ADHD Resource Hub

ADHD Treatment

ADHD 101

The 3 pillars of treatment

First, ‘treatment’ for ADHD is not about trying to fix something that’s broken. It’s about finally finding the operating manual to the complex entity that is yours, or your loved one’s brain. When it comes to identifying a ‘reason to treat‘, we also know research has identified that untreated ADHD reduces life expectancy, and treatment improves all-cause mortality

We want to address our own blind spots, reduce risks and unleash the potential (rather than spend all of that cognitive energy ‘coping’. 

That’s an important perspective shift, especially for parents. 

According to all major consensus documents and guidelines, the three pillars of treatment for childhood or adult ADHD are:

  1. Medication indicated for ADHD, 
  2. Family-based behaviour therapy and ADHD-adapted psychotherapy,
  3. ADHD / Executive function coaching.

What does treatment really mean?

Want to learn more about the best practices for the management of adult ADHD?   

ADHD is a very treatable disorder, with more methods that yield more transformational improvement in more people than all other disorders in mental health.

A combination of medication and ADHD-adapted psychotherapy leads to superior outcomes, manifesting in reduced inattention, emotional symptoms, maladaptive thoughts and improved quality of life.

This happens through a combination of addressing any unhealed relational and childhood trauma *and* building a new understanding of self and skills to create the life and relationships you desire. 

Pillar one

Medication

Medications prescribed by physicians with expertise in ADHD are referred to most commonly as stimulant medications.

These medicines have been used for over 50 years, are well-understood and have effectiveness rates of around 80% (which is significantly more than any other medicine in psychiatry and more than even cardiovascular medicines for example).  

There is a lot of misinformation and stigma about these treatments, so ensure you ask your physician for the most up-to-date evidence so you can make an informed decision with accurate information. 

How do ADHD meds work?

Here you can find a helpful medication chart, as well as current formulary coverage for these medicines across Canada. 

Stimulant medicines achieve their beneficial effects by increasing the levels, or availability, of neurotransmitters dopamine, serotonin, and norepinephrine in the brain.  

  • Dopamine, one of the most important neurotransmitters, has been directly linked to concentration, attention, and more recently show to be directly related to motivation and the willingness to take on difficult tasks.  
  • Norepinephrine plays an important role in daytime alertness.  


Some stimulant drugs also increase the level of glutamate, a neurotransmitter associated with behavioural control and inhibition.  People experiencing attention deficit hyperactivity (ADHD) often have low levels of glutamate.

  • When you start a trial of stimulant medication, it’s important to appreciate what outcomes you should be  looking for.  That is, you must track how symptoms such as impulsiveness, concentration, motivation, emotional dysregulation are affected in your daily life. This helps you collaborate with your physician to plan your treatment, and tailor the medical approach to your brain.
  • For current and evidenced based information about medication, please visit reputable websites like the Canadian ADHD Resource Alliance (CADDRA). CADDRA is an independent, not-for-profit, resource organization for medical, healthcare and research professionals with an interest in the field of ADHD.  

Hear from the experts

Listen in to the premiere episode of The Christina Crowe Podcast: making the invisible VISIBLE,​ featuring Dr. Joan Flood, talking about the nuances of evidenced-based treatment for ADHD brains.

Medication information straight from CADDRA,
​the Canadian ADHD Resource Alliance. 

Need help with treatment costs?

Click HERE for Canadian Provincial and Federal Public Formulary Overview (October 2020). 

Many manufacturers offer financial support, paying the difference, so you can continue to access the brand name medicine, have your co-pay covered or provide the medicine for you if you do not have drug coverage – you have to only register and let your pharmacist know. 
 
A reminder for Ontarians:
  • Patients can advocate through their HR department or through the media (patients/HCPs) and ask for exceptional coverage to meet theirs or their family needs. 
  • For medications listed on ODB (like Vyvanse), people under 25 can receive Vyvanse under OHIP+ at a pharmacy if they do not have private insurance coverage from parents,
  • Patients over 25 can apply for Trillium to get coverage. 

In Canada: 

In the U.S.: 

How do I know if my medication is working?

Download our ADHD Symptom tracker above
Your ADHD-trained therapist at Dig A Little Deeper, works with you to help identify what your ADHD symptoms actually are, and one by one, figure out how to get the best of your unique brain and presentation of ADHD. 

​At Dig a Little Deeper, your therapist or Nurse Practitioner helps: 
 
  1. Track your symptoms ​measure what the medicine is doing for you.  
  2. Coordinate care with your prescribing physician (unless you continue to see one of our NPs), so your care team knows what you are tracking and noticing and everyone is in the loop. ​

What about other stuff like cannabis?

