Evidence Based Treatment of ADHD

Many treatments exist for ADHD.  We recommend only using treatments that have published studies showing they work. Some treatments have more evidence than others about their effectiveness.   Below are brief descriptions of currently available evidence-based treatments and links for additional information.

ADHD Medication Options

ADHD Medication Options

Samantha Cohen, M.D., from the UC Davis MIND Institute talks about ADHD Medication Options

Behavioral Therapies

Behavioral interventions teach a person to monitor behaviors and provide rewards for desired behaviors to increase the likelihood of the positive behavior in the future. Planned ignoring or taking away a reward may also be used to reduce negative behaviors. To be effective, rewards for positive behavior must always be given if one is to use planned ignoring or taking away of rewards. The type of rewards used depends on the age and interest of the individual but can range from praise to privileges. Below are different types of behavioral approaches and their characteristics for both children and adults.

Evidence Based Behavioral Therapy for Children and Adolescents

  • Parents and caregivers learn how to teach children how to better control behavior
  • Is the first line treatment for preschoolers with ADHD and helpful for school age children and adolescents as well
  • Consists of several appointments with a therapist during which parents learn about positive communication skills, appropriate discipline, reinforcement of good behaviors, and structured environments.
    Between the appointments, parents practice these skills at home.
  • Takes time and effort but has been shown to have long term benefits
  • Commonly used programs include PCIT (Parent Child Interaction Therapy),
    Triple P (Positive Parenting Program), and Incredible Years Program
  • Parent training interventions for ADHD in children aged 5 to 18 years - a Cochrane Database Review »

Parent Child Interaction Therapy (PCIT)

  • Used for children 2-7 years old
  • Focuses on the parent child relationship
  • Teaches parents play-based skills and positive reinforcement through observation and practice of specific skills
  • Typically requires 1-2 weekly visits for3-4 months
  • Therapy is completed when parents are able to demonstrate the skills taught during therapy
  • Developed in the 1970s for children with disruptive behavior disorders
  • Good option to treat:
    Defiance
    Aggression
    Disruptive behaviors
    Attachment difficulties

    Positive Parenting Program (Triple P)

    Incredible Years Program

    Promising Therapies with Limited Research

    • Mindful Meditation
      • Not harmful
      • Trains the mind to focus on what is happening at this moment
      • Few small studies have been completed, but further studies needed
      • For additional information, see this Child Mind Institute article »
    • Physical Activity, Yoga, Tai Chi
      • Provides overall health benefits
      • Not harmful
      • Few small studies showing some improvements, but further studies needed
      • Attitude article - The Exercise Prescription »
    • Cognitive Behavioral Therapy (CBT) for Adolescents
      • Developed for adults, but has been utilized in adolescents as well
      • Can be beneficial for anxiety and depression
      • Research shows variable results, so further research is needed

    Evidence Based Behavioral Therapy for Adults

    Cognitive Behavioral Therapy (CBT)

    • Most commonly for adults; does not work with children with ADHD
    • Goal is to train  mindfulness, self-awareness, goal setting and organization
    • Allows person to be more aware of their behaviors, so they are better able to increase desired behaviors and decrease undesired behaviors
    • Requires some maturity
    • Can be used for many difficulties, including anxiety and depression
    • Specific programs for ADHD available
    • For more information about CBT

    Mindfulness/Mindful Meditation

    Exercise

    Behavioral Therapies with Possible Benefits, but Lacking Formal Research

    Medications Used to Treat ADHD

    Several medications effectively treat ADHD.  Medications should be considered if the symptoms are causing significant difficulty for the person with ADHD.  That being said, medications do not cure ADHD and should always be used in combination with behavioral treatment.  Medications can help develop skills to compensate for the difficulties associated with ADHD.

    Stimulants

    Stimulants are typically the first medication used for ADHD in both children and adults. Stimulants have been shown in multiple studies to be more effective than other medications in the treatment of ADHD.

    Possible Side Effects of Stimulants

    • Decreased appetite-often the most problematic problem
    • Difficulty sleeping
    • Irritability and poor mood-more often occurs when the medication is wearing off
    • Headache
    • Stomachache

    Additional Concerns About Stimulants

    Heart Conditions

    Poor growth

    • There have been concerns raised that stimulants can cause poor growth in children.  Studies have shown different results over time.  That being said, the majority of the research suggests that effects on growth is short lived and by adulthood there is no difference in growth between those previously on stimulants when compared to the general population.
    • Weight and height should be monitored by a doctor
    • ADHD Drugs and Growth by WebMD »
    • ADHD, Stimulant Treatment, and Growth: A Longitudinal Study » published in Pediatrics 2014

    Tic Disorder

    Drug Abuse

    • Stimulant medications can be used inappropriately or abused, most commonly by those without ADHD.  Many people worry that using them will cause addiction or increase the use of other drugs.  Research shows that when stimulants are used appropriately, they do not lead to abuse.  In fact, some studies suggest a decrease in drug use by those who have their ADHD symptoms treated appropriately with stimulants
    • Does Stimulant Medication Cause Addiction? - From ADDitude »

    Methylphenidate Type

    • Methylphenidate is the ADHD medication that has been used for the longest period of time and has the most research into its use. It has been found to work well for the majority of people with ADHD.

    Amphetamine Type

    Non-Stimulants

    Nonstimulants are typically used in patients unable to use stimulants or in addition to a stimulant.  They may also be used to target associated symptoms such as difficulty sleeping or anxiety.

    Atomoxetine (Strattera)

    • Although sometimes less effective than stimulants there is evidence that atomoxetine is effective for many with ADHD.  It is thought to be especially useful in those with anxiety.
    • Executive function is the set of skills that allow people to organize and complete tasks.  ADHD is often associated with difficulties in these skills.  Research supports an improvement in executive function associated with atomoxetine use in adults.
    • Only available in capsules that must be swallowed whole.
    • Must be given daily and decreased gradually if stopped.  Takes several weeks to begin working.
    • Side effects of atomoxetine
      • Tiredness
      • Upset stomach
      • Dizziness
      • Decreased appetite-less frequent and less severe than with stimulants
      • Mood swings
      • Black box warning
        • A black box warning is placed on drugs by the US Food and Drug Administration when there is evidence to suggest a possible serious hazard with a drug.
        • The FDA placed a black box warning on atomoxetine due to rare reports of increased suicidal thoughts in children and adolescents.  Although there were no suicides or increased suicide attempts, it is important to watch patients for suicidal thoughts.
    • Resources

    Alpha Agonists