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.
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.
- 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
- For a more detailed information on PCIT
- Evidence supporting PCIT
Positive Parenting Program (Triple P)
- Used for children 0-8 years old
- Provides parents with multiple tools and strategies to build strong relationships with the children
- Multiple ways of using the program, including an online version
- Large amount of research showing positive results
- For more information
- Evidence Supporting Triple P
Incredible Years Program
- Used for children ages 0-12 years old
- Developed to promote emotional and social abilities and to decrease aggression and emotional problems
- Different programs for parents, teachers, and children
- Typically taught in small groups
- For more information:
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
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
- Trains the mind to focus on what is happening at this moment
- Provides overall health benefits
- Studies found improvements in mood, quality of life, and attention in adults practicing mindfulness
- Resources about Mindfulness/Mindful Meditation
- ADDitude article - Mindfulness Meditation for ADHD »
- PsychCentral article - Mindfulness Skills Useful in Addressing ADHD »
- UCLA free downloadable guided meditations »
Exercise
- Provides overall health benefits
- Several studies demonstrate improvements in ADHD symptoms with consistent exercise, but most of these studies have some shortcomings in research design
- For more information about exercise and ADHD click below:
- Science Daily article - Exercise can help adults better cope with ADHD symptoms »
- Attention article - The Exercise Prescription »
Behavioral Therapies with Possible Benefits, but Lacking Formal Research
- Family/Marital Counseling
- ADHD Coaching
- ADHD Support Groups
- Professional Organizers
- Social Skills Training for ADHD in children aged 5 to 18 years » - a Cochrane Database Review
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 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
- Due to the fact that stimulants can cause small increases in heart rate and blood pressure, it is important to follow up with your doctor after starting a stimulant or changing doses
- If the patient has a history of heart problems, it is essential to discuss this with the prescribing doctor.
- Be sure to discuss any family history of heart problems, arrhythmias, or sudden death with the prescribing doctor.
- Resources
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
- Tics are sudden, quick, repeated movements or sounds that occur without control of the person affected. Tic disorders, like Tourette Syndrome, are more common in children with ADHD.
- Concerns that stimulant medications cause or worsen tic disorders have been raised over time. Studies have shown that the use of stimulants does not cause stimulants and rarely worsens tics.
- Pharmacological treatment for Attention Deficit Hyperactivity Disorder (ADHD) in children who have both ADHD and tic disorders » - a Cochrane Database Review
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.
- Includes short acting (Ritalin, methylphenidate chewable, Methylin solution) and long acting (Concerta, Quillivant XR, Metadate) forms
- Available in many forms including pills, capsules that can be sprinkled, chewables, liquids, and patches
- Resources
Amphetamine Type
- Amphetamines have been used for many years and have a large amount of research about their use for ADHD.
- Include short acting (Adderall, Evekeo, Zenzedi) and long acting (Adderall XR, Dexedrine Spansule, Vyvanse, Dyanavel, Adzenys XR) forms
- Available in many forms including pills, capsules that can be sprinkled, dissolving tablets, and liquid
- Resources
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
- Often used to help with sleeping difficulties and tic disorders
- Side effects of alpha agonists
- Stomach upset
- Headache
- Decreased appetite-less frequent and less severe than with stimulants
- Sedation
- Lowered heart rate and blood pressure
- Warnings regarding alpha agonists
- Due to the effects of alpha agonists on heart rate and blood pressure, these medications should be taken every day. If you choose to stop the medication, speak with the prescribing doctor to discuss a gradual decrease in medication.
- Guanfacine
- Available in short acting pill (Tenex) and long acting pill (Intuniv)
- Guanfacine For ADHD: An Effective Treatment & Adjunct from Mental Health Daily »
- Guanfacine from ADDitude »
- Clonidine
- Available in short acting pill (Catapres), long acting pill (Kapvay), and patch (Catapres TTS)
- Can be especially helpful if there are sleep difficulties
- Clonidine For ADHD: An Effective Treatment & Adjunct from Mental Health Daily »
- Kapvay from ADDitude »
- Resources