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Do you struggle to sit still, focus on a task, tend to interrupt others while they talk, find it difficult to concentrate or act impulsively without thinking things through? It interferes with their day to day living in such a way that they struggle to learn, form lasting relationships and pursue a career. ADHD behaviour must also be present in two or more settings for example at shome, school or the workplace. In the above two presentations a person should have 5 or more (6 or more for children and teens) symptoms present to be diagnosed with ADHD. A person exhibiting hyperactivity, impulsivity and inattention are considered to have the combined presentation of ADHD, which combines all of the above symptoms.
For a diagnosis of ADHD, the symptoms must also have appeared before the age of 7 (for childhood ADHD), and have continued for at least 6 months.
Medication, behavioural therapy, emotional counselling, and practical support will help a person with ADHD cope with the disadvantages of the disorder.
These medications only control ADHD symptoms on the day they are taken, so it’s important to remember that the disorder is not actually cured. Stimulant medications commonly prescribed for attention deficit disorder include methylphenidate (Ritalin, Concerta, Metadate, Methylin) and certain amphetamines (Dexedrine, Dextrostat, Adderall).
In psychotherapy (commonly, cognitive-behavioural therapy for ADHD), the patient can be helped to talk about upsetting thoughts and feelings, explore self-defeating patterns of behaviour, learn alternative ways to handle emotions, feel better about him or herself despite the disorder, identify and build on their strengths, answer unhealthy or irrational thoughts, cope with daily problems, and control their attention and aggression.
Behaviour therapy is focused on helping an individual understand how changing their behaviour can lead to changes in how they are feeling.
Social skills training teaches the behaviours necessary to develop and maintain good social relationships, such as waiting for a turn, sharing toys, asking for help, or certain ways of responding to teasing. Social skill training helps the child to learn and use these skills in a safe practice environment with the therapist (or parent). Skills include learning how to have conversations with others, learning to see others’ perspective, listening, asking questions, the importance of eye contact, what body language and gestures are telling you. If you suspect you might be suffering from ADHD, get more information by completing the ADHD Quiz.
Primary care physicians, pediatricians, and psychiatrists account for approximately 80 percent of attention deficit hyperactivity disorder (ADHD) treatments prescribed in the United States.
In this article, we explore use of long-acting versus short-acting treatment for attention deficit hyperactivity disorder (ADHD) by primary care physicians, pediatricians, and psychiatrists. We obtained data on total retail prescriptions for ADHD medications in March, April, and May 2008 from Verispan’s Vector One National (VONA), which captures nearly half of all prescription activity in the US. In 2007, almost seven million Americans filled at least one prescription for an ADHD therapy.
We examined the data further to determine whether there were any differences in use of short-acting versus long-acting ADHD treatments by patient age.
The data presented in this article suggest that pediatricians are ahead of the curve compared to many psychiatrists and primary care providers in regard to utilizing the clinical advantages of long-acting medications for ADHD. The possibility of diversion or nonmedical use of stimulants is an issue clinicians should be aware of even though it is not a problem for the vast majority of patients. Long-acting ADHD stimulant medications may also be less prone to contribute to the development of drug abuse or dependence.
Lisdexamfetatine is a pro-drug that requires enzymatic cleavage of lysine before dexamphetamine, to which it is attached, becomes biologically active.
Medication adherence is also a well-known problem in a chronic disorder like ADHD, with only about 20 percent of patients remaining on the same medication 15 months after first being prescribed that medication.[11] The need for multiple daily dosing of immediate-release medications only further increases the risk of nonadherence in children, adolescents, and adults.
In adults, the reported prescribing pattern data suggest that some psychiatrists and primary care providers have as yet failed to fully take advantage of long-acting ADHD medications. Clinicians and patients also have to take into account the possible negative impact of uncontrolled ADHD on driving performance. When deciding on which medication to prescribe a patient with ADHD, it is important to keep in mind that prescribing short-acting ADHD medications in some situations can also be advantageous. In the end, it comes down to a judgment call by the clinician after consultation with each individual patient, his or her family, and other sources if needed.


