Treatment Options for ADHD Patients and Their Effectiveness Literature Review
Attention deficit hyperactivity disorder, or ADHD, is a medical condition where a person has changes in their brain development which affects their ability to sit still, attention and lack of self-control. ADHD if diagnosed early on can lead to faster treatment plan which helps the patient manage the symptoms. However, there are many disagreements towards which treatment works the best for ADHD patients. The first treatment proposed is medication . By prescribing certain stimulants such as amphetamine (Adderall) or methylphenidate (Ritalin), it adjusts the chemistry in the patient’s brain to relief the patient of their symptoms. These stimulants do have side effects however and is further questioned by Claire Advokat and Mindy Scheitheauer in their research paper where they discuss the abuse and effectiveness behind stimulant drugs by both ADHD-diagnosed students and normal individuals. The next treatment proposed is cognitive behavioral therapy. Cognitive behavioral therapy (CBT) is a branch of psychotherapy where the negative thoughts of individuals are challenged and altered to change unwanted behavioral patterns. Authors William E. Pelham Jr, Trilby Wheeler, and Andrea Chronis discuss the benefits of CBT over the prescription of stimulants for ADHD patients. However, there is also an argument made where using both CBT and stimulants prescribed to ADHD patients will lead to the best treatment, which is discussed by Brynjar Emilsson, Gisli Gudjonsson, Jon F Sigurdsson, Emil Einarsson, Halldora Olafsdottir and Susan Young. In this paper, by comparing each research study, we will be able to find out if there exists other remedies that are more beneficial besides medication to help ADHD patients better combat their symptoms
ADHD Stimulant Medication
In the scientific journal “Attention-deficit hyperactivity disorder (ADHD) stimulant medications as cognitive enhancers” authors Clair and Mindy both realized the potential harm Adderall has to its user. They noticed an increase in, both adults and children, non-medical use and misuse of these stimulants, “5.9–7.1% in children and adolescents, and 5.0% in adults, represent 25% and 13.6% increases, respectively” (Advokat, Scheitheauer,2013), which raised concern whether the benefits outweighed the cons. In the end after assessing both clinical trials and more real-world examples, they saw that “5.9–7.1% in children and adolescents, and 5.0% in adults, represent 25% and 13.6% increases, respectively… Even in children, treatment discontinuation is high, with adherence typically ranging ‘from 36–84.8%’”(Advokat, Scheitheauer,2013), where the main reason for discontinuation was for the psychological side effects which included mood changes, irritability, depression, and personality changes. In that assessment, Advokat and Scheitheauer concluded that even though the stimulants were effective in reducing the symptoms, the ADHD patients discontinued using it. Clair and Mindy also noted that the majority of its use is found in non-prescribed students. By also assessing the different probable causes for stimulant abuse such as anxiety caused by academics or by peer pressure, Clair and Mindy also ran experiments concluded that using stimulants did not increase academic outputs, but rather decreased response types.
Similarly, in the research paper done by Brynjar, Gisli, Jon, Emil, Halldora, and Susan in “Cognitive behavior therapy in medication treated adults with ADHD and persistent Symptoms: A randomized controlled trial” where they also explored the benefits of stimulant medication. The group agrees that the stimulant medication is necessary for the treatment however they also believe that “treatments need to not only target symptom reduction, but aim to improve quality of life by addressing the multiple problems that impair daily social and emotional functioning” (Emilsson, Gudjonsson, Sigurdsson, Einarsson, Olafsdottir, Young, 2011). These problems can include creating a independence from medication, social dysfunction, and regulating emotions. In order to conclude whether adding cognitive behavioral therapy will help improve these symptoms, the group conducted an experiment where they will have some ADHD patients attend group interventions while they still remained on their medication and they will have some ADHD patients just attend group interventions without the medication to truly see if the psychological treatment is more effective above medication alone. In conclusion, Emilsson, Gudjonsson, Sigurdsson, Einarsson, Olafsdottir, Young,(2011) stated that,
“the participants in the CBT/MED [Group condition receiving CBT and medication] condition had significantly lower scores on the inattention scale of the BCS[Barkley ADHD current symptoms scale] than those in the TAU/MED[control condition receiving ‘treatment as usual’ and medication] condition at the end of treatment and at three month follow- with large effects sizes. The participants in the CBT/MED condition also scored lower on symptoms of hyperactivity/impulsivity on the BCS both at the end of treatment and at three month follow-up with small and medium effect sizes, respectively”,
where it further proves that cognitive behavioral therapy can be an effective psychological treatment in reducing ADHD symptoms. It is even more effective when combined with medication where the most improvements can be seen in the long term.
