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| The Treatment of Adult ADHD At this time, our biggest challenge in the treatment of adult ADHD is finding physicians who are qualified and willing to take on ADHD patients. Until recently, ADHD was considered a childhood disorder and it was believed that children outgrew ADHD in their adolescence. We now know that at least sixty percent of adults maintain at least one of the core symptoms, resulting in some impairment. Most children in Canada with ADHD are treated by pediatricians, which causes a problem in the continuing care when these children grow into adolescence and adulthood. Not surprisingly, many pediatricians end up treating their patients' parents since there is such a shortage of psychiatrists who are knowledgeable in ADHD. There are adult psychiatrists who still believe that ADHD does not exist into adulthood, despite many studies and treatment trials that clearly show otherwise.Treatment for adult ADHD needs to be multimodal. Treatment should not rely on medication alone, but include support and follow-up care. Education about ADHD and how it affects any one particular person is essential. Since symptoms and their severity vary widely, it is important that coping strategies, dealing with particular symptoms, be discussed and implemented. Follow-up care is important, since coping skills will need to be repeated and adapted frequently throughout the beginning of treatment. Due to the lack of psychiatrists who deal with ADHD, it has fallen on family doctors to do much of the follow-up care for adult ADHD. Family doctors are slowly becoming more comfortable with prescribing medication for ADHD, however they do not have the time or expertise to do any type of psychoeducation for patients with ADHD. There are psychologists and some other health care professionals, such as social workers and therapists, who are experienced in counseling for ADHD, however these professionals are not covered by the provincial health care plans and can be very expensive. Some private health care plans do cover up to $500 a year per patient for psychological visits. There are a few adult psychiatrists in Canada who offer group educational sessions for their adult ADHD patients, however they are very difficult to access. Any form of education material around ADHD, as long as it comes from a reputable source, can be helpful. There are many excellent web sites and books available that can provide insight into how ADHD can affect daily functioning. They also supply information on coping skills around executive functioning impairment. Reading about others' experiences with ADHD can provide further insight and supply suggestions on ways to alter your lifestyle. Since four out of five adults with ADHD also have a comorbid disorder, or another disorder that accompanies the ADHD, having a very thorough assessment is essential. Treating the ADHD alone is not sufficient when disorders such as anxiety, depression, substance abuse, Bipolar Disorder and others are also present. These conditions should be screened for in a thorough history and evaluation done during the assessment process. Medication There are now more choices available in types of medication to treat ADHD. In uncomplicated cases of ADHD, medication management is fairly straight forward and typically effective with minimal side effects. The type of medication that is most often used to manage ADHD is stimulant medication. There are two basic compounds of stimulant medication; Methylphenidate (Ritalin) and Dextroamphetamine (Dexedrine). Stimulant medications are controlled substances and are therefore strictly regulated, however, they have been around for more than fifty years and thousands of published research papers are available detailing their safety and effectiveness. In the last five years, the development of time-released formulations that need to be taken only once a day, have significantly improved these same medications. A time-released medication helps to prevent medication levels from fluctuating or causing peaks and valleys during the day. These time released medications usually cover the adult during the whole work day and into the early evening. Some adults do metabolize these medications more quickly than others and may not have coverage for as many hours. These medications are in a form that is difficult to abuse and are therefore safer than old forms of stimulant medication. There are two Methylphenidate-based time-released medications available in Canada at this time: Biphentin and Concerta. The Dextroamphetamine-based medication available is Adderall XR: A once-a-day preparation seems to make more sense for adults who have problems remembering to take their medication, however some adults prefer the short-acting medication. If an adult feels they require medication only at those times that they are doing highly-focused desk work, they have the choice of taking a medication that stays in their system only three to four hours. There is now also a non-stimulant medication available in Canada. It is classified as a noradrenalin reuptake inhibitor. This medication's ingredient is Atomoxetine Hydrochloride and the trade name is Strattera. Strattera stays in the system longer and may therefore be beneficial for those adults who experience symptoms late into the evening. This medication may be your doctor's choice of treatment, if you experience problems with anxiety or a tic spectrum disorder. The first medication that you try may not always be the best one for you. Physicians should always start with a low dosage and increase the it gradually. It may therefore take some time to discover that the first medication tried does not work. Fortunately eighty percent of people respond to the first type of stimulant medication tried and of the twenty percent who do not, eighty percent of those respond the other type of stimulant medication. Side effects may also be an issue with one medication and not the other type of stimulant medication. This trial and error approach does not mean that your doctor does not know what he/she is doing. Individuals react differently to medication and unfortunately at this time we have no way of knowing which medication will work best for you without actually doing a drug trial. Doctors are now able to improve the main symptoms of ADHD in a very short period of time, however medication should never be the only treatment used. For detailed information on various medications for ADHD, dosages, costs and possible side effects, access; http://www.caddra.ca/english/pdfs/Medication_17.pdf For the management of simple medication-induced side effects such as sleep problems and a decrease in appetite, access: http://www.caddra.ca/english/pdfs/Medication_18.pdf |