Pharmaceutical medications are considered the first line of treatment for ADHD. Central nervous system stimulants are the first choice since they have the greatest effect with generally mild side effects. Excellent safety records are documented for short- and sustained-release preparations of methylphenidate (Ritalin, Ritalin-SR, Concerta, Metadate CD, Metadate ER), dextroamphetamine (Dexedrine, Dexedrine Spansule, Vyvanse), and dextroamphetamine and amphetamine salt combinations (Adderall, Adderall XR).

Newer preparations of methylphenidate include Methylin, a chewable form; Daytrana, a methylphenidate path; and dexmethylphenidate, the D-enantiomer (Focalin), and its longer acting from Focalin XR. These newer preparations aim to maximize effects and minimize adverse effects. Vyvanse, approved by the FDA for children 6 years and older, is less likely to have risks of abuse or overdose.

Stimulants are contraindicated in children, adolescents, and adults with known cardiac risks and abnormalities.

Nonstimulant medications approved by the FDA for the treatment of ADHD include atomoxetine (Strattera), a norepinephrine uptake inhibitor that requires monitoring for potential increases in suicidal thoughts or behaviors. A-agonist including clonidine (Catapres) and guanfacine (Tenex) have also been found effective in treating ADHD. Antidepressants, such as bupropion (Wellbutrin, Wellbutrin SR) have been used with mixed success in the treatment of ADHD.

Psychotherapy and Counseling

Children with ADHD often benefit from behavior therapy, psychotherapy, social skills training, and parent skills training and counseling. These types of therapy may be provided by a psychiatrist, psychologist, social worker or other mental health professional. Some children with ADHD may also have other conditions such as an anxiety disorder or depression. In these cases, counseling may help both ADHD and the coexisting problem.

Counseling for adult ADHD generally includes psychotherapy, education about the disorder and learning skills to help one be successful. Cognitive-behavioral therapy teaches specific skills to manage one’s behavior and change negative thinking patterns into positive ones. It can also help an individual deal with life challenges, such as school, work or relationship problems, and address other mental health conditions, such as depression or substance misuse.

Marital counseling and family therapy can help loved ones cope with the stress of living with someone who has ADHD and learn what they can do to provide support.