How is attention deficit hyperactivity disorder (ADHD), inattentive type, in adults treated?

How is attention deficit hyperactivity disorder (ADHD), inattentive type, in adults treated?

Although there is no cure for the disorder, it can be successfully treated. There are several different approaches for treating adults, but generally some combination of medication and behavioral therapy yields the best results.

Medications. Prescription drugs that are used to treat ADHD in children usually are effective for most adults with the predominantly inattentive form of ADHD. However, the dosage and frequency of medications may have to be adjusted early during the course of treatment. It is important to match the needs of the person with ADHD with the characteristics of the drug.

The major classes of prescription medications that are prescribed for ADHD are psychostimulants, antidepressants, and nonstimulant drugs. These treatments affect the neurotransmitters that send signals to brain cells.

• Psychostimulants are the medications of choice in treating ADHD. The two types that are most commonly used are amphetamine and methylphenidate. Mixed amphetamine salts are marketed under the brand name Adderall®. Methylphenidate is sold under the brand names Ritalin®, Concerta®, Metadate® and others. Immediate release, sustained released and extended release forms of amphetamine and methylphenidate are available. The dosage and frequency of these medications may have to be adjusted to maximize their effectiveness. Extended-release formulations are recommended over immediate-release formulations.
  In certain cases, if psychostimulants are not effective or the person has a co-existing psychological disorder that may be affected by stimulant treatment, other medications might be prescribed.
• Antidepressants: Drugs such as tricyclic antidepressants, monoamine oxidase inhibitors, bupuprion (Wellbutrin®) and venlafaxine (Effexor®) increase norepinephrine levels in the brain and have a positive effect on the symptoms of ADHD. These drugs are not approved by the FDA for this indication, although they are used off-label.
• Nonstimulants: These medications may be required in cases where a patient does not respond to stimulants or has an adverse reaction to them. They may also be used for people with co-existing psychiatric conditions. Atomoxetine (Strattera®) was the first nonstimulant drug approved by the U.S. Food and Drug Administration to treat ADHD in adults. Guanfacine (Intuniv®, Tenex®) is another example of a nonstimulant medication.

Behavior modification or other forms of therapy. Various approaches may be used to treat adults with inattention problems. Cognitive-behavioral therapy (CBT) helps patients identify problem behaviors and create and implement strategies to self-regulate (control your behavior, emotions and thoughts), change behavior and achieve goals. With CBT, patients identify automatic or irrational thoughts that may result in negative behavior and replace them with positive thoughts and behaviors. Acceptance Commitment Therapy is another form of therapy designed especially to empower individuals to pursue personal values and engage in behavior consistent with their values as opposed to trying to change the individual. Other programs have been developed to enhance self-management, but these are not yet widely available. Group therapy may be effective for adults with ADHD, especially for women.

Coaching

Coaching is a relatively new approach that has become more popular over the past few years. Coaches help people with ADHD handle the challenges of daily life by providing feedback, recommendations and encouragement, and directing the individual to attend to their own solutions to problems. They also offer practical solutions to address certain issues--such as time management and organization--and help their clients achieve goals.