ADHD Treatment Options

ADHD is a chronic condition that can significantly impact various aspects of an individual's life, including academic and occupational achievements, social relationships, and emotional well-being. Research has shown that individuals with untreated or poorly managed ADHD are at a higher risk for academic underachievement, job instability, and involvement in legal issues. It's not all doom and gloom however - early diagnosis and appropriate interventions can lead to better long-term outcomes. Treatment plays a crucial role in improving symptom management, executive functions, and overall quality of life for individuals with ADHD.

As discussed in last week's deep dive into what is ADHD (See blog post here if you missed it), there are genetic, neurobiological and brain structural differences in individuals with ADHD. Research into best practice interventions for ADHD has identified several effective approaches for managing and treating the disorder. These interventions typically encompass a multimodal approach that combines medications, behavioural interventions, psychoeducation, and a good dose of understanding from those close to the individual with ADHD. The key research-backed interventions include:

Medication:

Medications used to treat ADHD primarily work on the brain's neurotransmitter systems, specifically targeting dopamine and norepinephrine. These medications aim to improve attention, impulse control, and other executive functions affected by ADHD. In many cases, medications will assist with the focus and retention of the learning from the education and training part of combined therapy - it is this integrated approach addresses both the behavioural and neurobiological aspects of the disorder, leading to improved outcomes.

The two main classes of medications used for ADHD are stimulants and non-stimulants, both of which have different mechanisms of action:

1. Stimulant Medications: Stimulant medications, such as methylphenidate (e.g., Ritalin, Concerta) and amphetamines (e.g., Vyvanse), are the most commonly prescribed drugs for ADHD. They work by increasing the levels of certain neurotransmitters in the brain, particularly dopamine and norepinephrine.

• Dopamine: Stimulants primarily enhance the release of dopamine in the brain. Dopamine is a neurotransmitter involved in the brain's reward and pleasure pathways, as well as executive functions like attention, motivation, and impulse control. By increasing dopamine levels, stimulants can improve attention and focus in individuals with ADHD.

• Norepinephrine: In addition to boosting dopamine levels, stimulant medications also increase the release of norepinephrine. Norepinephrine plays a role in arousal, alertness, and the "fight or flight" response. By enhancing norepinephrine activity, stimulants can further support attention and alertness in individuals with ADHD.

It's important to note that despite the term "stimulant," these medications have a calming and focusing effect in individuals with ADHD, likely due to their impact on the brain's neurotransmitter balance.

2. Non-Stimulant Medications: Non-stimulant medications, such as atomoxetine (Strattera) and guanfacine (Intuniv), are also used to treat ADHD. While their exact mechanisms of action are not fully understood, they generally work by affecting the levels or activity of norepinephrine or other neurotransmitters in the brain.

• Atomoxetine: Atomoxetine is a selective norepinephrine reuptake inhibitor (NRI). It works by blocking the reuptake of norepinephrine, thereby increasing its availability in the brain. This, in turn, can improve attention, focus, and impulse control in individuals with ADHD.

• Guanfacine: Guanfacine is an alpha-2 adrenergic agonist that acts on norepinephrine receptors in the brain. It helps regulate norepinephrine activity, leading to improved attention and impulse control.

Non-stimulant medications are generally considered as alternatives for individuals who do not respond well to or have contraindications to stimulant medications.

It is essential to recognize that while medications can be effective in managing ADHD symptoms, they are not curative - that is, they will not fix everything. Medications may provide symptomatic relief and improve functioning, but they do not address the underlying neurodevelopmental differences associated with ADHD. In many cases however - medication does allow for better learning and retention of the strategies taught in adjunctive therapies such as Psychology or Occupational Therapy.

Moreover, the response to medications can vary among individuals, and finding the most appropriate medication and dosage often requires careful monitoring and individualised treatment plans.

Therapeutic Behavioural Inverventions:

Behavioural or other therapeutic interventions are another important aspect of ADHD treatment. They aim to improve others' and self-understanding of behaviour externally seen as symptoms of the underlying brain differences, improve self-control, and teach coping or problem-solving strategies. This can involve techniques such as:

• Parent Training: Parents learn strategies to manage their child's behavior, provide consistent discipline, and implement rewards and consequences effectively.

• Classroom Interventions: Teachers use techniques to structure the learning environment, set clear expectations, and provide positive reinforcement for appropriate behaviour.

• Individual Therapy: Children and adults with ADHD can benefit from individual counseling to address emotional challenges, improve self-esteem, and develop coping skills.

• Cognitive-Behavioral Therapy (CBT): CBT is a form of talk therapy that focuses on changing negative thought patterns and behaviors. It can be beneficial for individuals with ADHD, especially those struggling with anxiety, depression, or low self-esteem.

• Sensory Integration Therapy: For individuals with co-occurring sensory processing difficulties, sensory integration therapy can help improve sensory processing and regulation, leading to better attention and task processing.

• Executive Functioning Training: Specific interventions aimed at enhancing executive functioning skills, such as planning, organization, and time management, can improve day-to-day functioning in individuals with ADHD.

