What are the treatment options for ADHD?

An Overview of Causes & Treatments

Attention Deficit Hyperactivity Disorder (ADHD) is an incurable disorder treated with a combination of drug and cognitive/behavioral therapy. Despite high treatment success rates much controversy surrounds the issue of treatment. There exists many misconceptions surrounding ADHD that cloud understanding of effective therapy.

Parental Worry

The natural worry of parents understandably creates concern when children are prescribed medication. Stigma worries of labeling children due to diagnosis also exasperate the concern of parents. These concerns are not without merit but parents working closely with professionals such as doctors, teachers, coaches, and therapists work through these concerns.

One of the largest concerns for parents that can deter treatment of ADHD is the over-diagnosis controversy shadowing treatment. Many people believe ADHD is an over-diagnosed syndrome and treatment (specifically drugs) are not needed. This belief is not without merit but over-diagnosis does not invalidate drug and behavioral therapy as the most effective treatment for ADHD.

Over-Diagnosis

The relative newness of ADHD, having only been formally recognized by the American Psychiatric Association (APA) in the late 1960s, provides a short backdrop to research and understanding (Lange, Reichl, Lange, Tucha, & Tucha, 2010). Prior to formal recognition, the disease, known as hyperkinetic impulse disorder, traces back approximately 200 years in various theories and names. ADHD’s modern diagnostic criteria occurred between 1970 and 2000 (Lange, Reichl, Lange, Tucha, & Tucha, 2010). The primary issue of ADHD diagnosis stems from the criteria difficulties used to diagnose the disorder. Differences in how the disease is diagnosed and comorbidity issues have motivated changes, making all diagnostic criteria necessary in different situations beyond school (Lange, Reichl, Lange, Tucha, & Tucha, 2010).

This problem is coupled with the fact that the causes of ADHD are still unknown. Unlike other disorders, ADHD does not appear to be a genetic disorder. There is a lack of evidence of biological or genetic evidence and this complicates diagnosis because there is no distinctive etiology that researchers can find (Lange, Reichl, Lange, Tucha, & Tucha, 2010). This further complicated by comorbidity.

Despite these challenges, DSM criteria designated proves effective diagnosing the disorder. Increased awareness and a better understanding of ADHD has led to an increase in the diagnosis. The problem of overdiagnosis appears to be linked with the prescribing of medication.

Many cases of ADHD are questionable because of the manner in which they have been diagnosed. Many parents take their children to medical doctors who routinely prescribe medications for ADHD and this has led to a situation in which many people think their children have ADHD but in reality, they are merely being treated for the symptoms thus leading many to believe the illness is overdiagnosed when in reality it is the medication that is being overprescribed.

The prescribing of medication for ADHD has proven to be a positive measure in most cases. However, Consumer Report sponsored a study of ADHD medications and found that 65% of the children who are diagnosed with having ADHD are taking drugs such as Ritalin (Consumer Report, 2005). The report also stated that many children were being prescribed this drug without a clinical diagnosis. The report went on to warn parents that any diagnosis of ADHD should receive a second opinion because of the complex nature of the disorder (Consumer Report, 2005). Dr. Mary Solanto a leading researcher and head of the ADHD program at Mount Sinai School of Medicine stated, “The evaluation can’t be done in the 15-minute office visit,” and went on to say that many kids who need help with ADHD do not get it” (Consumer Report, 2005).

Reports such as this show that ADHD drug treatment is likely overprescribed by doctors who are just treating the symptom. However, this problem does not detract from the fact that ADHD is a real disorder and that its treatment methodology is valid.

There is a tendency for people to interpret reports such as consumer reports as meaning that the disorder does not exist or that it is being treated improperly. This is not the case. The difficulty of defining ADHD etiology is likely the cause of overprescribing of medication. As well, just because a doctor prescribes medication for symptoms, this does not mean that this is a blanket diagnosis of ADHD. In most of these instances, a doctor is treating the symptoms and telling the parents that they need to seek a more comprehensive diagnosis. The controversy that stems from misconceptions surrounding overdiagnosis creates the problem of people seeking alternative therapies and falsely believing that current drug and behavioral therapy is not effective for ADHD.

Alternative Treatments and Arguments

As a result of people misunderstanding the problem of diagnosis, alternative treatments and arguments have arisen to try to explain ADHD. In many instances, these alternative treatments lack efficacy and scientific evidence.

In particular, Dr. Daniel Amen has devised treatment protocols based on MRI studies of the brain. has studied over 80,000 brain scans which led to some interesting conclusions (Amen, 2015). Dr. Amen has linked images with a diagnosis which he believes creates a more effective means of treating disorders. This work shows that conditions are more complex than clustering groups of symptoms and that these conditions need to be treated in a more individualized manner based on brain activity (Amen, 2015). This is an intriguing concept but stands in contrast to current beliefs that ADHD is not genetically based. Based on Dr. Amen’s MRI and electroencephalogram work, he has determined that ADD has a large genetic contributing factor caused by irregular dopamine levels produced by the brain, specifically the basal ganglia (Amen, 2015). Drug therapies work by increasing dopamine levels in ADD patients offsetting the shortage caused by the abnormally small basal ganglia and this increases concentration (Amen, 2015).

