Hyperactive, impulsive or inattentive behaviors test the patience of even the most unflappable people. Attention deficit/hyperactivity disorder, or ADHD, is a disorder that diminishes a person’s ability to stay focused, calm and organized. Perhaps a more challenging undertaking is concluding how to best manage this incurable disorder. According to the National Institute of Mental Health, the NIMH, medications for ADHD demonstrate benefits to those with uncontrollable or disarranged behaviors, but don’t come without bothersome and sometimes problematic side effects.
ADHD, although usually starting in childhood, affects children and adults alike. According to the NIMH, ADHD is the most common mental disorder in children and adolescents and 4.1 percent of adults have it. ADHD may impair academic and social functioning due to trouble focusing, following instructions, sitting still and maintaining personal space boundaries. Those with ADHD may blurt out inappropriate comments or interrupt others’ conversations or activities. Adults with ADHD may encounter problems at work and in relationships and find it difficult to be productive. ADHD medications may help reduce these symptoms.
Medications do not cure ADHD but control the symptoms. Physicians commonly prescribe stimulants for ADHD, because medicines that stimulate other people can actually calm those with ADHD. Manufacturers make pills, capsules, liquids or patches that may be short- or long-acting. Atomoxetine is a non-stimulant medication approved for ADHD. Not all of these medications are approved for use in adults, although physicians sometimes prescribe them on an “off label” basis. Although not FDA-approved for ADHD, sometimes antidepressants are used. A 2005 study conducted by T.E. Wilens and associates and published in "Biological Psychiatry" journal shows that the antidepressant bupropion demonstrated benefits for adults with ADHD.
Medications for ADHD affect the brain chemicals norepinephrine and dopamine, reducing hyperactivity, impulsivity and inattention. According to the NIMH, ADHD medications may also improve physical coordination. Michael Bloomquist, Director of the Attention and Behavior Problems Clinic at the University of Minnesota, notes that children with better self-control have fewer academic, behavioral and social problems. With effective ADHD treatment, many will achieve academic success and live productive lives that might otherwise not be possible.
According to the NIMH, the most common side effects of stimulants include: decreased appetite, sleep problems, anxiety, irritability and sometimes mild stomachaches or headaches. Less commonly, sudden, repetitive movements or sounds called "tics" may develop. Some children seem to lose their emotional expressiveness. The NIMH in the Preschoolers with ADHD Treatment Study found preschoolers were more sensitive to the side effects of stimulants and exhibited a slowed growth rate. A review of data of those with taking medications for ADHD showed that those with preexisting cardiovascular conditions had a higher risk of experiencing strokes, heart attacks or sudden deaths. Additionally, there is a one in 1,000 risk of developing psychiatric problems, such as being out of touch with reality or becoming manic. These findings led to a FDA warning of risk of cardiovascular and psychiatric problems in anyone taking medications for ADHD. Children and adolescents on atomoxetine for ADHD retain a higher risk of developing suicidal thoughts and require close monitoring. Stimulants can be abused, and those taking them can develop a tolerance. Despite these potential challenges, the FDA considers stimulant medications safe when taken under medical supervision.
Teachers and parents may mistake undiagnosed or undertreated ADHD for disciplinary problems, and those with predominant symptoms of inattention may be mistakenly treated for learning problems. A full psychiatric evaluation helps to discern the exact problem to properly guide effective treatment. Determining the most effective treatment for ADHD may require trying several medications and various doses. In addition to medications, parental and school interventions using a system of rewards and punishments, environmental controls and organizational strategies can help a child with ADHD succeed. Psychotherapies designed to teach a child to master appropriate social skills and behaviors may also reduce symptoms.
- National Institue of Mental Health: Attention Deficit Hyperactivity Disorder
- National Institute of Mental Health: Mental Disorders in America
- "Skills Training for Children with Behavior Problems"; Michael Bloomquist, PhD.; 2006