Psychosocial treatments for Adult ADHD – Final Coursera ADHD Thoughts

A camping trip with my youngest child delayed this last posting on the final lecture from the Coursera class on ADHD. It was buggy, cold, and rained most of the trip. Watching him jumping around in the campsite, hopping from rock to rock in the cold rain, brought home to me one of the important criteria for a true ADHD diagnosis. No matter how active a person is or how often they switch their focus, they cannot be clinically diagnosed with ADHD unless it causes impairment. My son’s natural inclination to be constantly in motion at the campsite may be an evolutionarily desirable trait. Perhaps high-energy children were less likely to be overcome by hypothermia and were more likely to reach adulthood and have children of their own.

Yet ADHD traits are not at all helpful in modern classrooms and offices where children and adults are expected to sit still and focus their brain power on tedious items. That does not mean that ADHD traits are not adaptive for other situations and environments. The trick for adults with ADHD tendencies is to find occupations and environments that work with their natural high energy and high distractibility as much as possible. Then structure their lives and surroundings with external scaffolding to compensate for their relative lack of internal executive organization and function.

As a person with ADHD moves from childhood through adolescence to adulthood the manifestations of their ADHD evolves. A child with ADHD is likely to show high physical activity, aggressiveness, low frustration tolerance, and impulsiveness. An adolescent with ADHD is more likely to sit still but will be easily distracted and inattentive. An adult with ADHD will frequently shift activities, be impatient, restless, and easily bored. Incidentally, this may also be true of a highly gifted individual who is in a unfulfilling occupation. What makes the ADHD adult stand out is that the impairment is usually across multiple domains. A lifetime of  ADHD, especially ineffectively treated ADHD, can highly impair an individual. From finances to occupations, relationships to physical and mental health, ADHD takes its toil. One of the most insipid effects is the demoralization that can occur due to a negative belief system. Adults with ADHD have typically spent years watching themselves fail to meet seeming simple challenges. They may not have good coping skills and may have developed a paralyzing hopelessness that feeds into their self-image.

Medical treatments for ADHD are a critical part of the treatment for adult ADHD, yet pills alone cannot teach new coping skills or help individuals recover from a lifetime of negative self talk. Psychosocial interventions that have shown promise include helping individuals, either individually or in groups, with psychoeducation, problem management, decision-making, procrastination, organization, time and effort management, cognitive modification, and behavior modification. Cognitive Behavioral Therapy (CBT) is very effective for adults with ADHD especially when combined with specific treatment goals and organizational strategies. Therapists can help adults with ADHD externalize their executive functions as much as possible.

Adults with ADHD need to put in more effort than more cerebrally typical people to keep themselves organized and on task. The good news is that many of the behavior interventions that help tame ADHD tendencies are generically healthy for everyone. They include creating regular routines for waking times and bedtime to ensure a full night of sleep. Daily exercise to increase available dopamine for clearer thinking and better focusing. Eating regular nutritious meals with a low glycemic index to prevent hypoglycemia which increases ADHD symptoms.

Environments should have an organizational structure with specific places for items that are easily misplaced such as keys and papers. Electronic reminders, especially ones easily programmable on smart phones, can help individuals stay on task while not getting so lost in an activity that they accidentally miss upcoming events and deadlines. Visible timepieces, concrete plans with start and end times, and regular reviews of what is working and what needs a better strategy all help the adult with ADHD. It is important for the adult to forgive themselves and to be realistic. Recognize what does work vs. what should work. Find the right tools to address outstanding problems and automate and/or outsource problematic tasks whenever possible. Recognize that certain feelings and situations may lead to detrimental impulsivity and prepare plans and coping strategies to avoid or mitigate this type of predictable trouble.

Beyond drugs and psychosocial therapy there are a few other ADHD treatments worth mentioning. Although not enough data is available to determine how to maximize the effectiveness of these treatments, neurofeedback, computerized cognitive training, and targeted working memory training are all showing some promise in treating ADHD.

The bottom line is that, especially given the more liberal definition of ADHD in the DSM-V, if you feel like you are impaired by ADHD, help is available. Although drugs might be part of the solution that works for you, do not neglect your environment. The more you can do to structure your world and life in a way that works with your brain’s natural tendencies, the more effective you will be.

Drugs for ADHD: Coursera ADHD Class Weeks 9 & 10

Drugs are one of the most common, if not the most common, treatment for ADHD. They can help individuals be more productive, calm, and in control of themselves, at least while the drugs are active. ADHD drugs are similar to prescription eye glasses. They help an individual function while they are in use, but they do not cure the underlying condition.

The Coursera class on ADHD takes the standard medical line that if used as prescribed and not abused, ADHD drugs, in most cases, cause no significant or long-term ill effects. Dr. Rostain cites statistics that stimulants are not over-prescribed for ADHD and that untreated ADHD leads to much worse outcomes than medical treatment of ADHD. Most studies on drugs for ADHD last just months, not years. Given that many individuals with ADHD take drugs for 5 years or more, and start at a young age, it is troubling that there aren’t better long-range studies on their effects.

Dr. Rostain covers many myths about stimulant drugs for ADHD. One stood out to me. The myth is that these drugs do not improve academic achievement. He states that stimulant treatment of ADHD improves work productivity, classroom conduct and rule-following, peer interactions, grades, and leads to reduced punishment, fewer days absent, and makes repeating grades less likely. So yes, on stimulants a child with ADHD will appear to be a better student and will certainly be easier for the teacher to have in class. Dr. Rostain didn’t mention that some studies have shown that psychostimulants have not been shown to achieve long-term positive changes in peer relationships, social or academic skills, or school achievement. He also did not mention that there is evidence that stimulant treatment of ADHD in juveniles can damage their developing brains. Long-term use of ADHD can also create a loss of motivation. Students, especially college students, may feel that their success is due to the drugs and a shift of agency may create a dependence on the drugs and low self-esteem.

There are three basic types of drugs used to treat ADHD: stimulants, non-stimulants, and antidepressants. Each affects the signaling of neurons in the brain in a slightly different manner and the lectures on them were too detailed to easily summarize. The comprehensive “What we know” brochure on Managing Medication for Children and Adolescents with ADHD from the National Resource Center on AD|HD is a good place to start. The last couple pages have suggested readings and then a handy reference chart for the drugs which includes the generic names, the brand names, the duration of action for each drug, the form the drugs come in, the dosage ranges, and the common side effects.

Even though there is a great deal of evidence that drugs can help treat ADHD symptoms in the short-term, they still carry risks. Risks that your pediatrician or health services provider may not mention. The best approach if you are considering ADHD drugs for your child is to learn all you can about the various drug options and then carefully, with the help of your child, monitor both the short-term and the long-term effects of any drug you give your child. Pay attention to both the physical side effects, such as stomach aches and sleep problems, and the more subtle psychological effects that may include decreased drive and motivation. Ask yourself, are you trading their initiative and innate personality for a child that is easier to live with and more compliant?