Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental medical condition in which there are more than three million new cases in the United States every year. Patients diagnosed with ADHD range from as early as two years old to as late as eighty years old. Although this condition is not life threatening, an ongoing pattern of inattention or hyperactivity-impulsivity can interfere with functioning and development. In recent years, neuropsychological professionals have presented patients with two main options for treatment: stimulants (oral medication) in combination with therapy. 

The therapeutic approach allows patients to better understand and recognize the symptoms of their disorder. Furthermore, communication with others who have ADHD traits may help certain patients to cope with their symptoms. The most common forms of therapy are support groups, Cognitive Behavioral Therapy (CBT), and anger management. CBT is especially interesting because it is based on three core principles:

#1 – Psychological problems are based, in part, in unhelpful ways of thinking. 

#2- Psychological problems are based, in part, on learned patterns of bad behavior. 

#3 – People suffering with psychological problems can learn better ways to cope. 

Support groups and CBT, as reported by the Center for Disease Control (CDC), are some of the most effective ways to treat symptoms of ADHD through therapeutic intervention. CBT treatment centers around ways to change patients’ thinking patterns. Some of these strategies include gaining a better understanding of the motivations of others, using problem-solving to cope with difficult situations, and raising confidence in oneself and (his/hers/their) own abilities. Furthermore, psychological professionals administering CBT would encourage patients to face their fears instead of avoiding them, and would also role-play scenarios in which ADHD traits could manifest. One of the main benefits of CBT is a better understanding of oneself and their environment. 

But what happens if therapeutic interventions are not enough? 

Many patients (children and adults alike) turn to oral medication in order to help alleviate some of their symptoms. Medications prescribed to patients with ADHD are divided into two categories: short-acting medication and long-acting medication. The four most commonly prescribed short-acting medications in the United States are amphetamine, (Adderall) dextroamphetamine, (Dexedrine, ProCentra, Zenzedi) dexmethylphenidate, (Focalin) and methylphenidate (Ritalin). Dosage often depends on the height and weight of the patient, but many are frequently prescribed somewhere between 5 m/g and 40 m/g a day. A prescription of more than 40 m/g per day indicates the patient has prolonged symptoms of ADHD that severely impact the individual’s ability to carry out everyday functioning. A benefit of taking a short-acting stimulant medication is that the synaptic levels of monoamine dopamine, (DA) serotonin, (5-HT) and norepinephrine (NE) increase immediately. This results in alertness, attention and energy for the patient. It is also associated with less mood and eating side effects. Due to the fact that patients have to take multiple pills to achieve a stable level of focus and alertness, it is likely that the patient will be more stringent with the medication. They will also be less likely than long acting stimulant users to overuse or abuse the drug. In terms of eating, the reason why short-acting stimulants are preferred to long-acting stimulants is because the medication(s) usually wear off between four to six hours after ingestion. This means that patients’ talking a short-acting medication will be more likely to eat a full meal at lunch or dinner time than those taking long acting medication. Both groups of stimulants list appetite suppression as a well-documented side effect, but taking a long-acting stimulant results in prolonged appetite suppression for many patients. 

Now, there are also some benefits to long-acting medication. The most prescribed long-acting stimulants include amphetamine, (Adzenys XR, Dyanavel XR) dexmethylphenidate, (Focalin XR) and dextroamphetamine (Adderall XR). Again, dosage often depends on the height and weight of the patient, but many are frequently prescribed somewhere between 5 m/g and 40 m/g a day. It is quite interesting how patients are commonly prescribed between 5 m/g and 40 m/g regardless of whether or not they ingested a short-acting or long-acting stimulant. The benefits of long acting stimulants are that patients may only have to take one pill every morning and that they remain at stable levels of focus and alertness for roughly 12 to 14 hours. The major side effects of long-acting stimulants are that users have a greater risk of overdose – this is due to the fact that the medication does not reach peak effectiveness until 4 to 6 hours after ingestion. Furthermore, appetite suppression is more common in those taking long-acting stimulants. This may cause patients to inadvertently lose weight and may lead to greater health complications as a result of diminished caloric intake and weight loss. 

I believe that there is an argument to be made in support of both long-acting and short-acting oral medications for ADHD. More research is absolutely necessary in order to expand our knowledge about patient responses to each type of stimulant. I hope to see future studies further examine ADHD and possible treatment options. 

Sources: 

Cascade, E., Kalali, A. H., & Weisler, R. H. (2008). Short-acting versus long-acting medications for the treatment of ADHD. Psychiatry (Edgmont), 5(8), 24.

Punja, S., Zorzela, L., Hartling, L., Urichuk, L., & Vohra, S. (2013). Long-acting versus short-acting methylphenidate for paediatric ADHD: a systematic review and meta-analysis of comparative efficacy. BMJ open, 3(3), e002312.

López, Frank A., and Jacques R. Leroux. (2013). Long-acting stimulants for treatment of attention-deficit/hyperactivity disorder: a focus on extended challenges. ADHD Attention Deficit and Hyperactivity Disorders, 5(3), 249-265.

Swanson, James M. “Long-acting stimulants: development and dosing.” The Canadian Child and Adolescent Psychiatry Review 14, (Suppl 1), 4. 

Rains, A., & Scahill, L. (2004). New long-acting stimulants in children with ADHD. Journal of Child and Adolescent Psychiatric Nursing, 17(4), 177.