Most of us experience this from time to time, but for a person that has ADHD these behaviours are uncontrollable and persistent. Predominantly Hyperactive-Impulsive Presentation — Symptoms of hyperactivity-impulsivity but not symptoms of inattention have been shown for at least 6 months. Predominantly Inattentive Presentation — Symptoms of inattention but not symptoms of hyperactivity-impulsivity have been shown for at least 6 months.
Combined Presentation — Symptoms of both inattention and hyperactivity-impulsivity have been shown for at least 6 months.
Someone who can pay attention at work but is inattentive only at home usually wouldn’t qualify for a diagnosis of ADHD. These are well-tolerated, act quickly (usually soon after a person takes them), and in most people, have few side effects. If one medication doesn’t appear to be working after a few weeks of treatment, a doctor will often try another medication. Methylphenidate is a short acting drug, and in older forms, had to be taken multiple times a day. The goal of behaviour therapy is usually focused on increasing the person’s engagement in positive or socially reinforcing activities. These skills are usually not taught in the classroom or by parents — they are typically learned naturally by most children by watching and repeating other behaviours they see. Selection of short-acting versus long-acting ADHD treatment varies by specialty with long-acting agents representing 56 percent of primary care prescriptions, 64 percent of psychiatrist prescriptions, and 79 percent of pediatric prescriptions. Approximately 80 percent of therapies prescribed were written by primary care physicians (21%), pediatricians (28%), or psychiatrists (30%). The data presented in Figure 2 show that there does appear to be a difference in long-acting therapy use among pediatric and adult patients.
Children and adolescents given long-acting medications for ADHD generally are adequately treated for the entire day with once-daily morning dosing. With extended-release stimulants, the slower rise and fall of MPH, amphetamine, and dexamphetamine levels in the brain may contribute to decreased drug abuse potential.[6] Two studies compared short-acting and long-acting MPH formulations to examine this hypothesis. Lisdexamfetamine’s need for enzymatic cleavage may reduce the risks of intravenous and nasal abuse due to significantly decreased levels of the active compound seen in animal studies. As there is a significant likelihood that one of the parents of a child with ADHD will also have ADHD (often undiagnosed), or another psychiatric disorder, there is potentially a significant risk that the parent will forget to give the additional immediate-release doses of medication to the child every 4 to 6 hours. It is important to consider that often a day in the life of late adolescents and adults is full of activities and responsibilities. Poor driving records that include multiple speeding tickets, multiple accidents, and ignoring driving regulations at times resulting in points on one’s drivers license or loss of license are seen in many young adults with ADHD.[13] Safe driving demands that one remain attentive. For example, a number of patients will benefit from the addition of a short-acting stimulant taken at 5 or 6 o’clock in the evening, sometimes to supplement a long- or another short-acting medication given earlier in the day. The clinician weighs the risks and benefits of the various ADHD medications and discusses these openly with the patient and his or her family. Online Assessment Tool Research White Papers Call now to schedule a Free Consultation800-877-5500 Who We Can Help ADHD Learning Disorders Behavioral Issues Processing Disorders Asperger’s PDD-NOS Not sure why your child is struggling?
This is normal and most people will switch medications to find the one that works best for them at least once. But some children — especially those with attention deficit disorder — have a harder time learning these skills or using them appropriately. There appears to be a correlation between short-acting versus long-acting treatment selection and age, with long-acting agents accounting for 78 percent of prescriptions for pediatric patients (age 0–17) but only 49 percent of prescriptions for adults (patients aged 18+). Figure 1 displays short-acting versus medium-acting versus long-acting ADHD treatments prescribed by physician specialty.
Long-acting agents account for 78 percent of ADHD prescriptions in pediatric patients ages 0 to 17 years, but only 49 percent of adult ADHD prescriptions. The benefits of this once-daily dosing are that these children are not forced to go to a very busy school nurse or school office to receive their medications, nor are they singled out from their classmates in order to receive an additional dosage of immediate-release, short-acting ADHD medication.
