Attention-Deficit/Hyperactivity Disorder (ADHD) - Combined presentation

Finding the right treatment

Treatment

ADHD - Combined presentation has multiple proven means of treatment including professional therapy, coaching, medications, and small but helpful life-hacks that individuals can adopt. All of these are often very effective, particularly when combined together.

Finding a therapist

While medications can be the catalyst for real change in people with ADHD, therapy can support individuals through teaching new ways to work with symptoms, and an increased awareness of thoughts and feelings. Most therapists have experience working with adults with the combined type of ADHD.

There are different kinds of professionals who can provide effective therapy, including:

• Clinical psychologists (PhD)
• Licensed clinical social workers (LCSW or LMSW)
• Licensed professional counselors (LPC)
• Licensed clinical professional counselors (LCPC)
• Licensed Marriage and Family Therapists (LMFT)
• National certified counselors (NCC)
• ADDCA Certified Coaches

Therapists can often help clients identify key issues that result from ADHD and discuss their solutions. Many therapists use cognitive behavioral therapy (CBT), which is a method that helps the individual identify unhelpful thought patterns and challenge self-destructive cognitions, and replaces them with more constructive thinking.

Therapists (or trained ADHD coaches) can also help individuals with more pragmatic goals such as organization, time management, and communication skills, among others. In concert with medication and with the new understanding and skills that a therapist provides, individuals can make meaningful changes.

The decision to start therapy

Many people try to cope with their distress on their own, and then feel disappointed when they find that this is very difficult to do. Deciding to start therapy can be hard; it takes courage.

For some people, it can take time to warm up to the idea of sharing one’s intimate thoughts or disclosing details of one’s life, especially for those who grew up in a culture where seeking psychological help was frowned upon.

Psychotherapy is increasingly accepted as not only a way to improve mental health symptoms, but also a means for self exploration and personal growth. No problem is too small for a trained therapist: an individual need not worry that others may have it worse. The willingness to reach out for help is increasing: in 2020, one out of every six Americans (men and women) reported seeing a therapist.

Seeing a therapist with whom one feels comfortable, and a sense of connection, and who also participates in their insurance network, is essential. It may take a couple tries to find a therapist who feels like the right fit. If therapy didn't help the first time around, it can be helpful to give another therapist a try because therapeutic styles vary so much from therapist to therapist.

Where to start

Asking one’s physician to make a referral is often a good place to start. Many health insurance cards have websites or 1-800 numbers to call for a list of in-network providers.

To find a therapist who takes your insurance, the National Institute of Mental Health offers a comprehensive list of resources.

Psychology Today also lists therapists by type, location and insurance.

Determining whether medications will play a role in treatment

Medications are central in the lives of many people with ADHD. There are two types of medications that the Food & Drug Administration (FDA) has approved to treat ADHD - Combined presentation.

Stimulant medications

Stimulant medications have been around for decades. They include amphetamines such as Adderall & Vyvanse and methylphenidate such as Ritalin and Concerta.

More than 70% of people with ADHD receive stimulant medications as their primary treatment. Stimulant medications can work quickly and are documented to address many of the symptoms of ADHD - Combined presentation. Many doctors and patients are hesitant to use a controlled substance, but they are highly effective and safe when used according to doctors’ orders.

Non-stimulant medications

Some doctors prefer to avoid prescribing stimulants, particularly in their patients who have struggled with substance abuse. Non-stimulant medications are the second category of medications approved for treating ADHD. Atomoxetine (Strattera), has been available for over fifteen years. More recently, Qelbree, the newest non-stimulant medication for ADHD, was approved.

In general, long-acting stimulants are preferred for people with ADHD because they are convenient, and don’t require a person to remember to take the medication multiple times a day. “One and done” can work best for most people. In contrast, short-acting medications need to be administered several times during the day. They also are absorbed all at once, creating a rapid peak, and then decline of drug blood level. Long acting medications are delivered at the same rate from onset to offset.

Although they are priced lower than most long-acting medications, short acting medications fluctuate so much in the bloodstream that they are hard to assess.

*Note: All individuals under consideration for stimulants should be evaluated for heart disease with a medical history, physical examination, and discussion of sudden deaths in the family before stimulants are prescribed. In addition, a current or past history of any form of substance abuse should be explored.

Healthcare providers that can prescribe medications

Psychiatrists, psychiatric nurse practitioners, and physician assistants are practitioners who are trained to diagnose and treat mental health conditions by prescribing medications. Sometimes it's hard to find a psychiatric provider because there are so many people who need them. So, individuals often choose to see a different kind of provider who can prescribe. This could be a doctor they already see, like a primary care doctor, family doctor or OB/GYN.

Dietary supplements

There are an increasing number of supplements, such as an herb, vitamin, mineral, and other supplements claiming to improve sleep, depression, stress, restlessness, or anxiety. While it is possible for a supplement to improve one’s symptoms, their effects are often unproven. Be aware that dietary supplements are not controlled by the FDA and, therefore, are not subject to the standards of quality, uniformity, and testing for efficacy and safety as regulated medications. It is important to share a list of all medications and supplements with one's treating provider because some of them may interact with the medications they prescribe.