ADHD Predominantly Inattentive - Treatment

Treatment

Recent studies indicate that medications approved by the U.S. Food and Drug Administration (FDA) in the treatment of ADHD tend to work well in individuals with the predominantly inattentive type. These medications include two classes of drugs, stimulants and non-stimulants. Drugs for ADHD are divided into first-line medications and second-line medications. First-line medications include several of the stimulants, and tend to have a higher response rate and effect size than second-line medications. Some of the most common stimulants are Methylphenidate (Ritalin, Concerta), Adderall and Vyvanse. Second-line medications are usually anti-depressant medications such as Zoloft, Prozac, and Wellbutrin. These medications can help with fidgeting, inattentiveness, irritability, and trouble sleeping. Some of the symptoms the medications target are also found with ADD patients.

Although ADHD has most often been treated with medication there are questions as to the efficacy of these medications. Medications do not cure ADHD they are used solely to treat the symptoms associated with this disorder. The symptoms will come back once the medication stops. Also, medication works better for some patients while it barely works for others.

The use of these medications is often the first treatment choice and is based on a bio-medical model of ADHD which views the disorder as a result of deficiencies in brain processing most likely resulting from defective genes.

Many studies have shown the use of psychostimulants to be an effective treatment for ADHD, as well as ADD, however these studies have shown a number of methodological flaws. Firstly they measure behaviour changes from the perspective of the parents, or teachers involved and assume that this change in behaviour is helping the child without ever consulting with the child. This has led to a questioning of who the medication is actually helping, and if the medication is being used simply to eliminate unwanted childhood behaviours rather than to actually help the child. Although most studies focus on children with ADHD the side effects and potential misuse of stimulant medications is identical for ADHD as many of the same medications are used (e.g. ritalin).

These studies have often failed to look at long term efficacy and side effects. The psychostimulants used to treat ADHD normally start to lose efficacy after a very short period (often less than six weeks, and as this efficacy decreases the dosage given to the child must be increased, leading to a continuous cycle of more and more medication. These medications do work very quickly once administered and so may affect behaviour almost immediately, although this has again led to the idea that the medication may be getting used as a way to remove unwanted behaviours in a short term situation.

The popularity and normalcy of these drugs and the diagnosis itself has led some educators to seek out the medication for students. This may in some cases cause children and even their parents to feel as if the child must go on the medication regardless of the other treatment options available. In one case a six young boy was given the ultimatum of going on a medication to treat for ADHD or being removed from the school. He remains on the medication, at the request of the school, seven years later despite complaints that it makes him feel “drained” and “not himself” (guardian). This ultimatum was most likely offered based on the common belief that ADHD medications are a safe and effective treatment and are the best way to treat ADHD.

Along with medication, behavioral therapy is recommended to improve organizational skills, study techniques or social functioning.