A recent detailed analysis of ADHD medication prescribing trends in Australia found that ADHD medication prescriptions doubled between 2013 and 2020. While this is clearly an important finding, it should be considered. in the context of overall prescribing rates, guideline recommendations and, most importantly, the prevalence of ADHD.
ADHD stands for Attention Deficit Hyperactivity Disorder. Approximately 5% of children and adolescents and 2.5% of adults worldwide suffer from ADHD. Although ADHD is a neurodevelopmental disorder that typically begins in childhood, symptoms and/or difficulties associated with the disorder continue into adolescence and adulthood.
In Australia and many countries outside of North America, ADHD is still underdiagnosed in children. This means that for many, ADHD will be first diagnosed in adulthood.
International ADHD guidelines list medication as the most effective approach to reducing the core symptoms of ADHD. But non-drug treatments can provide additional support to minimize the daily impact of ADHD symptoms.
So what is ADHD?
The main characteristics of ADHD are real and substantial difficulties in maintaining attention and concentration (especially for activities that are not of great interest), poor organizational skills, forgetfulness, impulsiveness (making decisions before thinking) and hyperactivity (restless, agitated, always on the go-ahead).
We all experience some of these symptoms from time to time, but for those with ADHD, these symptoms are felt at a high level most of the time and negatively impact daily life. ADHD is not new; reports of the condition we now call ADHD date back to the 1700s.
Why are ADHD drug prescriptions increasing in Australia?
Current ADHD guidelines recommend medication as first-line treatment for ADHD. It wouldn’t be surprising, then, to see prescription rates increase, as recognition improves and diagnosis rates more closely track actual ADHD rates.
Current data suggests that about 4% of children and adolescents are treated for ADHD, which is reasonable given a prevalence of about 5%.
For adults, however, the rates are much lower, around 0.4%. This means that fewer than one in five adults with ADHD are currently receiving ADHD medication. While this is an improvement from 2013 – when rates were below half – there is clearly some way to go.
What are the main medications for ADHD?
Several medications have been shown to be very effective in reducing the main symptoms of ADHD in children, adolescents and adults.
Medications that are stimulants such as methylphenidate, dexamfetamine, and lisdexamfetamine are now considered the first-line medications for ADHD. These drugs are thought to work by increasing the efficiency of several key brain circuits through their action on the neurotransmitters dopamine (the chemical in the brain that makes you feel good) and norepinephrine (the chemical that, when is released, increases alertness and attention). The effects of these drugs are rapid and can be seen almost immediately.
Two non-stimulant medications are approved for the treatment of ADHD, atomoxetine and guanfacine. Non-stimulants are less effective than stimulants and usually take several weeks to show clinical effect. For these reasons, they are generally reserved as a second-line treatment.
Medications for ADHD are not easy to obtain. They can only be prescribed to people who have been diagnosed with ADHD. For many people, this can be a long process due to a shortage of properly trained clinicians. Current guidelines require ADHD to be diagnosed by a medical professional who has experience in the area, such as a pediatrician, psychiatrist, or psychologist.
The ADHD diagnosis process should involve a detailed clinical history that explores when symptoms began and their impact on daily life. As part of the assessment of ADHD in children, information should be collected from parents and the school. For adults seeking a new diagnosis, evidence of onset of symptoms in childhood is required. This may involve the healthcare professional reviewing old school reports or speaking with parents of adults.
What other non-drug supports should be offered?
Supports will be different for children/adolescents and adults. Whatever the age, changes in the environment must be considered to best support the person. This may include making changes to the environment at school or at work for adults.
Sleep deprivation can exacerbate ADHD symptoms and so lifestyle changes can be considered to help reduce the impact of ADHD, such as getting a good night’s sleep and regular physical activity. Most people with ADHD also have one or more additional mental health problems (such as anxiety or depression). These additional challenges should be considered when planning treatment and supports.
For children with ADHD, the primary evidence-based non-drug support that can be offered is parenting support. It’s not because ADHD is caused by bad parenting; there is no evidence to suggest this. On the contrary, parents often need the option of support because raising a child with ADHD can sometimes be difficult.
Research shows that providing support to parents of children with ADHD is associated with more positive parenting behaviors and less strained parent-child relationships. For older teens and adults with ADHD, the main non-drug support that can be offered is cognitive behavioral therapies, which can help minimize the daily impact of ADHD.
ADHD treatment should be comprehensive and will usually include both drug and non-drug interventions. However, which treatment works best for which patient depends on the individual and how ADHD affects their life.
/ Courtesy of The Conversation. This material from the original organization/authors may be ad hoc in nature, edited for clarity, style and length. The views and opinions expressed are those of the authors.