Educational Support and Classroom Accommodations:

Providing academic and environmental accommodations in the classroom are instrumental in helping children with ADHD succeed academically. Accommodations may include environmental and academic accomodations and it is essential to work collaboratively with the student, parents, and educational professionals to identify the most appropriate accommodations for each individual.

Environmental Accomodations:

These are changes aimed at modifying the physical context of the learning environment to best suit the needs of the individual with ADHD (and often, ALL students benefit from many of these modifications).

• Differentiated and Flexible seating: Consider the use of wobble stools or cushions, standing or cycling desks to enable students (both with and without ADHD) to move between active modes of remaining engaged.

• Preferential seating: Involves specifically placing a child in areas with minimal distractions such as thoroughfares, windows or corridors. Often, but not always this might be at the front of the classroom or nearer to the teacher, but other strategies can include using a study carrel or partitioned space to reduce visual and auditory distractions at times.

• Minimise Distractions: Create a visually clutter-free and organised classroom environment. Use neutral wall colors, minimize posters, and keep the classroom tidy. Consider using noise-cancelling headphones or white noise machines to reduce auditory distractions.

• Visual Schedules and Timers: Display daily schedules, assignment timelines, and task lists using visual aids. Timers can help students with time management and transitions between activities.

• In-hand fidget tools where appropriate

• Regular movement and sensory breaks

• Structured Routines: Establish consistent classroom routines and procedures. Clearly communicate expectations and transition points to help students with ADHD anticipate and prepare for changes. Ensure these are communicated with relief teachers wherever possible to minimise difficulties on those days.

Academic Accomodations:

These are more task-based accomodations that allow for the differences in learning styles and increased need for assistance with executive funcitons required by individuals with ADHD.

These may include

• Teacher/Academic staff Understanding that movement may actually be assisting the child to regulate and remain actively engaged in their learning.

• Extended Time for Assignments and Tests: Provide extra time for completing assignments, quizzes, and exams to allow students with ADHD to work at their own pace without feeling rushed, and allows for delayed processing that is often a difficulty.

• Chunking Tasks: Scaffolding and teaching the discrete task of breaking larger assignments into smaller, manageable tasks with clear instructions and deadlines if extremely helpful for students with ADHD, starting in primary school. This helps students with ADHD stay organised and focused through the completion of smaller components, rather than becoming overwhelmed with a more 'macro' view.

• Individualised instruction and task content: Where able, individualising assignment content or topics to those of high interest, can assist the student's engagement (as this works with the dopamine-seeking centres of the brain positively).

• Gamefied Learning Platforms: Similar to the above, gamified educational apps and platforms can engage students with ADHD through interactive and rewarding learning experiences, making the learning process more enjoyable and motivating.

• Graphic Organisers/Mind Mapping techniques: Using mind-mapping or graphic organisers to help students with ADHD visualise and organise their thoughts for writing assignments or complex tasks.

• Assistive Technology: Can help with task organisation and completion through the ease of re-arranging thoughts and completed parts, and allowing the student to work through in a concrete manner. Some examples include:

  • Digital Calendars and Reminders: Electronic calendars and reminder apps can help students keep track of assignments, deadlines, and appointments. They can set up notifications and alarms to prompt them about upcoming tasks, reducing the risk of forgetting important responsibilities.

  • Note-Taking Apps and Audio Recorders: Note-taking apps and devices with audio recording capabilities allow students to capture lectures and discussions. This can be particularly helpful for students who may struggle with maintaining attention during class or have difficulty with traditional note-taking.

  • Text-to-Speech and Speech-to-Text Technology: Text-to-speech tools can read text aloud, making it easier for students with ADHD to process and comprehend written information. On the other hand, speech-to-text technology allows students to dictate their thoughts or responses, aiding in written expression.

  • Organisation and Task Management Apps: There are various apps and software designed to help students with ADHD organize their tasks and assignments. These tools often offer features like to-do lists, task prioritization, and progress tracking.

• Note-Taking Support: Provide outlines or pre-printed notes for lectures and presentations to help students with ADHD stay focused on the content rather than writing.

• Alternative Testing Environment: Offer a quiet and distraction-free environment for exams or assessments to reduce anxiety and improve focus.

• Peer Support and Group Work: Encourage some group activities to promote social interaction and collaboration, however this often requires monitoring for on-task behaviours and productive discussion. Assigning peer buddies to help with organisation and task completion can assist with the accountability that can be problematic for those with ADHD (this is a form of Body-Doubling).

• Positive Reinforcement: Use positive reinforcement and praise to motivate and reward positive behaviors and academic achievements.

Mindfulness and Yoga: Mindfulness practices and yoga have shown promise in helping individuals with ADHD improve self-awareness, attention, and emotional regulation.

Support Groups: Support groups can provide individuals with ADHD and their families with a sense of community, emotional support, and valuable insights from others facing similar challenges.

It is important to recognise that the effectiveness of interventions may vary among individuals with ADHD. Tailoring individualised treatment plans to each person's unique strengths and challenges is crucial, as is the involvement of all key stakeholders - parents, teachers, therapists and the individual themselves.