Medication

                          Now that someone has been diagnosed, and provided the symptoms of AD/HD are such that they are impacting adversely on the person (child or adult) then the following medical options are available.

The most common treatment is stimulant medication. Ritalin and Dexamphetamine are the most commonly prescribed medications in Australia. Both of these drugs have been the subjects of many clinical trials and research projects, with Ritalin being one of the most studied medications ever. They will not cause addiction as long as the person only takes the prescribed dose orally. Side effects will not be gone into here at this time, but a search using Google, will supply this information to you. Both Ritalin and Dexamphetamine make more of the neurotransmitter dopamine available. It is also thought that Ritalin may also affect the available levels of another neurotransmitter called Serotonin. While Dexamphetamine will also encourage the release of the neurotransmitter noradrenalin. Both of these drugs are effective in 80 – 90% of those with AD/HD-C. However they would only be effective in about 30% of those with AD/HD-I.

Some AD/HD people with co-morbid disorders are not able to take stimulants due to side effects. But these cases are rare. Dexamphetamine has an advantage over Ritalin. This is because some people who take Ritalin complain of a rebound effect, which occurs when their Ritalin dose wears off; this does not occur with Dexamphetamine. Stimulants can suppress appetite and cause sleep problems. Sometimes Catapres is used to help sleep. Both Ritalin and Dexamphetamine are available in Australia on the PSB.

Some say that Catapres also helps with the symptoms of AD/HD, however so far the research is divided. As Catapress is usually prescribed for high blood pressure, it may not be available for AD/HD on the PSB. It costs about $26:00 a month.

Other medications are tried for those who are not able to take stimulants. Such as Strattera which is a noradrenalin reuptake inhibitor, which means that there is more noradrenalin in the space between the nerves and thus there is more available to stimulate the next nerve. Strattera is not a stimulate medication. Strattera started off as an anti depressant, however, it was found to assist with the symptoms of AD/HD. Currently it appears that Strattera is not living up to the high hopes, in that it may not be as effective in relieving AD/HD symptoms as well as was first thought. Strattera is not subsidized and costs something like $150 a month.

Provigil is another non-stimulate drug what was first used to Narcolepsy (sleep night time and during the day). It was trialed for AD/HD as it was thought it might improve the components of Inattention. Several clinical trails have been carried out and it was found that just over 50% of the AD/HD subjects had a reduction in the three main symptoms of AD/HD. So it is looking like a promising alternative for those who cannot take stimulate medication. Unfortunately Provigil is not subsidized by the PSB unless the person suffers from Narcolepsy. It costs just under $180 in Australia.

BUSPAR (busiprone) is a medication, which is usually prescribed for anxiety. It can also be used with SSRIs (see following). Buspar is a serotonin receptor agonist, which means it assists serotonin to bind with the neuron it is stimulating. Mostly used for depression or anxiety.

Antidepressants are not normally used to treat a child or adult with AD/HD. However, they can be prescribed with other AD/HD medications if the child or the adult has depression. Antidepressants commonly affect the neurotransmitters of serotonin or noradrenalin.

SSRIs are Selective Serotonin Reuptake Inhibitors. They work by stopping the serotonin being taken back into the neuron, which sent it out in the first instance. Thus there is now more serotonin available to stimulate the next neuron. However, there have been some recent concerns regarding the safety of some antidepressants, such as Paxil or Zoloft and particularly for adolescents or children. Even so, they can and are often prescribed with the patient being monitored. These concerns do not mean that a person should not take an SSRI at all, but rather care should be taken. A person should not suddenly stop taking them, but rather wean off them, with their doctor monitoring the process.

As those with AD/HD-I do not respond to stimulants as well as those with AD/HD-C, and when they do respond, they can also take one of the SSRIs. These SSRIs help sub clinically with some of the symptoms of AD/HD-I, but also with any co-morbid Depression, which is often the case.

There are also Tricyclic antidepressants, however they are out of fashion and replaced mainly by SSRIs. Then there is the MAOs (monoamine oxidase inhibitors) however the MAOs are troublesome as certain other medications cannot be taken with them, and the person’s diet needs to be watched for certain foodstuffs, which can cause an adverse reaction. These drugs are not usually prescribed for AD/HD.

Education

                       Not all children with AD/HD be it the combined type or the inattentive type will have problems with their learning at school. However most will. The first thing that will become obvious is that the child is not progressing, as they should with their schooling; their reading is behind etc.

The AD/HD-I child and the AD/HD-C child have dissimilar causes of their learning difficulties. The level of problems that these children will have depends on their intelligence and just how severely their AD/HD has impacted upon them. It also depends on any co-morbid disorder they may have. Dyslexia can quite often go with AD/HD-C and this makes learning more difficult still.

The AD/HD-I child just does not take in all the information given to them, and because of their poor short-term memory they will need to have things repeated to them. Nor are they able to problem solve as well as they should, due to a poor working memory, and not necessarily retrieving the correct information from their long term memory. They try but it is not easy for them. Due to visual perceptional problems, which are more severe than that of the AD/HD-C child, their reading can be behind. If an AD/HD-I child is having problems with their schoolwork they will need remedial teaching and one to one teaching. This is necessary so the teacher can make sure the child keeps their mind on the work they are doing.

The AD/HD-C child can like their AD/HD-I cousin have co-morbid learning problems. They too will have problems with their working memory, with their attention. Their attention problems are because they are distracted by anything about them, and as they cannot self motivate, they will need some reward of some kind so that they can be motivated to do their work. Obviously as they are also hyperactive, it is difficult for them to sit still. And particularly so, when they have not learnt to inhibit the impulse to move.

To sum up do not expect miracles. To educate an AD/HD child, is not an easy matter. Much depends on the child’s particular learning problems (short term memory, working memory, and executive functioning), the severity of them, co-morbid learning disabilities e.g. dyslexia and the child’s general level of intelligence coupled with the level of co-operation from the child. Meaning if the child can be motivated. If by the time the child has completed primary school (age about 12) they have a good grasp on reading, writing and at the very least some spelling and some basic maths, then the child, the teachers and parents have not done too badly

 

Bebaviour Coaches

                                                   Generally it has been found that those with AD/HD do better with both medication and some form of therapy. This will apply for both adults and children. But do not expect miracles.

Therapy may be needed for the symptoms of AD/HD itself or for any co-morbid condition that may also exist. Problems with school, work or relationships can be helped with some therapy. However there is no guarantee that this will work. The therapist needs to be one, who is well versed in AD/HD.

The therapy sought may come from a person who calls themselves an Educator or Coach. These people will help the AD/HD person how to organize, how to make better decisions, to set realistic goals, they help the person to learn their weaknesses and their strengths. The Educator or Coach will recommend that the AD/HD person attend classes in areas where they think that the AD/HD person is lacking. Such a social classes, decision-making classes etc. They help the AD/HD person find their way at school or work.