Attention Deficit Hyperactivity Disorder (ADHD)

Treatments

Cognitive-Behavioral Group

Treatment Summary: In the study referenced below: A Cognitive Behavioral Group and the participants were studied. The group was developed to help reduces fears and panic attacks in their participants. In a cognitive behavior group of clients that were suffering from severe panic attacks and agoraphobia. They studied clients on a waiting list that had not entered in a controlled cognitive behavior group. The groups consisted of six patients, they also received physiotherapy, and they received treated by ergo therapists. The treatment implemented was psych education, cognitive restructuring, homework, bodily exercise, breathing control and exposure to agoraphobic situation. Cognitive Behavior groups help clients suffering from panic disorder and agoraphobia and learn skills to help minimize the symptoms associated with their disorders.

• Reference: Rosenburg , NK,Hougarrd E. (2005) Cognitive- Behavioral group treatment of panic disorder and Agoraphobia in a psychiatric setting: a naturalistic Study of effectiveness Nord J Psychiatry 2005; 59:198-204. Oslo ISSN 083-9488.
• Submitter: N/A

Non-stimulant medication

Treatment Summary: An example of a non- stimulant is Atomoxetine (Straterra). Atomoxetine greatly inhibits noradrenergic transporters. Non- stimulant medications are often used on adult prison inmates because there is a good chance the inmates will buy or sell the fast acting psycho stimulants to other inmates. The incarcerated environment allows psychiatrists to use the non stimulant medications because non-stimulant medications like atomoxetine may take weeks to show changes in behavior.

• Reference: Allen, A., Casat, C., Ruff, D., Moore, R., & Michelson, D. (2008). Atomoxetine and osmically released methylphenidate for the treatment of attention deficit hyperactivity disorder: Acute comparison and differential Response. The American Journal of Psychiatry, 165(6), 721-30. Retrieved October 1, 2009, from Proquest Psychology Journals. doi: 1492997861 Antai-Otong, D. (2008). The art of prescribing: Pharmacological management of adult ADHD: Implications for psychiatric Care . Perspectives in Psychiatric Care, 44(3), 196-201. Retrieved October 1, 2009, from Proquest Psychology Journals. doi: 1521910031
• Submitter: N/A

Non-medication treatment

Treatment Summary: Cognitive behavioral programs to help students with ADHD practice behaviors that help them interact socially, think positively, and perform better in school. These three behaviors combined have helped students with ADHD to improve academically and socially. The counselor place emphasis on correcting negative thoughts the students have about themselves. During sessions with the school counselor, students are encouraged to discover their positive attributes and to focus more on what they are good at instead of how they have failed. These techniques allow the student to feel confident and become motivated to interact with peers.

• Reference: Schultz, B., Evans, S., & Serpel, Z. (2009). Preventing failure among middle school students with attention deficit disorder: A survival analysis. School Psychology Review, 38(1), 14-27. Retrieved October 1, 2009, from Proquest Psychology Journals. doi:1670259861 Shillingford, M., Lambie, G., & Walter, S. (2007). An integrative, cognitive-behavioral, systematic approach to working with students with attention deficit hyperactive disorder. Professional School Counseling, 11(2), 105-112. Retrieved October 1, 2009, from Proquest Psychology Journals. doi:1397136661
• Submitter: N/A

Approaches with Co-morbidity

Treatment Summary: When a child has ADHD depression co-morbidity, desipramine or tricyclic antidepressants help to reduce the adverse symptoms of ADHD. The tricyclic antidepressants are not used as much because they present problems to the heart and blood vessels

• Reference: Appelbaum, K. (2008). Assessment and treatment of correctional inmates with ADHD. The American Journal of Psychiatry,165(12), 1520-4. Retrieved October 1, 2009, from Proquest Psychology Journals. doi:1607951691 Daviss, W. (2008). A review of co-morbid depression in pediatric ADHD: Etiology, phenomenology, and treatment. Journal of Child and Adolescent Psychopharmacology, 18(6), 565-71. Retrieved October 1, 2009, from Proquest Psychology Journals. doi:1619163641
• Submitter: N/A

Behavioral-Psychosocial

Treatment Summary: The first step is educating the parents and child about the disorder, the resources available to them and treatment options. Behavior modification has proven to be successful in treating this disorder. Teachers and parents can work together to set clear goals and expectations, rewards and consequences for the child’s academic performance and social behavior.

• Reference: Root, R., & Resnick, R. (2003). An update on the diagnosis and treatment of attention deficit/hyperactivity disorder in children. Professional Psychology: Research and Practice; 34 (1), 34-41.
• Submitter: N/A

Cognitive Behavioral Therapy (CBT)

Treatment Summary: CBT was administered individually to adults diagnosed with ADHD over nine sessions. CBT was administered to all participants; half received ADHD medication and the other half received a placebo. The first sessions focused on psychoeducation of ADHD and relating ADHD symptoms to their life. The following sessions focused on implementation of skills learned from modules completed by the patient. CBT was used to change cognitive distortions (e.g. selective attention, overgeneralization, etc.). The study found that all patients showed significant improvements with no differences between the groups. Short-term CBT had the same lasting effects as the medication and is a useful treatment for adults with ADHD.

