Introduction to ADHD
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that begins in childhood. Those affected often suffer from persistent problems with attention, impulse control, and hyperactivity. Researchers at Washington University School of Medicine in the United States have found that medications commonly prescribed for ADHD, such as Ritalin or Adderall, "act primarily on the brain’s reward and alertness centers, rather than its attention circuitry."
How ADHD Medications Work
The study shows what such stimulants can actually do and what they cannot do. This information is important for people with ADHD because it shows why some tasks suddenly feel less strenuous for people on medication. The Washington University research team examined brain scan data from nearly 5,800 children and found that the drugs primarily affected the reward and alertness centers of the brain. They didn’t light up the brain’s attention circuits, and this remained the case in an additional experiment with adults.
Effects of ADHD Medications on the Brain
The researchers interpreted this to mean that the drugs "enhance performance by making individuals with ADHD more alert and interested in tasks, rather than directly improving their ability to concentrate" and help "make activities that the child normally has difficulty concentrating on relatively more rewarding." Children are more likely to persevere because learning feels less tedious. The medications make people more alert and motivated, allowing them to stay focused.
Treatment of ADHD
The treatment guidelines for ADHD generally recommend a graduated approach. The first option is to provide information and everyday support to structure and establish routines. Depending on the severity of the disorder, psychotherapy may be helpful. In moderate to severe cases, medications may be used in addition to or as an alternative to other remedies. Medications such as methylphenidate, amphetamines, atomoxetine, and guanfacine are used to treat ADHD.
Types of ADHD Medications
Ritalin, a methylphenidate, and Adderall, an amphetamine mixture, are stimulants that rapidly increase dopamine and norepinephrine levels. Atomoxetine and guanfacine are “non-stimulants” and do not produce acute alertness or euphoria. Instead, they tend to stabilize attention, impulse control, and emotional irritability. ADHD medications are typically prescribed as part of a broader treatment plan and are only used under the supervision of specialized physicians.
Behavioral Therapy for ADHD
Treatment often begins with behavioral therapy, in which people with ADHD learn, with the help of a therapist, to structure their day and to divide tasks into manageable parts, to organize themselves effectively using tools such as calendars and reminder apps, and to better deal with frustration or overwhelm. This does not “cure” ADHD as such. But clear routines, reward schedules, and self-soothing techniques are all strategies for managing symptoms.
Importance of Sleep in ADHD Management
One of the most surprising aspects of the study was how stimulants helped children with ADHD who were sleep-deprived. The medications were associated with better school grades and cognitive performance. However, this was not the case for children who got adequate sleep and did not suffer from the disorder. For the children who didn’t get enough sleep, the stimulants essentially eliminated sleep deprivation from the brain scans. In the short term, the drugs acted like an artificial substitute for good sleep. However, the team warned that this would not necessarily work in the long term. Lack of sleep is biologically harmful to humans, even if it can be temporarily masked by medication. ADHD patients need to be carefully evaluated for sleep deprivation and whether this may be the cause of their symptoms. Simple adjustments to sleep hygiene, daily routine, or stress reduction may be most needed.