Many people ask about the effects of cannabis on the ADHD brain, both in terms of treatment, and also substance use disorders.  

​CADDRA has published a position statement on the use of Cannabis in ADHD, and can be reviewed here

Pillar two

ADHD-Adapted Psychotherapy for ADHD

ADHD-Adapted Psychotherapy refers to the necessary application of the knowledge of ADHD as a neurodevelopmental disorder, and the treatment nuances a therapist must be aware of, applied to whatever therapy modality they work from. Dig a Little Deeper has been implementing, teaching and presenting on ADHD adaptions since 2015. 

“Behaviour therapy” for ADHD is often misunderstood as a therapy a child with ADHD receives to help them alter their behaviour. 

ADHD behaviour therapy for children with ADHD actually entails teaching the parents and other adults who interact with the child, specialized ADHD behavioural management techniques.  For children with ADHD younger than 6 years of age, evidence is robust that first-line intervention should be parent behaviour training.

An important perspective shift for parents: children with ADHD are not choosing to be difficult; it is their cognitive difference – their ADHD brain – that makes it difficult for them to follow rules, sit quietly, think before acting and generally do the things that adults want them to do.  

​Processing this is a fundamental shift that informs how a parent can interact with their child in a healthy and supportive way. 

As adults who interact with children with ADHD it is up to the adult to alter the environment and provide the appropriate support the child requires to succeed. Behaviour management strategies work best when aligned between school and home.

More on ADHD-Adapted Psychotherapy ...

Struggling with the consequences of undiagnosed ADHD often leads adults to diagnoses of anxiety or depression.  In fact, what adult ADHD often looks like is anxiety and depression. The important question is, which came first? 

While these conditions can be present alongside ADHD (called ‘comorbidities’), they are more often a result of living a lifetime with undiagnosed ADHD, which can be quite demoralizing.  

Adhering to global treatment recommendations means including psychosocial interventions in your ADHD treatment. ADHD-Adapted Therapy for ADHD can be transformational because it both addresses the challenging emotions that were underpinning the anxiety and depression symptoms, as well as helps folks build new relational skills to confidently self-advocate and strengthen one’s relationships. 

Studies have shown ADHD-Adapted cognitive behaviour therapy (CBT), dialectical behaviour therapy (DBT) and interpersonal psychotherapy (IPT) to be effective forms of therapy to help support:

  • the diagnostic journey, 
  • the acceptance and understanding of the diagnosis,
  • learning how to navigate the emotions, relationship challenges and self-care aspects of living with ADHD. 
  • longer term management of unpacking and finding the gifts within, of an ADHD brain.  
It is critically important that the therapist knows what ADHD is, understands the brain-based functions and nature of how to work with each persons individual presentations, and be able to differentiate a symptom of ADHD from an emotional or psychological symptom

YOU SHOULD KNOW

Neurodivergent-affirming care is a form of cultural competence. Therapists who are neurodivergent-affirming have taken steps to be aware of possible biases and to gather appropriate knowledge about neurodivergent clients before working with them to avoid doing harm.

Always ask your therapist up front what specific training they have had in treating ADHD and what their clinical experience is. 

 

Read more about Neurodivergent-Affirming Clinical Practice on The Dig Deeper Blog.

Pillar three

ADHD executive function coaching

​ADHD Coaching is different from therapy. It is also referred to as ‘Executive function coaching.’
 
Coaching helps people improve their performance on areas they need to work on and focus in the here and now. Coaches actively help you build a tailored scaffolding and develop strategies to better perform at work, school, and in interpersonal relationships based on your own goals and circumstances. They help you develop a plan and your coach helps keep you accountable for following through with that plan.

ADHD coaching provides the external structure and support to change behaviour, monitor progress and create a sense of accountability. Coaching helps you achieve your goals by breaking down and simplifying all the specific tasks you need to complete first in order to reach those goals. 

Executive functions & skill building

​Our team at DALD ​include therapists who are also certified professional coaches, and can work with you in a non-judgmental partnership that emphasizes practical tools for attention and energy management, planning, organizing, prioritizing, and decision-making systems for effective daily living.

7 areas of focus

  1. Flexible thinking skills
  2. Planning ahead & time management
  3. Self-monitoring
  4. Emotional regulation & self-control (managing impulsivity)
  5. Working memory (remembering information)
  6. Attention & energy management
  7. Organizational skills

ADHD Coaching articles

Read our essential coaching articles on The Dig Deeper Blog! ​

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