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Attention Deficit Hyperactivity Disorder

Best Treatment for ADHD

04/22/2002

Question:

I am doing a research paper on ADHD treatment and the controversy on the best form of treatment. I, myself, have been diagnosed with ADHD. I was on Ritalin, Adderall, and Prozac for the condition. I am also in counselling and have been for many year. I was wondering what you think is the best form of treatment for students with ADHD, medication, counselling, or a combination of the two. I need a professional`s opinion and I believe that you are the best person to go to for this requirement. Thank you.

Answer:

Great Question! The short answer is, the "best" form of treatment varies from person to person but the “long” answer follows. Ideally, medication, coaching, psychotherapy, meditation, body-work (such as therapeutic touch or acupuncture), and other relaxation techniques all should be considered. Medication 1. Stimulant medication is the gold standard. Anyone with ADD/ADHD can benefit from medication as long as they have no medical contraindications, no major uncomfortable side effects, and can afford it. 2. There are two basic kinds of stimulant medication, methylphenidate and dexedrine. Each has several sub-categories, usually divided into groups by how long they give a therapeutic effect. Interestingly, even though two medications may be considered equivalent by the FDA, persons with ADD/ADHD often find very notable differences. Some tolerate the 12-hour methylphenidate well but are physically uncomfortable on the eight-hour or four hour methylphenidate. Others find the opposite. One person may do best on the four-dexedrine salt preparation, another on short-acting dexedrine, and a third on dexmethylphenidate. 3. Even two people on the same drug can have great variance in how often they need to receive a dose and what their ideal dose is. For instance, regarding methylphenidate---although unusual, I have had adult patients who take 5 mg every four hours and others who take 50 mg every three hours. In each case, most have improved greatly, have no major side effects, and stay at the same dose (or lower) for years (maybe decades---I have only prescribed these medications as a specialist for 5 ½ years and long-term studies take, well, long-term). Coaching/Tutoring · Some people benefit greatly from learning how to get organized or write a paper, etc., once they are medicated · Others find working with a qualified ADD/ADHD coach on the Internet keeps them focused on retraining Psychotherapy · Years of living with ADD/ADHD can take its toll. Some need to explore more intensely into their lifestyle and life-choices to “undo” some of that baggage · More than half of the people diagnosed with ADD/ADHD have another psychoneurologic problem such as depression, obsessive disorder or oppositional-defiant-disorder. Although we have many good medications for these, not all people need medication and medication alone is often just helpful moderately or short term if not accompanied by healthy learning and change. Meditation/Guided Imagery/Body Work (e.g., Tai Chi, massage) These practices, when accomplished regularly, can have an extremely positive effect on many aspects of ones health. I have had patients tell me they had tried meditation or Tai Chi in the past but were unable to stay focused enough for either, until they were taking medication. In my practice at The Affinity Center we get many “difficult” cases, as commonly happens to specialists in any medical field. Many of our more complex patients have come to us after unsuccessful care elsewhere. However, we also see a good number of patients who are actually not particularly complex. Some of them already received an ADD/ADHD diagnoses and have no other major confounding problems but have not been optimally medicated and/or have not received appropriate counseling, couching or psychotherapy---they have tried one or two low dose medications, and maybe a counseling referral, but are not comfortable with any further steps. In some cases, if their physician(s) had felt comfortable with a wider variety of treatments and/or using higher doses, and/or had been more knowledgeable about the variety of other referrals for various situations, the specialist work up might not have been necessary. This is common for all medical concerns. As a family physician, one of my more important responsibilities is to understand when I do not know enough to feel sure I will “first do no harm.” I sometimes ask a colleague about a patient’s case---other times I refer. I, like other physicians, often use medications outside of the Food and Drug Administration (FDA) suggested guidelines. However, if I am not extremely familiar with a drug, its interactions and side effects, I stay within the FDA suggested guidelines. All this is to say that you, other students, or adults no longer in school may benefit from a variety of therapies. Although some of those do not fit in the realm of "usual and familiar" with many physicians, there are likely several that do. The more ones therapy is tailored to specific needs, lifestyle, and preferences, the more successful it is likely to be.

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Response by:

Susan Louisa Montauk, MD
Formerly Professor of Family Medicine
University of Cincinnati