ADHD: Treatments For Focus
Require More Than Medication
by Darline Turner Lee, Physician Assistant, ACSM Exercise Specialist
Article Last Reviewed: Sept. 9, 2006
In ADHD Part I published in the April edition,
we looked at the origins and current theories about the causes of Attention
Deficit Hyperactivity Disorder (ADHD). Part II addresses treatment of
ADHD in children and adults. Treatments consist of medication, psychotherapy,
behavior modification and combinations of the above.
The heated debate surrounding ADHD is over stimulant medications being
used for treatment. The medications are believed to stimulate areas of
the brain by increasing the levels and activity of neurotransmitters available
to transmit messages and the receptors available to receive them. Individuals
on medications are better able to focus, exhibit energy levels appropriate
for a given situation and to control impulse behavior.
Ritalin, a drug that had been used mostly to treat narcolepsy, was the
first medication prescribed for the treatment of Attention Deficit Disorder
(ADD), the term used before ADHD. Methylphenidate, the active compound
in Ritalin, is a central nervous system stimulant more potent than cocaine
and less potent (but resembling) compounds in the amphetamine family.
It has high potential for abuse and dependence. Violence, psychosis and
deaths have been reported as a result of Ritalin being taken by teens
and young adults wanting to experience “the high” or to stay
awake longer and work harder, e.g. during final exams. It’s been
reported that teens prescribed Ritalin can resell the tablets individually
for as much as five dollars a pill. It can be taken orally, crushed and
snorted or crushed and mixed with water and injected. The injected form
is particularly dangerous because insoluble fillers used to make the pills
can become lodged in small blood vessels causing serious organ damage.
Other medications have been developed that have the same effect on the
brain and neurotransmitters but reportedly have lower potential for abuse
and more tolerable side effects. Opponents still argue that these medications
are harmful to the children and adults taking them. For newer medications
like Strattera, which manufacturer Eli Lilly and Company claims “is
the first non-stimulant medication approved for the treatment of ADHD
in children, adolescents and adults,” the long-term effects aren’t
yet known. Individuals taking any of these medications need close monitoring
by their clinicians.
There is no one right treatment plan for ADHD. Clinicians,
psychologists and patients themselves (or their parents) repeatedly stressed
the fact that treatment is not just medication or psychotherapy or building
learning skills. A combination of treatments has to be employed. The National
Institutes of Mental Health reached this same conclusion in its ongoing
study titled The Multimodal Treatment Study of Children with
Attention Deficit Hyperactivity Disorder. The researchers
are following children with ADHD starting from ages seven to nine years
old through adolescence on various treatment regimens and are looking
at the effectiveness of the modalities alone and in combination. Results
published in December 1999 indicate that long-term combination therapy
is significantly superior to single treatments alone in reducing ADHD
symptoms.
“I utilize a combination of psychotherapy, parent training and,
when indicated, medications.” says Nancy Nussbaum, Ph.D of the Austin
Neurological Clinic.
“Structure is very important to people with ADHD. They need to
know clearly what the boundaries are so that they know what they should
and should not do. Children need to know that there are consequences for
their actions, both negative and positive, and the consequences need to
have immediate effect. Parents are educated on the importance of consistent
behavior and are encouraged to be consistent as a unit so children don’t
receive mixed messages.”
Anita Stoll, LCSW, an Austin psychotherapist and certified hatha yoga
instructor, utilizes yoga effectively with teenaged girls, including those
diagnosed with ADHD. Stoll, along with co-therapist Kelly Inselmann, facilitates
weekly therapy groups called Yoga and Talk. The program consists of a
half hour of yoga and one hour of group therapy. “The yoga helps
the girls focus and teaches them techniques to decrease anxiety.”
Stoll says. The girls develop improved self-esteem and confidence because
they are able to do something to help their symptoms. This reduces some
of the discouragement the teens face. The talk sessions provide an opportunity
for the girls to support one another and to share ideas and experiences.
Rich Goldstein is one of the owners of YogaYoga at the Westgate location.
He offers seminars and workshops for children with focus challenges.
“Kundalini yoga is a form that uses meditation along with movement.
This is a great combination for kids. The kids learn movements coupled
with rhythmic breathing and chants.” Although there is no scientific
data to support the benefits of yoga, the children enjoy the classes and
are able to transfer the techniques that they learn in yoga to other areas
of their lives requiring focus. Goldstein says, “It’s another
tool that can be used as needed.”