Jasinski, et al.,[9] in a human study, also showed that 50mg of lisdexamfetamine given intravenously to known stimulant abusers showed a lower cmax and much longer tmax as well as decreased drug likeability scores that were not significantly different than placebo when compared to 20mg immediate-release dexamphetamine.


It is possible that minimizing peak-trough medication-related attention problems by using long-acting ADHD medications might also help boost driving performance and improve traffic safety as well, though additional research is needed in this area. Attention and other ADHD symptoms then improve for a night class or important evening meeting, without keeping the patient awake all night. The safety and tolerability of long-acting medications are similar to those of short-acting medications, appear to have a somewhat lower risk of abuse and diversion, and may be associated with significant improvements in medication adherence, while short-acting medications may allow for more flexibility with the dosing frequency, titration, and determining drug tolerability and can be taken on an as-needed basis when coverage is only needed for a few hours. Although taking stimulants for treatment may seem risky, there is significant research that demonstrates that when taken as directed by your psychiatrist or physician, they are safe and effective in the treatment of adult ADHD. Weisler is an Adjunct Professor of Psychiatry at the University of North Carolina, Chapel Hill and Adjunct Associate Professor of Psychiatry at Duke University, Durham, North Carolina. As seen in Figure 1, selection of short-acting versus long-acting ADHD treatment varies by specialty with long-acting agents representing 56 percent of primary care prescriptions, 64 percent of psychiatrist prescriptions, and 79 percent of pediatric prescriptions. There is also less likelihood of diversion of long-acting agents because the giving and taking of medication is supervised at home during the morning dosing. In a recent review article, Kollins[10] concluded, “Patients with ADHD are at increased risk for SUD [substance use disorder]. With long-acting medications, many patients report that their mental focus remains clearer for them throughout the full day and sometimes into the early evening due to minimizing the negative impacts of the peak-trough effects often seen with twice or thrice daily dosing of immediate-release ADHD medications. If a clinician is concerned about how a particular patient will respond to a dosage titration or whether he or she will be able to tolerate a stimulant, sometimes it is best to begin with short-acting agents. Monitoring the Future: National Survey Results on Drug Use, 1975–2005, Vol II, College Students and Adults ages 19–45.
Illicit use of specific prescription stimulants among college students: prevalence, motives, and routes of administration. Characteristics of adolescents and young adults with ADHD who divert or misuse their prescribed medications. PET study examining pharmacokinetics, detection and likeability, and dopamine transporter receptor occupancy of short- and long-acting oral methylphenidate. Comparison of acute behavioral effects of sustained-release and immediate-release methylphenidate.
Human pharmacology of intravenous lisdexamfetamine dimesylate: abuse liability in adult stimulant abusers. A qualitative review of issues arising in the use of psychostimulant medications in patients with ADHD and comorbid substance use disorders. Review of long-acting stimulants in the treatment of attention deficit hyperactivity disorder. Driving in young adults with attention deficit hyperactivity disorder: knowledge, performance, adverse outcomes, and the role of executive functioning. Under certain conditions, psychostimulants may be a pharmacologic option in the treatment of patients with comorbid ADHD and [SUDs]. Hyperactive symptoms when present are better controlled in many cases with long-acting ADHD medications for the same reason. This may also be the case when ADHD is comorbid with other psychiatric or medical disorders that potentially could worsen with use of a stimulant. However, clinicians should be mindful of the risks and benefits of this treatment approach in a high-risk population and should also bear in mind the labeling guidelines when working with this comorbidity.” In difficult cases like those patients with comorbid ADHD and SUD, long-acting ADHD medications are, in my opinion, almost always preferable to short-acting agents. Long-acting agents vary in duration with atomoxetine, a nonstimulant norepinephrine reuptake inhibitor, providing 24-hour coverage after chronic dosing in those patients that respond. Some individuals even with significant ADHD manage to cope extremely well or they have structured their lives in such a way that taking an ADHD medication on an as-needed basis for special situations is all they really need.
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