Dr. Amen presents his ideas based on the interpretation of MRI data. The problem with this research is that research has consistently shown that these forms of tests provide a limited understanding of brain function. For example, patients suffering schizophrenia show structural and functional differences with healthy control groups when undergoing neuroimaging studies but these differences are not present in all cases and require more testing to in order to show causal relationships to impact how the disease is diagnosed (APA, 2006).

The science of neuroimaging is simply not advanced enough to support Amen’s findings. This is further complicated by the fact that ADHD is often diagnosed in children and the use of these imaging techniques is not reliable in children due to their brains still developing. Yet based on these findings, Dr. Amen has classified ADHD into subtypes including ADD ADHD Combined, Inattentive ADD ADHD, Overfocused ADD, Temporal Lobe ADD, Limbic ADD, Ring of Fire ADD, and Trauma-Induced ADD (Amen, 2015). These subtypes are treated with different drugs which Amen claims to have determined which drug therapies are most effective in accordance with his subtypes (Amen, 2015). The problem is that Amen presents no proof other than testimonials of his success in treating ADHD. Dr. Amen is just one example of many alternative treatments that provide no scientific evidence.

There are countless alternative therapies for ADHD claiming causes ranging from vitamin deficiency to food additives. The treatments used range from special diets to medications. However, there is no scientific evidence to support the use of any alternative therapies other than some medications being tested. These medications are not meant to replace traditional therapy only to replace certain drugs that can cause side effects (Brue & Oakland, 2002). Even these alternative medications have limited success.

ADHD Treatment

The standard treatment protocol for ADHD is drug therapy combined with behavioral therapy. This form of treatment is typically dived into four options including:

1. Medications
2. Behavioral intervention strategies
3. Parent training
4. School accommodations and interventions (CDC, 2015).

There are many drugs that are used in the treatment of ADHD and these are divided into two categories of drugs: stimulant and non-stimulant. Medications also carry a variety of side effects such as loss of appetite, anxiety upset stomach, and in extreme cases suicidal thoughts (CDC, 2015). The diversity of medications has occurred in an effort to combat side effects which can vary between individuals.

Despite side effects, the effectiveness of these drugs is well researched. Drug therapies that are of the highest efficacy are stimulant medications including methylphenidate, dextroamphetamine, and mixed amphetamine salts (Faraone, Biederman, Spencer, & Aleardi, 2006). These drugs have produced the best results and have a long history of research to back their usage (Faraone, Biederman, Spencer, & Aleardi, 2006).

Coupled with drug therapy is behavioral intervention strategies. Drugs do not cure ADHD and in order to combat the disordered behavior, interventions are needed in order to reduce problems. According to the CDC (2015), there are many different strategies that can be employed such as:

• Creating routines and consistent schedules of daily activities.
• Increasing organization by placing belongings in the same place in order to reduce the chance of losing or forgetting their place.
• Avoid distractions during activities such as homework by turning off computers and other devices.
• Parents should limit choices such as offering a one or the other option for things such as meals or toys to reduce the risk of overwhelming or overstimulating the child (CDC, 2015).

Many of these strategies are aimed at creating a routine such that a child will not become confused and struggle to remember. These behavioral strategies are an intrinsic part of overcoming the areas of cognitive dysfunction that medication cannot correct. In order to implement these strategies, parent training is required as part of the therapy process as well as working closely with schools to make accommodations and to implement educational strategies. By combining these treatment interventions, ADHD shows the greatest positive outcomes for learning and behavioral issues (CDC, 2015).

Conclusions

Current drug therapies and behavioral interventions have proven to be the most effective means of treating ADHD. While these therapies are not perfect there are currently no other alternative treatments that are considered scientifically valid. Continued research in ADHD has provided a wealth of medications that continue to improve results and reduce side effects.

The controversy of whether ADHD is over-diagnosed persists to create the illusion that ADHD treatment is ineffective. In the worst cases, this controversy appears to spark the idea that the condition does not exist. While ADHD is a difficult disorder to diagnose, it is a real disorder that requires therapy. As such, drug and behavioral therapy should not be dismissed by parents for unproven alternative treatments. Disseminating this need to follow this type of therapy should be a primary focus of professionals dealing with ADHD patients and families.

References

Amen, D. D. (2015). Attention Deficit Disorder ADD/ADHD. Retrieved from Amen Clinics: http://www.amenclinics.com/the-science/spect-gallery/attention-deficit-disorder-addadhd/#

APA. (2006). PRACTICE GUIDELINE FOR THE Psychiatric Evaluation of Adults. American Psychiatric Association, STEERING COMMITTEE ON PRACTICE GUIDELINES. APA.

Brue, A. W., & Oakland, T. W. (2002, January). Alternative treatments for attention-deficit/hyperactivity disorder: does the evidence support their use? Altern Ther Health Med. , 8(1), 68–70.

CDC. (2015). Attention-Deficit / Hyperactivity Disorder (ADHD). (C. f. Control, Producer) Retrieved from Center for Disease Control: http://www.cdc.gov/ncbddd/adhd/treatment.html

Faraone, S. V., Biederman, J., Spencer, T. J., & Aleardi, M. (2006). Comparing the Efficacy of Medications for ADHD Using Meta-analysis. Medscape General Medicine, 8(4).

Lange, K. W., Reichl, S., Lange, K. M., Tucha, L., & Tucha , O. (2010). The history of attention deficit hyperactivity disorder. Attention Deficit and Hyperactivity Disorders, 2(4), 241–255.

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