 2020, it has become pretty common that ADHD patients have to wait extra days to get their prescription.

Not only that, ADHD patients can only get 2 weeks worth of Concerta, and the doses they can get are actually pretty low compared to international standards.

Also, if for some reason the patients lose their pills (for example, once again, because of their inattention they throw the pills to the garbage), which isn't that uncommon, they cannot get prescribed the medication, until the 2 weeks they already were given.

This means, people with ADHD cannot get advance prescriptions for travel or things like that.

In other words, the current health system of Japan makes the life of ADHD patients worse than it should be just because of a dumb media scandal back in 2007.

2 ( +3 / -1 )

Patients who do not benefit from the meds are free to stop taking them, but if some patients benefit they can choose to continue. Nobody is forcing anyone to take these medicines.

That is incorrect.

In much of the west the government is forcing children because the so-called experts say it is better.

Refusing can get your children taken away by child services and then they are forced to be medicated

-2 ( +0 / -2 )

@Antiquesaving, no the government at least in the US is not forcing kids to take ADHD medications. Our little boy is ADHD and on the Autism Spectrum. Like other parents we have tried different prescription meds with varying degrees of success. The need that drives use of such meds is to allow he child to sit still in a classroom with other kids and learn. Absent the meds the child's behaviors interfere with the child's ability to learn and it disrupts the entire classroom, making it impossible for the other kids in the class to learn or for the teacher to conduct his or her lessons. It is not all a grand plot to control people and living with such a kid I grow tired of people making such claims.

Later in life it can affect one's ability to hold a job and be productive. We in the end gave up on meds because after trying three because they simply had no effect, but other parents we know have had good results with them. Talking to a local psychologist about ADHD, Autism and meds he mentioned the place I work, which is filled with scientists and engineers has a lot of very senior well regarded members who are on meds. Every individual is different. I know at least one other adult with ADHD who's life is going nowhere fast courtesy of being kicked out of school and only having a GED earned in a continuation school. Not controlling or treating ADHD can have life long consequences.

I will pick a nit with the author however inasmuch in our experience a form of behavior therapy called Applied Behavior Analysis seems to be highly beneficial. It teaches both the proper way to respond to situations and it teaches them how to recognize when they are becoming agitated and regulate it before they spin up like the Tasmanian Devil cartoon character. It has helped our little man hugely. That and teaching him something called "Zones of Regulation" has improved his behavior greatly.

0 ( +1 / -1 )

Login to leave a comment

Facebook users

Use your Facebook account to login or register with JapanToday. By doing so, you will also receive an email inviting you to receive our news alerts.

Facebook Connect

Login with your JapanToday account

User registration

Articles, Offers & Useful Resources

A mix of what's trending on our other sites