All three sources understand the benefits of prescribing stimulant medication. It provides short-term relief and is often the easiest treatment plan. However they also see the side effects of the medication and agree that there has to be more options available for ADHD patients. Although Clair and Mindy don’t provide an alternative to stimulant medication only just providing evidence of the unwanted side effects of common stimulant medication, Emilsson, Gudjonsson, Sigurdsson, Einarsson, Olafsdottir, Young, both proposed and supported the idea of having both psychotherapy and medication prescribed to ADHD patients. By doing so, the group concluded that the patients will be receiving the benefits from both treatment options while also reducing the side effects from stimulant medication. Each research study understands that medication is the fastest acting and the easiest solution to the problem although there is still research to be done with psychotherapy treatment which is discussed in the following paragraph.
Psychotherapy Treatment
The authors William, Trilby, and Andrea of the scientific journal “Empirically Supported Psychosocial Treatments for Attention Deficit Hyperactivity Disorder”, discuss the ramifications of prescribing stimulant medication and proved the alternative treatment of cognitive behavioral therapy. William, Trilby, and Andrea state,“Pharmacological treatments for ADHD are far more widely employed, are less expensive” (Pelham Jr., Wheeler, Chronis,1998), which is what leads it to be the more popular option. This is also why prescribing stimulant medication has more empirical data to support the treatment. By conducting literature reviews for empirical data of psychotherapy treatment, William, Trilby, and Andrea were able to conclude that “both behavioral parent training and behavioral classroom interventions meet criteria as empirically supported treatments for ADHD” which proves that CBT can be a viable treatment plan technically. However, they do conclude that CBT is not effective for all the ADHD patient symptoms such as “academic performance of children with ADHD” (Pelham Jr., Wheeler, Chronis,1998). However, they did conclude that cognitive interventions are effective for impulsivity (Pelham Jr., Wheeler, Chronis,2015). CBT can have longer lasting effects with less side effects which be a preferable treatment although it is still not as popular. It does take a while for these treatments to take effect which is why the short-term treatment of stimulant medication is preferred.(Pelham Jr., Wheeler, Chronis,1998).
The best treatment option for ADHD patients is to have a combination of both. Just like with the evidence provided in “Cognitive behavior therapy in medication treated adults with ADHD and persistent Symptoms: A randomized controlled trial”, having a treatment consisting both CBT and stimulant medication can be the best option for ADHD patients. According to Pelham Jr., Wheeler, Chronis (2015), “the acute effects of contingency management interventions, although large, are typically not as large as the acute effects of medication”, where there are reported improvement in managing symptoms by combing both types of treatment. Both sources agree that there is a need for people to do more research on the benefits of using psychotherapy however, all three sources still agree that with the current research present it is better for the ADHD patients to stick with the ADHD medication. Unless there is an advancement in psychotherapy techniques, all three sources agree that medication is the most popular solution to date.
Conclusion
The common similarity between all three sources is the lack of absolute certainty on the best treatment for ADHD patients. It is however agreed that constantly prescribing stimulant medication is effective for the short-term it will not be as effective and can be harmful in the long-term. Although stimulant medication can bring instant relief to an ADHD patient’s symptoms, it is agreed by all three sources that these medications are not the best solution. Whether it be the lack of motivation to continue with the medication plan or the physiological side effects, prescribing stimulant medication cannot be the only treatment plan. It is agreed that there must be better treatment plans that will limit the side effects and be great for the long term. This is whereby combining both CBT and medication as a treatment plan it is the most effective and a first step in moving away from a strictly stimulant medication treatment. By also including psychotherapy, ADHD patients will be better able to control their mental health and combat the side effects from the stimulant medication and will often times feel better with just the psychotherapy itself. Although we are far from a cure, there are still steps being made in trying to reduce the symptoms of ADHD patients so they can live a normal life.
References
Advokat, Claire, and Mindy Scheithauer. “Attention-Deficit Hyperactivity Disorder (ADHD) Stimulant Medications as Cognitive Enhancers.” Frontiers in Neuroscience, vol. 7, 2013, doi:10.3389/fnins.2013.00082.
Emilsson, Brynjar, et al. “Cognitive Behaviour Therapy in Medication-Treated Adults with ADHD and Persistent Symptoms: A Randomized Controlled Trial.” BMC Psychiatry, vol. 11, no. 1, 2011, doi:10.1186/1471-244x-11-116.
Jr, William E. Pelham, et al. “Empirically Supported Psychosocial Treatments for Attention Deficit Hyperactivity Disorder.” Journal of Clinical Child Psychology, vol. 27, no. 2, 1998, pp. 190–205., doi:10.1207/s15374424jccp2702_6.
