Can Medication Help Most People with ADHD?
The use of medication to treat people with attention-deficit hyperactivity disorder (ADHD) has climbed in recent years. These days, more prescriptions than ever are being written for girls and adults with ADHD.
“Medication for ADHD used to be reserved for the most severe cases—usually boys who were constantly in trouble at school and at home,” says Columbia psychiatrist Ryan Sultán, MD, who specializes in ADHD. “We now know that ADHD affects a much wider range of people, including girls and adults with milder symptoms. When used appropriately, ADHD medications help patients of all ages not just feel better, but live safer, more productive lives.”
Dr. Sultán explains how the understanding and diagnosis of ADHD has evolved and what these changes mean for treatment.
Is ADHD more common than it was in the past?
ADHD isn’t really more common. But changing diagnostic criteria, greater awareness, and reduced stigma around the disorder have let us identify—and treat—more people with milder or different ADHD symptoms who previously flew under the radar.
What is our current understanding of ADHD symptoms?
The rambunctious little boy who is always getting in trouble at school and at home, the teen who crashes his car because he was distracted by texting—these are clichés that may describe some people with severe hyperactive or impulsive ADHD symptoms. We have since learned that ADHD doesn’t only affect children and teens with hyperactivity or impulse control.
Many people with ADHD have inattentive symptoms, such as difficulty paying close attention to details, focusing on schoolwork or conversations, organizing tasks, and eliminating distractions. Inattentive symptoms are often more subtle than hyperactive symptoms. Young people with inattentive ADHD might be thought of as daydreamers, but as they get older, their inability to focus may affect job performance, which may, in turn, affect self-esteem.
Recognition of this inattentive type of ADHD has led to an increase in diagnoses among girls and adults, both male and female.
How have changes in diagnosis affected access to treatment?
People with inattentive ADHD and milder symptoms are less likely to engage in high-risk behavior. In the past, many of these patients were overlooked.
Today, more people with milder ADHD symptoms are being diagnosed. They are getting the help that previous generations missed out on, whether that includes cognitive behavioral therapy (CBT), medication, or both. The expansion of telehealth services during the pandemic also made getting diagnosed and starting treatment easier than ever. This is a huge victory for awareness and access to care.
Does ADHD medication work for patients with milder symptoms?
One way that researchers measure how well ADHD medication works is by looking at people’s ability to prevent unwanted outcomes. A recent study from Sweden looked at severe outcomes—things like self-harm, traffic accidents, and arrests—in about 247,000 people with ADHD when they were taking medication and when they weren’t. Individuals were far less likely to have severe outcomes during periods of their lives when they were taking ADHD medication compared to periods when they were off medication.
As the study went on, the risk of severe outcomes while taking medication continued to decrease, but only slightly. That doesn’t mean that ADHD medication became less effective; it may still prevent accidents, injuries, jail time, and worse. But as the people in the study got older, combined with a broader population of people with milder symptoms who were taking medication, the protective effects of medication against severe outcomes were diluted.
It’s important to remember that the goal of ADHD treatment is to reduce core symptoms so each person functions at their best. For some, this could help prevent the type of impulsive behavior that raises the risk of accidents. But for others, the effect may be less obvious but no less trivial. For instance, improving a person’s concentration might help them finish school assignments on time, hold a job, maintain relationships, and feel in control of their life.
If the study had measured things like creative output, self-esteem, or friendships maintained, we would likely find that medication has benefited this broader group. In fact, a comprehensive review of ADHD medication studies found improvements in risky behaviors, as well as school performance and social relationships.
How could this newer understanding of ADHD affect treatment?
Working with a trusted mental health care provider who is familiar with various ADHD symptoms is key to getting a careful diagnosis and individualized treatment, whether that involves medication or other therapies like CBT. It could also help to identify individuals with ADHD who have other mental health conditions, which increase the risk of suicide, aggression, and other adverse behaviors.
This personalized approach can lead to many meaningful benefits, whether it’s helping an individual focus in school, control aggressive behavior, be a better romantic partner, or have better self-esteem. Improvement in these outcomes, not just symptoms, is what matters for individuals with ADHD.
Ryan Sultán, MD, is an assistant professor of clinical psychiatry at Columbia University Vagelos College of Physicians and Surgeons.