Can ADHD be managed successfully into adulthood?
ADHD, or Attention Deficit Hyperactivity Disorder, is one of the most common neurobehavioral disorder of childhood.[1] It's estimated that between 3-8% of school aged children are affected, with boys 4x more likely to receive the diagnosis than their female counterparts.[2] This article will explore some of the symptoms and treatment options for ADHD.
What are the symptoms of ADHD?
ADHD is a chronic disorder that affects the lives of children and adults. Some symptoms can include having trouble staying on task or finishing any one task, difficulty controlling impulses, impatience and difficulty waiting their turn in games. It can also involve a child's being overly emotional, excessive talking without interrupting others, leaving his or her seat at inappropriate times and forgetting items that have been put down.
It's not just about being hyperactive or inattentive, though those are common symptoms. This is why ADHD screening encompasses many different characteristics including emotional instability, impulsiveness, forgetfulness, and more. These symptoms can lead to a number of difficulties with day-to-day life such as school, work, and relationships.
How to know if your child has ADHD?
ADHD is one of the most common chronic diagnosis for children, but there are still doubts about how to manage ADHD successfully in adulthood.
A prevalent myth a lot of people assume is that everyone with ADHD outgrows it eventually, which isn't true.[3] Some people end up managing their condition on their own as they grow older, and others need lifelong treatment.
There are some key things to look for if you're not sure whether or not your child still has ADHD as they grow older. For one, if your child is still experiencing problems with focus, hyperactivity, and impulsivity, then it's likely that they still have ADHD. Additionally, if your child is struggling in school or with relationships, that's another sign that they may need help managing their ADHD.
If you're not sure whether or not your child needs help, it's best to consult with your primary care provider. They can do an evaluation and determine the best course of action. They will most likely utilize various behavioural questionnaires like the SDQ, the CHADD or the CADDRA.[4] With the right management, however, most people with ADHD can lead healthy lives.
What are the treatment options for ADHD?
There is no one-size-fits-all answer to managing ADHD. What works for one person may not work for another. But there are a number of strategies that can be used to help manage the disorder. Some common treatments include medication, therapy, and lifestyle changes to manage the condition into adulthood.
Medication is often the first line of treatment for ADHD.[5,6,7] There are a number of different medications that can be prescribed, depending on the symptoms. Stimulants like methylphenidate are the most common type of medication used to treat ADHD. They work by increasing dopamine and noradrenaline levels in the brain, which helps to improve focus and attention. Some common stimulants include Ritalin, Adderall, and Concerta and serious adverse side effects could include zombie-like behaviour, hallucinations and glassy eyes.[8]
A major risk of stimulant medications is also addiction. If a person takes a stimulant for ADHD every day for weeks or months, the body will begin to require the drug just to function. Stopping abruptly can result in severe withdrawal symptoms from both physical and psychological dependencies on the medication; these symptoms may include blinding headaches and insomnia.
Another risk is that the medications may be abused. People without ADHD may turn to stimulants as a way to cope with stress or increase their energy levels. This can lead to serious health problems, including heart attacks and strokes.[8] Ritalin has commonly been screened for misuse in academic settings like college and university. The Canadian Agency for Drugs and Technologies in Health noted in their 2013 Rapid Response Report that many stimulant prescriptions were being directed to those without a prescription.[9]
It is also important to note that stimulants are not a cure for ADHD, nor are the other agents like dextroamphetamine or atomoxetine. They only help to manage the symptoms. Without other non-pharmacological interventions, such as therapy and lifestyle changes, the symptoms of ADHD are more likely to persist.[10,11]
What are some additional changes that can help manage ADHD?
The American Academy of Paediatrics updated their guidelines for the management of ADHD in 2019 and identified that first line therapy in preschoolers (4-5 years) is parent training in behaviour management (PTBM). This is also an intervention encouraged into elementary aged children.[12] Therapy is a well-established and common treatment for ADHD, not only for the children, but the family as a whole. Therapy can help to address the underlying causes of the disorder and help to improve coping skills.
Lifestyle changes can also be helpful in managing ADHD. Some changes that may be helpful include getting more exercise, establishing a routine, and avoiding distractions. In one study, 20-minute bouts of aerobic exercise improved neurocognitive measures like the accuracy of their responses and improved how long they could sit and read.[13]
Let's talk some of the other non-pharmacologic interventions you might consider.
