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Current and Effective ADHD Treatments
Rory T. Hill
Brigham Young University
Writing 150
Kelli Skinner
October 14, 2023
Current and Effective ADHD Treatments
According to an article from Forbes Health
, about 6 million children and an additional
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8.7 million adults have been diagnosed with ADHD in the U.S. (Wirth, 2023). The data shows that the percentage of children receiving treatment for ADHD in the U.S. is approximately 32% are treated with both pharmacological and behavioral treatments, 30% are treated with pharmacological treatment only, 15% receive behavioral treatment only, and 23% do not receive treatment (Wirth, 2023). These percentages inspire the question: What treatments for ADHD are currently available and which are the most effective in alleviating the symptoms of ADHD?
The most current resources (ranging from 2021-2023) were gathered from databases such
as Academic Search Ultimate, APA PsycTests, and ERIC to find the answers to this question. Keywords such as ADHD, treatment, effectiveness, pharmacological, behavioral, and improvement were used to collect the sources referenced in this report. This report will divide ADHD treatments into two main categories: pharmacological treatments and non-pharmacological treatments; in doing so, the most common treatments and their effects will be analyzed to determine which is the most effective in easing the symptoms of ADHD. Pharmacological Treatments
Pharmacological treatments are the most common treatments used among children in the U.S. However, there is some debate regarding the two main types of pharmaceuticals: stimulants and non-stimulant drugs. According to Mucci et al. (2021), stimulants are “endowed of a prompt efficacy and safety” and are faster acting but have a higher risk for misuse, while non-stimulants require more time to become fully effective but “are useful when a substance abuse history is detected” (para. 1). This section will further explore the differences and effects of stimulants and non-stimulants.
Stimulants
According to a review published in 2022, stimulants have been the leading treatment
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option for ADHD for the past few decades (de Faria et al., para. 2). The most prevalent stimulant used as a treatment is methylphenidate, commonly referred to as Ritalin. Methylphenidate works by increasing dopamine and norepinephrine levels in the central nervous system. This increase of
dopamine and norepinephrine has been shown to improve executive functions and brain activity relating to fatigue and hyperactivity (Mucci et al., 2021, para. 10). However, the actual effectiveness of methylphenidate has been further explored by the studies conducted in 2021 by Grandjean et al. and in 2022 by de Faria et al. The study conducted by Grandjean et al. (2021) focused on the treatment’s ability to suppress impulsive actions in children with ADHD. The study focused on a group of 65 children,
comparing untreated children with ADHD to children treated with methylphenidate; they also involved a control group of children without ADHD. This study concluded that methylphenidate did indeed play a role in improving the efficiency of the inhibitory processes of children with ADHD (Grandjean et al., 2021, p. 148). The authors also suggested that based on the results, “[methylphenidate] could improve ADHD symptoms by indirectly influencing other cognitive processes, such as selective attention” (Grandjean et al., 2021, p. 149). This conclusion supports the belief that methylphenidate effectively reduces symptoms of ADHD.
In contrast, de Faria et al. (2022) felt that a lot of the research regarding the previously mentioned belief had a high risk of bias and felt the need to explore further the efficacy of methylphenidate on academic performance and behavior during tasks. To conclude the actual effectiveness of the drug, the authors reviewed nine different studies that varied in study group, duration, and dosage. Based on the results, they felt most of the study groups had considerable limitations, including some risk for bias. Of their nine sources, five of the studies concluded that methylphenidate does prove to be
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effective in improving the academic performance of students with ADHD. However, three of the remaining sources concluded the opposite. These three sources stood out even more as they had the best scores on the Newcastle-Ottawa Scale, a scale used to reflect the effect of limitations on the studies. Because of these results, de Faria et al. (2022) conclude by saying, “Although some studies indicated that its short-term use may improve outcomes in the school environment, the evidence is quite fragile and does not adequately weigh the risks and benefits of the treatment” (p.18) Therefore the question remains, how truly effective is methylphenidate? The answer appears to be up to interpretation. In terms of other stimulants used as treatment, amphetamines are another typical example. Amphetamines come in various options, including other formulations like lisdexamfetamine dimesylate. They also vary regarding dose amounts and longevity (Mucci et al., 2021). Amphetamines work very similarly to methylphenidate and similarly have a risk for misuse. According to Mucci et al. (2021), common side-effects such as “
euphoria, higher libido and reduced sense of fatigue” are commonly found, especially when taken by healthy individuals
rather than individuals with ADHD (para. 17). Side-effects such as these, increase the risk of addiction and misuse. Therefore, amphetamines tend to be a “second-line treatment” or backup plan for when methylphenidate is ineffective (Mucci et al., 2021, para. 19). This indicates that methylphenidate is not only preferred over amphetamines but may also prove to be more effective in the long run, hence its overall prominence as a widely used treatment for ADHD.
Non-stimulants
According to the article by Mucci et al. (2021), three common non-stimulant medications
are used to treat ADHD. The most recently approved is atomoxetine, a non-stimulant that acts as
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an inhibitor for the norepinephrine transporter, increasing the levels of norepinephrine in the brain. The drug also has a minor effect on dopamine levels. The “clinical effect” of atomoxetine begins to show in about two to four weeks, much longer than stimulants – which are generally fast-acting (Mucci et al., 2021, para. 20). Mucci et al. (2021) also note that the effects of the drug
have also been shown to improve other symptoms such irritability. However, there is also a lower
risk for substance abuse, making atomoxetine a preferred choice when treating patients with a history of substance abuse (paras. 20 and 25). Another common non-stimulant is guanfacine, a selective agonist of central “α-2
a receptors” (Mucci et al., 2021). An agonist is a substance that creates a physical response when applied to receptors in the brain. The authors state that although guanfacine was initially designed as an “antihypertensive medication,” it was approved by the FDA in 2010 as a “second-
line” treatment option for ADHD, beneficial for patients with comorbid mental illnesses (Mucci et al., 2021)
. Therefore, guanfacine is likely not as effective as other treatment alternatives when it comes to ADHD, even though it does help regulate some of the symptoms. In comparison, clonidine is also an α-2
a receptor agonist. However, rather than targeting just the α-2
a receptor, it targets multiple other receptors. Therefore, clonidine is a more vital medication than guanfacine. However, its original purpose, like guanfacine, was to treat hypertension and migraines before the FDA allowed clonidine to be a backup option to treat ADHD (Mucci et al., 2021). In addition, Mucci et al. (2021) report, “
Cases of abuses of [clonidine] together with benzodiazepines or opioids are also reported, possibly explained by the effect of [clonidine] to enhance and prolong the benzodiazepine-induced sedation, as well as the opioid-induced euphoria” (para. 33). Due to its similar properties to guanfacine and high risk of misuse, clonidine would prove to be less effective than atomoxetine as well as most stimulant
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