Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that causes a host of symptoms, including a lack of focus and the inability to sit still. It’s often diagnosed at an early age and associated with childhood, but ADHD usually follows children into adulthood. However, ADHD may present differently in adults than it does in children. Adults with ADHD may also go through other treatment options than what is typically available to children. But what medications are used to treat adults with ADHD, and what is the best medication option?
Learn more about ADHD medications and how they work to treat adults that have problems with inattention and hyperactivity.
Do Adults Get ADHD?
It was once believed that only children could be diagnosed with ADHD and that they would one day grow out of it. Many of the symptoms of ADHD are associated with child-like behavior, including the inability to sit still. However, it’s now known that children don’t grow out of ADHD symptoms, but adults may experience their symptoms differently. Because ADHD is a neurodevelopmental disorder, the symptoms begin early in life.
However, it’s possible to be undiagnosed or misdiagnosed during childhood. In some cases, adults are diagnosed with ADHD later in life when their symptoms become difficult to manage. Women and girls are particularly underdiagnosed because they are less likely to experience hyperactive symptoms, which are easier to spot.
How Are Adults Diagnosed with ADHD?
Children are typically diagnosed with ADHD between the ages of 3 and 12. ADHD can’t be diagnosed before age 3, but it’s more likely to be noticed when a child reaches school age. A child that has ADHD will continue to have symptoms into adulthood, even if symptoms change or develop over time. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, adolescents and adults need to have experienced symptoms before age 12; other side symptoms may be better explained by another issue.
To be diagnosed with ADHD, children under 17 have to have experienced at least six ADHD symptoms, but adults only have to have experienced five symptoms. Symptoms must be persistent and occur in at least two settings, including home, work, or school. They also have to interfere with functioning in these different settings.
How Do Adults and Children Experience ADHD Differently?
Children with ADHD are often first diagnosed when their symptoms begin to interfere with their performance at school. Children may be less likely to resist impulses to run, climb, talk out of turn, and cause disruptions. Adults with ADHD may learn to cope with certain symptoms over time with experience, but they may still struggle with the same symptoms in different ways.
For instance, a child may feel hyperactive impulses that lead them to climb on things they aren’t supposed to. An adult may not have the impulse to climb on a statue at the museum, but they may still feel that hyperactive impulse. Instead, they may be fidgety, they may have trouble staying seated for long periods, or they may feel the need to get up and pace. College lectures, long work meetings, or events may be a challenge to sit through.
Adults with ADHD are likely to be anxious, and they may have co-occurring anxiety disorders. When ADHD makes everyday activities and tasks more difficult to manage, it could lead to the feeling of being overwhelmed and depressed.
There are two major categories of ADHD symptoms: inattentive type and hyperactive type. Inattentive symptoms include distractibility, lack of attention to detail, poor listening skills, and poor time management. Children may experience these symptoms in school, which can cause them to fall behind their peers. Adults have more responsibilities. Inattentive symptoms may affect them at work, but they could also affect them in their relationships, home responsibilities, and other areas of life.
What Medications Are Used To Treat ADHD?
Central nervous symptoms stimulants make up the largest and most common category of ADHD medications. They are usually first-line options for treating ADHD, which means they may be the first drugs your doctor recommends. Stimulants work to increase activity in the central nervous system, which can have some positive effects on many ADHD symptoms. Stimulants are potent drugs, and some may not be appropriate for use in small children. However, adults are able to take stimulants with fewer significant side effects.
- Amphetamines. Amphetamines are common in ADHD drugs. Adderall is a mix of amphetamine salts that are generally well-tolerated. Amphetamines increase dopamine levels in the brain, but they can also affect serotonin and norepinephrine for more positive effects. They can be misused and abused as a recreational or performance-enhancing drug.
- Methylphenidate. Methylphenidate is another stimulant that’s sold under the brand names Ritalin and Concerta. It has many similarities with amphetamines, including its effect on dopamine levels in the brain. But like amphetamines, it may be used as a performance-enhancing or recreational drug.
- Dexmethylphenidate. Dexmethylphenidate is another prescription stimulant that’s used to treat ADHD. It’s sold under the brand name Ritalin. It’s sold under the brand name Focalin. Like other stimulants, it’s used to increase nervous system activity and dopamine levels in the brain.
- Lisdexamfetamine dimesylate. Lisdexamfetamine is a prescription drug that’s sold under the name Vyvanse. The drug is a prodrug that is converted into dextroamphetamine in the body. Dextroamphetamine is an amphetamine and one of the amphetamine salts in Adderall.
Stimulants can come with some side effects that some people will want to avoid. They may cause insomnia, anxiety, and other symptoms related to overstimulation. Some people may feel nauseous or generally uncomfortable taking them. Stimulants may also increase your blood pressure and heart rate, which may not be ideal for people with hypertension. You may also build up a tolerance to stimulants and need to switch to a different mediation.
In general, non-stimulant medications are less useful in treating ADHD, which is why they aren’t considered first-line options. However, they may be useful for people who can’t or would prefer not to take stimulants. Some non-stimulant drugs may be used alongside stimulant medications, though mixing drugs should only be done with medical advice.
Here are some common non-stimulant ADHD medications:
- Atomoxetine hydrochloride. Atomoxetine is sold under the brand name Strattera, which works by increasing the levels of norepinephrine in the brain. It may be used if stimulants aren’t a viable option. It also has a lower risk of abuse than stimulants.
- Clonidine. Clonidine is cold under the brand name Catapres, and it’s used to treat ADHD and high blood pressure. Because of its use as a blood pressure medication, it may be useful in people with high blood pressure that can’t take stimulants. But it should not be taken with other high blood pressure medications without consulting your doctor.
- Guanfacine. Guanfacine is sold under the brand name Tenex.
How Do Stimulant Medications Treat ADHD?
Treating ADHD with stimulants may seem counterproductive. Why would you want to take a stimulant if you can sit still? Won’t that make the problem worse? The reason stimulants work to treat ADHD has to do with the way ADHD works in the brain. ADHD is thought to be caused by a lack of dopamine in the brain.
Dopamine is responsible for pleasure and reward responses. To be interested in carrying out everyday tasks, you’ll need dopamine in your brain to create a sense of reward. Dopamine is released in larger amounts when you do things you enjoy, like eating a satisfying meal, but ambient levels of dopamine are present while you’re doing normal tasks throughout the day.
If dopamine levels are too low, you may become bored. Someone with ADHD may have a hard time resisting distractions that may offer a greater dopamine reaction. For instance, when you’re studying for an exam, someone talking in the hall may draw your attention as a potential source of dopamine.
Stimulant medications work to elevate dopamine levels in your brain. Most stimulant ADHD medications block dopamine reuptake, which is a natural process in which dopamine is removed to avoid a buildup. Blocking reuptake intentionally causes a buildup which can increase focus, energy levels, and wakefulness. Stimulants can also increase the levels of other chemicals in the brain, including norepinephrine, a chemical that controls things like blood pressure and heart rate. Increasing your blood pressure and heart rate can contribute to wakefulness and alertness.
How Do Non-Stimulants Work to Treat ADHD?
Non-stimulants cover a broad category that includes drugs that work in various ways. A non-stimulant ADHD drug is any drug that does not increase dopamine levels as its primary mechanism of action. Atomoxetine hydrochloride doesn’t increase dopamine levels, but it does have a similar effect on norepinephrine that psychostimulants do. Guanfacine works by activating a specific adrenoreceptor that enhances attention and behavior regulation in the prefrontal cortex. Clonidine works in a similar way.