Redge and Susanne Westbrook have created a structured home environment
for their fourteen-year old son Bill who takes Strattera. In school, he
is allowed extra time for examinations, tutoring and study hall assistance.
Bill says that things are going much better.
“When I was younger, I wasn’t in a very good place. I was
really angry, acting out in school and fighting. My anger is better now.
The medication has helped. I have more friends and I am doing pretty well
in school.” According to Bill’s parents he’s been on
the honor roll for the past two semesters.
For adults with ADHD, the challenge is not only diagnosis but also setting
limits to create structure in their lives. “K” (who did not
want her name published) was diagnosed with ADHD after she had her son
tested. She uses Ritalin in addition to behavior modification skills.
Of medication she says,
“Medication makes you available to coping skills. It allows you
to put some systems in place to protect yourself from errors. Mistakes
are going to happen. Arrange your life so that the mistakes are benign
and not catastrophic.” “K” notes some times of the day
are better suited for her to do focused tasks. Mundane tasks not requiring
concentration are completed at other times.
“M” (who also granted an interview on condition of anonymity)
was having her children tested for ADHD. As she reviewed the criteria
she recognized the traits in herself and was tested. “I’m
a classic case”, she says. Her biggest problems are punctuality
and completing tasks. “I am a great one for beginning new projects.
I just rarely complete them.”
As a child and adolescent she was the life of the party. She was a cheerleader
and in many clubs and activities. She did well in school but passed purely
on memory.
“I don’t feel that I really learned much. Studying was so
hard because I could not focus. My mind was always racing like a hamster
on one of those rings, running and getting nowhere. Those tests that tell
you to read a passage and then answer questions based on what you read
were impossible for me to do. I tried college but studying was so difficult
for me that I gave up trying. I wish that treatment had been available
then. I think that I could have had more career opportunities now.”
“M” started medication two years ago but had to go off last
year because of other medical problems. “It was a disaster. I wasn’t
able to focus on anything. I started all these projects and didn’t
finish any of them.” Sadly, now that “M” is restarting
medication, her old regimen doesn’t work for her. She and her physician
are working diligently to find the combination that will work best for
her now.
“M” is also working really hard to put structure into her
life. “Disorder makes me crazy. I find myself just bouncing from
one thing to another. When there is order, I am able to function and things
make sense.”
A common characteristic among those with ADHD is an ability to focus
intensely on tasks that they enjoy. “K” says “When I
get going on something that interests me, I work tirelessly, effortlessly
and I’m fully focused. I’ll look up and hours have passed
and I have done some really incredible work in that time.” “M”
also finds that she is able to focus best when she is working with children,
her passion.
“I can work with children all day. I love my job.”
“K” sums up the experience of being an adult with ADHD this
way:
“The most important thing I’ve learned with ADHD is
an understanding of myself and an understanding of the world. The task
is to figure out how you fit and how to create alliances with those
with different strengths. The diagnosis of ADHD has been both humbling
and empowering. I recognize not only my gifts but also the gifts of
others around me. I’ve learned to be respectful and empathetic.”
ADHD is a complex disorder. There are many characteristics
that researchers and clinicians don’t understand. Ongoing research
may some day provide answers to these questions. In the meantime clinicians,
parents, educators and patients continue to develop ways to manage ADHD
symptoms.
Darline Turner-Lee is clearly informed and focused on ADHD. You may e-mail
her at mail@nextstepfitness.com
Resources for more information on ADHD
The National Institutes of Mental Health
www.nimh.nih.gov
Children and Adults with ADHD (CHADD), a national
non-profit support for individuals with ADHD
www.chadd.org
Byron Kocen, M.D.
www.beyondadd.com
or 512-918-9188
John Breeding, Ph.D
www.wildestcolts.com
or 512-799-3610
Austin Neurological Center
www.austinneuro.com/anc-about_clinic.htm
or 512-458-6121
Yoga and Talk
Contact Anita Stoll, LCSW, at 512-586-2121
Books
Taking Charge of ADHD: The Complete Authoritative Guide
for Parents
Russell Barkley
The Wildest Colts Make the Best Horses
John Breeding, Ph.D
True Nature and Great Misunderstandings
John Breeding, Ph.D
Attention Deficit Disorder: A Different Perception
Thom Hartmann
The Edison Gene: ADHD and the Gift of the Hunter Child
Thom Hartmann
The Indigo Child
Lee Carroll and Jan Tober
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