Treatment of Adults
Adults with ADHD can benefit by identifying the areas of their life that are most impaired by their ADHD and then seeking treatment to address them. Adults with ADHD may benefit from treatment strategies similar to those used to treat ADHD in children, particularly medication and learning to structure their environment. Medications effective for childhood ADHD continue to be helpful for adults who have ADHD. Various behavioral management techniques can be useful. Some adults have found that working with a coach, either formally or informally, to be a helpful addition to their ADHD treatment plans. In addition, mental health counseling can offer much-needed support to adults dealing with ADHD in themselves or someone they care about. Since ADHD affects the entire family, receiving services from ADHD-trained therapists skilled in Cognitive-Behavioral Therapy can help the adult with ADHD learn new techniques to manage living with ADHD.
Improving functioning and quality of life
While improvement of the core symptoms of ADHD is important and crucial, it is often not the only goal of treatment. Rather, improved functioning in the real world (being self-sufficient, having a better quality of life and being able to cope with the demands of daily life) may be the most important outcome for an adult with ADHD. Controlled medication studies in adults with ADHD have begun to track and measure these functional improvements including psychosocial and quality of life functioning. Future controlled long-term medication studies in adults with ADHD are needed to accurately measure the effect of medication on functioning in the workplace, college and interpersonal relationships.
Q. When an adult has been diagnosed with ADHD and decides to seek medical treatment, should the person try MPH or AMP first?
A. There is no scientific basis for choosing one type of stimulant over the other for a given individual who has not yet tried either. Because MPH and AMP affect dopamine and norepinephrine somewhat differently, they also affect people differently.
Both MPH and AMP block the reuptake of dopamine and norepinephrine and increase their levels in the synapse (space where the brain cells connect). AMP also increases the levels of dopamine and norepinephrine in the synapse through another mechanism in the pre-synaptic (pre-connection) brain cell.
If one family of stimulants does not improve ADHD symptoms, the practitioner can try a different type. Because MPH and AMP have different mechanisms of action, combining MPH and AMP may be useful in a person who does not respond to either type alone.
Q. Are adults who take psychostimulant medications more likely to have substance abuse problems?
A. No. Generally, the stimulants are well tolerated in therapeutic doses without any abuse. There is no evidence to substantiate the fear that stimulant use leads to substance abuse or dependence. On the contrary, studies indicate that successful treatment of ADHD with stimulants lowers the chances of substance use disorders, compared to adults with untreated ADHD.
Adults with ADHD who have a co-existing substance use disorder and are actively using sometimes abuse psychostimulants. Generally, the active substance use disorder needs to be treated before the co-existing ADHD can be treated. In this case, it may be advisable not to use a psychostimulant for the treatment of ADHD. For people with a recent history of substance use but no current use, deciding to use stimulant medication needs to be dealt with on a case-by-case basis. Certain extended release preparations, such as Concerta (an extended release form of MPH with an delivery system that cannot be crushed and used other than as prescribed orally), are less likely to be abused.
Q. What are the possible side effects of stimulant use in adults with ADHD?
A. Side effects of stimulant use in adults are generally not severe. For MPH, one controlled study showed side effects such as insomnia, headaches, anxiety, loss of appetite, weight loss (but less weight loss than is seen in children) and some cardiovascular effects. The cardiovascular effects in those with normal blood pressure include increases in blood pressure (systolic and diastolic increases of about 4 mm Hg) and increases in heart rate (less than 10 beats per minute). A few long-term large-scale controlled studies of cardiovascular effects have been published. These studies found that stimulant use was not associated with increased risk of heart attacks, cardiac death or stroke. In addition, a study of adults with well-controlled hypertension showed that ADHD could be safely and effectively managed with mixed amphetamine salts. Regular monitoring of blood pressure is generally recommended in adults with or without ADHD.