• Reference: Weiss, M., Murray, C., Wasdell, M., Greenfield, B., Giles, L., & Hechtman, L. (2012). A randomized controlled trial of CBT therapy for adults with ADHD with and without medication. BMC Psychiatry, 12doi:10.1186/1471-244X-12-30
• Submitter: N/A

Clinical Behavioral Therapy (C1BT)

Treatment Summary: Parents of children with ADHD attend parent training programs over a series of 8 to 16 weekly sessions. Parents are taught standard behavioral techniques such as time out, giving effective commands and reprimands, and home point system-reward and response cost. Parents are often trained in groups, but some programs are individual sessions. Homework assignments are given to parents to track behaviors and practice techniques with their children and the parents are to bring results to the subsequent sessions for discussions. The C1BT therapists often work simultaneously with teachers in a consultation model to teach the same techniques that are taught to the parents. C1BT therapists often teach the teachers to do daily report cards (DRGs). The teacher monitors and gives feedback to parents on their child’s school performance, which if feedback is good, the parents rewards the child at home. With the parents and teachers reports of the child (ren), a combination therapy of psycho medication and behavioral therapy can be assessed and modified individually for the child.

• Reference: Pelham, W.E., & Gnagy, M.E. (1999). Psychosocial and combined treatments for ADHD. Mental Retardation and Development Disabilities, (5), 225-236.
• Submitter: N/A

Atomoxetine

Treatment Summary: Participants in the study were administered Atomoxetine as a single dose in the morning during the 6 week study. For the first 4 days, participants were given 0.8 mg a day. On the 5th day, dosage was increased to 1.2 mg a day for the remainder of the study. The investigator conducted assessments on the 3rd and 5th visit to determine the participant’s tolerance to medication. If the participant could not tolerate the increased dosage, then it was decreased to the minimum dosage. On the 5th visit, another assessment was conducted and the dosage was increased up to 1.8mg. If a participant could not tolerate minimum dosage, then the drug was discontinued. Results: Atomoxetine participants showed significant improvements in the baseline changes on the hyperactive/impulsive and inattentive subscales on the ADHDRS-IV (p=02 and 0.030)

• Reference: Zavadenko, N., Jarkova, N., Yarosh, A., Soldatenkova, V., Bardenstein, L., kozlova, I., Zykov, V. (2010). Atomoxetine in children and adolescents with attention-deficit/hyperactivity disorder: a 6-week, randomized, placebo-controlled, double-blind trial in Russia. European Child Adolescent Psychiatry, 19:57-66.
• Submitter: Uquay Robinson

Monoamine amino acid precursors and Organic Cation Transporter (OCT) assay interpretation

Summary of Treatment: In the study referenced below, patients with attention deficit hyperactivity disorder (ADHD) are given a precursors of amino acids along with a urinary monoamine assays to help relief symptoms of the disorder.

Patients between the ages of 4-18 were given amino acids of serotonin, a hormone, and dopamine; also a hormone followed with a urinary monoamine assay, screening test. As patients are given the precursor, a functional status test is completed, the organic cation transporter (OCT) was used.  Patients were given additional test to measure the amount of serotonin and dopamine in each patient and track the hormones effects to the liver, heart and intestines while also recording the relief of symptoms using the precursors.

The study noted 67% of the patients improved using only amino acid precursors and those that did not find relief of symptoms using the amino acid precursors only were also given the OCT assay interpretation.  Overall 77% of patients showed improved results from using this treatment method.

• Reference:  M. Hinz, A. Stein, R. Neff (2011) Treatment of attention deficit hyperactivity disorder with monoamine amino acid precursors and organic cation transporter assay interpretation.  Neuropsychiatric Disease and Treatment Journal, 7(1), pages 31-38.
• Submitted by: Esperanza Traino

Methylphenidate

Summary of Treatment: In the study referenced below, various pharmacological treatments were studied to examine their effectiveness toward Attention-Deficit Hyperactivity Disorder (ADHD). The most popular of these medications is methylphenidate (MPH).

MPH is usually the first option when prescribing medication to treat ADHD and has been a mainstay in treating the disorder for decades. Although other drug treatments have been developed and prescribed to treat ADHD over the years, MPH is widely considered to be the most effective. The time it takes for the medication to reach maximum effect is usually 1-2 hours. Effects from MPH typically last for approximately 4 hours after the dose. Recently, multiple extended-release formulations have been developed to increase effect time in MPH to 6-8 hours. A daily regimen of MPH consists of 2-3 doses of a normal preparation or 1-2 doses if the prescription is of the extended-release variety.

The most common side effects of MPH can include: dysphoria, insomnia, headaches, dizziness, tics, and abdominal pain. Other side effects, such as rash, fever, and dyskinesia, have been reported but are not as frequent. The more frequent side effects generally subside after several days. Also, clients who are prescribed MPH should be monitored on a frequent basis (once a month). Full blood counts are also recommended.

• Reference: Dowson, J.H. (2006). Pharmacological treatments for attention-deficit/hyperactivity disorder (ADHD) in adults. Current Psychiatry Reviews, 2(3), 317-331. doi:10.2174/157340006778018157
• Submitted by: Thomas Twomey