The Role of Medication and Other Approaches in the Treatment of AD/HD: What Speech-Language Pathologists Need to Know

Individuals with AD/HD often rely on medical treatments including medications, behavioral therapies, complementary alternative medicine (CAM), and other approaches to improve symptoms of AD/HD. Medication can be defined as any form of treatment taken to modify health.

Medication plays an integral part in the treatment plan for youngsters and adults with attentional issues. It is used to improve symptoms of AD/HD in order to allow the person to function more effectively. It does not cure the behavior, but allows the person to manage the behavior by alleviating the symptoms while the medication is active. Medication alone can provide significant symptomatic and academic improvement in the short-term. According to Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD; 2003), controlled studies involving more than 6,000 children, adolescents, and adults have been conducted to determine the effects of psychostimulant medications, one of the most researched medications. Although there are no studies on the long-term use of these drugs, many individuals have been taking medication for years without negative outcomes. We also are seeing a larger variety of active ingredients, new methods of delivery (e.g., chewable, patch, sprinkle), and a variety of duration of action. All should be administered with the consideration of effect size, tolerability, and safety in mind. Before any medication is administered, the individual should be screened for risk. This article will provide a description of the various medications and alternative treatments available to manage AD/HD.

Medication Versus Behavioral Therapy

A primary multi-modal treatment study of children with AD/HD (combined type) conducted by the National Institute of Mental Health (MTA Cooperative Group, 1999) found that for many children, the most effective way to mitigate AD/HD symptoms is through a combined approach (medication and behavioral treatment). The study followed 679 youngsters between the ages of 7 and 10 and compared the effects of four interventions: (1) children were administered medication only, (2) children were administered medication combined with behavioral therapy, (3) children received behavioral therapy only, and (4) no intervention was provided but standard community care was. Results indicated that the group receiving both medical and behavioral interventions fared better than medical and behavioral therapy alone or community care alone. Multimodal approaches proved to be effective in improving social skills for students from high-stress environments and for those children with a combined symptom of anxiety and depression.

In what is now considered a classic study, Arnold et al. (1997) found that for three groups of youngsters with AD/HD (medication only, medication with behavioral therapy, and behavioral only), the groups receiving both interventions fared better than the other two groups. The medication-only group fared better than behavioral-therapy only group, thus supporting the notion that medication is an effective form of intervention. The findings in the study apply to a wide range of children and families identified in need of treatment services.

A follow-up study (MTA Cooperative Group, 2004) conducted with 540 children with AD/HD (combined type) substantiated the original findings. Within the four treatment conditions, the general conclusions indicated that for children receiving medication and behavioral treatment there was a more positive outcome. However, intensive medication treatment was more likely to result in a normalized level of core AD/HD symptoms than either behavior or community care only. The combined treatment was associated with highest rate of "normalization."

For children and adults with AD/HD, a review of the literature indicates a clear pattern of symptom improvement with stimulants, with approximately 70 percent of patients responding to treatment. Once dosage is appropriately adjusted or titrated in adults, studies show similar patterns of improvement. AD/HD is presumed to stem from dysfunction of the catecholamine system, particularly dopamine and norepinephrine. Stimulants enhance the transmission of catecholamines, often blocking dopamine and norepinephrine reuptake transporters, with the net effect of increasing attention and decreasing impulsivity (CHADD, 2003).