When to Consider ADHD Treatments?

Before settling on a given intervention, it is very important to ensure that ADHD really is present and that the diagnosis was correctly identified. A thorough cognitive assessment in neuropsychology is in fact the best way to avoid false diagnoses and conclusions. For a complete list of diagnostic criteria for ADHD, click here.

To know whether a treatment should be initiated, experts in the field generally adhere to three main lines of action. Treatment is recommended if a person’s difficulties are significant enough to compromise one of the following areas:

1) Family Dynamics: Does inattention, hyperactivity, impulsivity or behaviour induce tensions or disputes within the family, between the children, between parents and children or between the parents themselves because of the child? Are adult ADHD symptoms significant enough that they disrupt a couple’s relationship?

2) Social relations: Do hyperactivity, impulsivity or inattentive behaviours prevent the person from integrating a group or from maintaining his friendships? Does the person’s overall behaviour irritate other or cause frequent conflicts? Or is it that the ADHD sufferer feels isolated, and is rejected by his peers because of his difficulties?

3) Academic progression or workplace efficiency: Is the child at risk of failing or is his learning and academic progression compromised by his behaviour or by a lack of focus? Is the time and effort invested in schooling or at work disproportionate to the results? Are efficiency and productivity regularly compromised?

At Neurosolution, we advocate a comprehensive approach and therefore also attach great importance to one last area of functioning when it comes to deciding on a treatment.

4) Health and security: Can the child’s behaviour place him in danger (crosses a street without looking both ways, gets lost in a shopping center without notifying the adult, gets injured often, does not perceive danger, etc.)? Can impulsivity jeopardize a teen or an adult’s health (conflicts, consumption habits, promiscuousness, unsafe sexual relations, etc.)? Or could there be risk of accidents and danger to others because of adult inattention (heavy machinery, driving long distances, etc.)?

These are all important questions to consider when deciding on whether or not to initiate ADHD treatments.

Learn more on:

ADHD Assessing for ADHD

Therapy or ADHD Medication?

An intervention in cognitive behavioural therapy can help address certain aspects of ADHD that medication alone cannot achieve. Indeed, psychotherapy will focus on modulating and abating behavioural difficulties associated with inattention and hyperactivity-impulsivity. Acceptance, self-observation, awareness of one’s difficulties, recognizing and learning to identify one’s behaviours or tendencies and understanding their impact in everyday life are some of the bases covered by an intervention in psychology. By addressing these aspects, the psychologist will help the individual develop strategies and means to modify, correct, predict, minimize or prevent his own difficulties from taking over. For example, accepting one’s difficulties and recovering self-confidence; recognizing the warning signs behind irritability and anger, and making use of relaxation techniques (breathing, visualization, etc.); developing strategies that will help an individual pay closer attention to details or become more aware of one’s own tendencies, so as to recognize moments when he or she may become vulnerable to distractions. Psychotherapy can be used to complement ADHD medication, and may also be useful in mild cases where pharmaceutical treatments for ADHD want to be avoided or are not absolutely necessary. Besides psychotherapy, there are also other professionals which are capable of helping younger students: for instance, remedial services and resource teachers to help them function better at school with regards to planning, organization and methods of work; or educational psychology to help address behaviour and social skills, or to help modulate emotions such as anger and opposition.

On the other hand, medication represents the other effective and recognized method of treatment for ADHD. However, it is important to understand that the product is not in and of itself a complete solution, but rather a tool and a means that will help optimize and maximize the individual’s overall functioning and performance. With this in mind, a parent’s choice is never easy and many become concerned and hesitant when faced with the reality of having to medicate their children. So long as the individual presenting with ADHD remains functional in his everyday life, the implementation of strategies and individualized education plans, or the support stemming from other specialists should help compensate one’s difficulties to a certain extent. However, when the ADHD symptoms become significant enough to compromise the quality and integrity of an individual’s family dynamics, social interactions, academic and professional achievements or health and safety, medication remains the best course of action.

ADHD Medication

The type of treatment for ADHD, the choice of product, as well as its dosage and administration strategies are decisions which rely upon the doctor’s own opinion, judgment and knowledge. However, the decision to actually initiate the proposed treatment is the parent’s own, until the child can decide for himself. For these reasons, it is important for parents to talk openly with their doctor with regards to the types of available treatments, their benefits, their side effects as well as any issue involving the child’s overall health. Commonly reported side-effects are mainly related to a loss of appetite, but in rarer cases sleep disturbances, gastrointestinal inconveniences, heart palpitations or adverse behavioral changes (anxiety, negative thoughts, apathy) have also been known to arise.

Three major classes exist, including methylphenidate-based psychostimulants, amphetamine-based stimulants and non-stimulants. Below is a list of currently available ADHD medication in Canada.

Methylphenidate-based Psychostimulants

Ritalin: Short-acting stimulant (3-4 hours) but also available in longer-acting, extended-release version known as Ritalin XR (6-8 hours). Though less prescribed these days, it still holds an important position in treatment choices, namely as a supplement or in cases where adverse events are reported with other products.

Biphentin: Long-acting stimulant (8-12 hours). Releases a larger initial dosage than its competitors, which makes it more effective in the morning than during the afternoon, thereby helping individuals become more alert during morning classes or workloads.

Concerta: Long-acting stimulant (8-12 hours). Gradual release of its dosage throughout the day and has the advantage of keeping attention levels stable in the afternoon.

Amphetamine-based Psychostimulants

Dexedrin: Short-action stimulant (3-4 hours) but also available in extended-release version (6-8 hours). Mainly prescribed to treat narcolepsy, but is also used as an ADHD treatment.

Adderall XR: Long-acting stimulant (10-12 hours). An Exception drug that is mainly prescribed when previous ADHD treatments have failed to show expected results, or have caused significant side-events.

Vyvanse: Long-acting stimulant (12-14 hours). Mainly prescribed in adolescents and adults, since its effectiveness is long enough to support the individual throughout the evening, after returning home. For example, allowing a person to remain efficient throughout evening-time studies or until the kids can be put to bed.

Non-stimulant Medication

Strattera: Very long-acting medication (24 hours). A little less effective in improving attention when compared to stimulants, but has the benefit of also addressing anxiety. More difficult to administer than stimulants because its effects will not be noticeable before 2 to 4 weeks, and because halting the medication requires a gradual decrease of its dosage over a few weeks’ time.

Intuniv: Very long-acting medication (24 hours). Used mainly to minimize behavioural symptoms such as anxiety, restlessness, impulsivity, anger or opposition. Sometimes used as a supplement to other ADHD treatments, or other difficulties altogether. Like Strattera, it requires more diligence because of its delayed onset and the need to gradually reduce the dose before its withdrawal.

For more information on available ADHD treatments, please refer to the CADDRA Guide of pharmacological treatments for ADHD in Quebec.