There are a number of different naturopathic approaches to ADHD that can be helpful in managing the disorder. Some of these approaches include dietary changes, supplements, and herbs. It is crucial for any care provider to open these discussions as 50 to 64% of parents to children with ADHD use integrative interventions to support their child.[14]
Dietary changes can be helpful in managing ADHD. Some changes that may be helpful include increasing protein and omega-3 fatty acids (via fish), and reducing sugar and artificial additives. A systematic review found that those who were given omega-3 supplements showed improvement in symptoms of ADHD.[15] A more recent systematic review noted children taking omega-3 fatty acids were able to lower their dose of conventional medications and helped improve compliance across interventions.[16]
Supplements can also be helpful in managing ADHD. Some of the most common supplements include omega-3 fatty acids (as discussed), vitamin D, magnesium, and zinc. Perinatal vitamin D levels were also predictive of the risk of the child developing ADHD later in life[17], and when supplemented, there were improvements in cognitive function and behaviour.[18] Smaller studies on magnesium showed healthy levels in the body can help decrease some symptoms of ADHD.[19] Finally, zincs action as a dopamine reuptake inhibitor in a manner similar to methylphenidate offers reason why it may benefit children with ADHD. Researchers showed improvements after 12 weeks of zinc supplementation[20] while another showed improvements 14-months post-intervention in those taking an iron-zinc combination.[21]
Herbs can also be helpful in managing ADHD when combined with other dietary and psychosocial interventions. Some of the most common herbs include ginkgo biloba, gotu kola, and brahmi (Bacopa monnieri). Standardized extracts and tinctures of these herbs have shown benefits in brain function, memory, impulse control and social function.[22]
It is important to note that ADHD can be managed into adulthood. There are a number of non-pharmacological interventions you may consider like therapy, lifestyle changes, and supplements. It's also worth discussing dietary changes as well because these too have been shown to help manage symptoms of the disorder. Whether it’s an integrative approach or psychosocial therapy, working with a diligent care team is crucial to get the best possible outcome for your child.
Share what has helped your child in their journey with ADHD!
References
Wilens, Timothy E., and Thomas J. Spencer. "Understanding attention-deficit/hyperactivity disorder from childhood to adulthood." Postgraduate medicine 122.5 (2010): 97-109.
Ramtekkar, Ujjwal P., et al. "Sex and age differences in attention-deficit/hyperactivity disorder symptoms and diagnoses: implications for DSM-V and ICD-11." Journal of the American Academy of Child & Adolescent Psychiatry 49.3 (2010): 217-228.
Barkley, Russell A. "ADHD Awareness Month–October 2021."
Emser, Theresa S., et al. "Assessing ADHD symptoms in children and adults: evaluating the role of objective measures." Behavioral and Brain Functions 14.1 (2018): 1-14.
Felt, Barbara T., et al. "Diagnosis and management of ADHD in children." American Family Physician 90.7 (2014): 456-464.
Cortese, Samuele, et al. "Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis." The Lancet Psychiatry 5.9 (2018): 727-738.
Iacobucci, Gareth. "ADHD: methylphenidate should be first line drug treatment in children, review confirms." (2018).
Morton, W. Alexander, and Gwendolyn G. Stockton. "Methylphenidate abuse and psychiatric side effects." Primary care companion to the Journal of clinical psychiatry 2.5 (2000): 159.
“Abuse and Misuse Potential of Drugs for Attention Deficit/Hyperactivity Disorder: A Review of the Clinical Evidence.” The Canadian Agency for Drugs and Technologies in Health, CADTH Rapid Response Service, 22 Aug. 2013, https://www.cadth.ca/sites/default/files/pdf/htis/aug-2013/RC472%20Abuse%20and%20misuse%20potential%20of%20drugs%20for%2n.d.HD%20final.pdf.
Drechsler, Renate, et al. "ADHD: Current concepts and treatments in children and adolescents." Neuropediatrics 51.05 (2020): 315-335.
Shrestha, Mahesh, Julianna Lautenschleger, and Neelkamal Soares. "Non-pharmacologic management of attention-deficit/hyperactivity disorder in children and adolescents: a review." Translational pediatrics 9.Suppl 1 (2020): S114.
Wolraich, Mark L., et al. "Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents." Pediatrics 144.4 (2019).
Pontifex, Matthew B., et al. "Exercise improves behavioral, neurocognitive, and scholastic performance in children with attention-deficit/hyperactivity disorder." The Journal of pediatrics 162.3 (2013): 543-551.
Gupte-Singh, Komal, Rakesh R. Singh, and Kenneth A. Lawson. "Economic burden of attention-deficit/hyperactivity disorder among pediatric patients in the United States." Value in Health 20.4 (2017): 602-609.
Sonuga-Barke, Edmund JS, et al. "Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments." American Journal of Psychiatry 170.3 (2013): 275-289.
Derbyshire, E. "Do omega-3/6 fatty acids have a therapeutic role in children and young people with ADHD?." Journal of lipids 2017 (2017).
Goksugur, Sevil Bilir, et al. "Vitamin D status in children with attention‐deficit–hyperactivity disorder." Pediatrics International 56.4 (2014): 515-519.
Vitamin, D. "the omega-3 fatty acids control serotonin synthesis and action, part 2: Relevance for ADHD, bipolar disorder, schizophrenia, and impulsive behavior; RP Patrick, BN Ames." FASEB Journal (2015): 2207-2222.
El Baza, Farida, et al. "Magnesium supplementation in children with attention deficit hyperactivity disorder." Egyptian Journal of Medical Human Genetics 17.1 (2016): 63-70.
Granero, Roser, et al. "The Role of Iron and Zinc in the Treatment of ADHD among Children and Adolescents: A Systematic Review of Randomized Clinical Trials." Nutrients 13.11 (2021): 4059.
Vazir, Shahnaz, et al. "Effect of micronutrient supplement on health and nutritional status of schoolchildren: mental function." Nutrition 22.1 (2006): S26-S32.
Sarris, Jerome, et al. "Complementary medicines (herbal and nutritional products) in the treatment of Attention Deficit Hyperactivity Disorder (ADHD): a systematic review of the evidence." Complementary therapies in medicine 19.4 (2011): 216-227.