Content reviewed and updated: 09/10/20
ADHD Treatment Options, Part 2: Beyond Stimulants
With ADHD affecting so many people, it is no surprise that a variety of ADHD treatment options are available. According to a 2016 survey, around 6.1 million children in the U.S. have been diagnosed with ADHD, and approximately 3 out of 4 children with ADHD receive treatment. Many adults also experience the effects of ADHD; in fact, as of 2003, almost 5% of adults in the U.S. have been diagnosed.
Stimulant medications like dextroamphetamine/amphetamine (Adderall) and methylphenidate (Ritalin) are usually prescribed for the initial treatment of ADHD. While stimulants are effective, non-stimulant ADHD medications and non-medication treatments can also play an important role in therapy.
THE CURRENT ADHD TREATMENT LANDSCAPE
Medication is a cornerstone of ADHD treatment. The main types of ADHD medication are stimulants and non-stimulants. These medications can help manage ADHD symptoms, such as inattention, hyperactivity, and impulsivity, among others.
Stimulants are the most prescribed ADHD medication because they have a long history of use and tend to be the most effective. Several stimulants for ADHD have been approved by the Food and Drug Administration (FDA), and they all act in a similar way. Stimulants primarily work by boosting the levels of certain neurotransmitters, namely dopamine and norepinephrine, in the brain. They tend to work fast, helping to alleviate ADHD symptoms within an hour of taking them.
Besides stimulants, those with ADHD may be recommended non-stimulant drugs, behavioral therapy, lifestyle and diet changes, or a combination of these.
NON-STIMULANT ADHD MEDICATIONS
Stimulant medications do not always have the desired effect. In fact, up to 30% of people with ADHD do not respond to stimulants at all. Some people experience negative side effects, like appetite loss and sleep disturbances. Furthermore, stimulants can become addicting if not appropriately managed by a highly trained licensed practitioner.
FDA-approved non-stimulant medications include atomoxetine (Strattera), clonidine (Catapres), and guanfacine (Intuniv). Strattera is a norepinephrine reuptake inhibitor, which means that it increases the availability and effects of norepinephrine without greatly affecting dopamine levels. On the other hand, the active ingredients of Catapres and Intuniv (alpha-2 adrenergic agonists) were originally used to treat high blood pressure, but Catapres and Intuniv may also help balance norepinephrine levels to improve memory, attention, and focus.
Compared to stimulants, non-stimulants take more time to work. It can take up to 4 weeks or longer for someone to experience the full benefits of non-stimulants. However, many people start seeing therapeutic effects within the first week of taking them.
NON-MEDICATION TREATMENTS FOR ADHD
Medication alone is not always enough to fully improve the symptoms of ADHD. Some healthcare providers will recommend a combination of medication and non-medication treatments. Others will recommend a non-medication treatment before starting a medication. Non-medication treatments include behavioral, psychosocial, diet, and lifestyle interventions.
After diagnosing ADHD, healthcare providers may recommend behavioral interventions, such as cognitive behavioral therapy (CBT). This intervention involves working with someone to establish a reflective, organized approach for changing certain behaviors and ways of thinking. As a type of psychotherapy, or talk therapy, CBT helps individuals with ADHD learn to identify the thoughts and emotions contributing to their symptoms and modify them over time to be more beneficial.
CBT can also help those with ADHD work toward clearly identified, measurable goals. For example, with organizational training, someone with ADHD can practice using a planner to manage tasks throughout the day.
Additionally, many individuals with ADHD have emotional regulation symptoms that respond well to CBT and other psychotherapy interventions.
Neurofeedback is an alternative form of ADHD treatment that is closely related to cognitive therapy. It involves measuring the brain’s activity while performing a task. For instance, an individual with ADHD can monitor their brain’s activity while playing a computer game that requires focus. An ADHD specialist will then coach the person on how to interpret the brain’s activity and train their mind to be more engaged.
Psychoeducation is not a form of behavioral therapy. Rather, the goal of psychoeducation is to provide individuals and their families with information about ADHD and potential treatment options. With the right resources, someone with ADHD can learn to be more aware of their symptoms and how to manage them.
Receiving an ADHD diagnosis can be overwhelming. However, psychoeducation equips patients, caregivers, and family members with the right tools to fully understand ADHD and its causes.
Exercise and Diet
Physical exercise can improve ADHD symptoms. After an ADHD diagnosis, most people are encouraged to maintain good exercise habits, such as exercising for at least 30 minutes per day. Exercise can help people manage impulsive behaviors and build self-esteem, which can counter the negative self-beliefs that often accompany ADHD.
Addressing dietary deficiencies in micronutrients like zinc, iron, and vitamin D may also be beneficial for improving attention, focus, and impulsivity.
BEYOND STIMULANT MEDICATIONS
Despite there being standardized guidelines for ADHD treatment, not everyone will respond to a treatment in the same way. What works for one person might not work for another. This is because the brain is like a fingerprint —everyone has a unique genetic makeup that dictates how they will respond to a particular treatment.
There are many effective non-stimulant treatment options for managing ADHD symptoms. Before recommending a specific treatment regimen, a healthcare provider will thoroughly evaluate a person’s past medical and family histories during an initial consultation. Working with an ADHD specialist who can help navigate the available treatment options often guarantees a person’s success in managing ADHD symptoms.