Research shows that multi-modal treatment - combining medications and psychosocial interventions - works best to treat ADHD in children. Clinical experience shows ADHD adults benefit from the same approach.
Doctors use the same medications for adult ADHD as they do in children. Psychostimulants such as Ritalin, Adderall, Dexedrine and Concerta are the "first line" (usually the most effective and safe) medications.
Unfortunately, stimulants have a high potential for abuse. There is considerable debate over whether or not to use stimulant medications in adults who have a history of substance abuse, a problem that is especially common among ADHD adults.
Some doctors refuse to prescribe stimulants to these patients. However, Paul Elliott, M.D., a Dallas, Texas physician who has worked with ADHD patients for over 25 years, disagrees. "Much of the substance abuse we see today is actually undiagnosed ADD patients who are self-medicating."
Elliott monitors these particular patients very closely. "I will not begin anyone on treatment for ADD with any of the abusable medications until they have been in successful recovery for at least 6 months. Furthermore, I advise the patient that their credibility in my eyes is very fragile and easily destroyed, and that I will not continue treating someone who fails to remain clean and sober; anyone who fails to keep appointments; and anyone who gives me any reason to believe he or she is misusing the medication in any way."
Stimulants may not be appropriate for other reasons, including a patient's high blood pressure or heart disease. For some of these patients, doctors may prefer antidepressants. Wellbutrin has shown promising results, has have tricyclic antidepressants. Some patients benefit from SSRI antidepressants like Prozac or Zoloft which are not generally considered a first choice for treatment.
Medication will not make you more punctual, well-organized, or easy to live with. But it can make it easier for you to overcome self-defeating habits and behaviors under the guidance of a well trained psychotherapist.
Psychotherapy is especially helpful for ADHD patients with co-morbid conditions such as depression and anxiety. It can also help adults deal with the frustration and anger they feel because their ADHD was never addressed in childhood. In addition, psychotherapists can help us improve our social skills and our ability to deal with ADHD-unfriendly situations.
Insight-oriented psychotherapy can help us make sense of our lives and know ourselves better, but other kinds of psychotherapies (such as Cognitive Behavioral Therapy and Interpersonal Therapy) are designed to target the way we think - which can lead to major changes in how we behave.
The ADD Coach
ADHD is a lifelong condition and while treating it helps us manage its symptoms, it is not a cure. Therefore, learning to live with your ADHD is an important part of taking control of your life and moving forward.
One way to help ensure that forward momentum is to hire an ADD Coach. Think of your coach as a personal trainer for your brain. This person is there to encourage you, to offer suggestions, and to hold you accountable to the goals that you set. Coaching is, by its very nature, goal oriented, which is important for people with ADHD.
Sandy Maynard, ADDitude's own Coach on Call, works with clients in person in her Washington, DC office. She also works with clients from as far away as Israel and Norway, using email or the telephone.
You Can Do This!
It's easy for the adult with ADHD to become discouraged. But many people with ADHD lead productive lives doing things they love to do. The trick is to accept yourself and find ways to maximize your strengths and minimize your weaknesses.
Michelle Novotni, co-author of the excellent book Adult ADD (Pinion Press, 1995), sums it up when she says "We believe the greatest difference in outcome is due not to the severity of the symptoms but to the attitude of the person with ADD."
"ADD is not an excuse, a way to duck responsibility," she writes. "It is a challenge that can be met and overcome. Those who meet the challenge of ADD, rather than rolling over and playing dead, are the ones who succeed."