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This is part 5 of 5 on modern perspectives on ADHD. Part 4: “What’s the Deal with Dopamine and ADHD” is available here.
Is Medication the Only Option for ADHD?
It should first be clarified that there are non-pharmacological ways of managing ADHD difficulties. For example, digital aids, including to-do lists, reminders, alarms, calendar and phone applications, can serve as an external working memory. This reduces the burden on an individual’s working memory, thereby increasing capacity for focus when required.
Another way ADHDers manage is through fidget toys or stimming behaviours. For example, squeezing a fidget toy while reading or listening can provide a strong enough dopamine to keep focus. Similarly, walking meetings, or reading on treadmills or a swinging hammock can assist with maintaining focus because the body’s needs for stimulation are being met.
Additionally, training of attentional regulation and impulse management through mindfulness-based therapies has also been shown to be effective in managing ADHD symptoms1. One approach is through extended mindfulness meditation practice.
I’ve personally found mindfulness meditation to be very effective. For a year of my life, I committed to meditating for 10 minutes every day. As well as providing wonderful equanimity, I found it strengthened my ability to notice and resist impulses to become distracted, speak, or move. Prior to this more formal practice, I’d made concerted, repeated efforts to listen to understand what they were saying in the moment rather than waiting to respond. While this was born from an empathic understanding of knowing what it’s like not be understood, I was unknowingly sharpening my impulse control using mindfulness.
ADHD Drugs
ADHDers may also choose to take medications that raise dopamine signal levels, reducing the need for as much environmental stimulation. Common drugs include stimulants such as dextroamphetamine (Dexedrine), which releases more dopamine into the synaptic cleft between neurons, or methylphenidate (Ritalin), which limits the reuptake of dopamine, ensuring it stays around longer. More broadly, simulants have been shown to successfully increase right inferior frontal cortex and insula activation—brain regions responsible for cognitive control and neurocognitive dysfunction in ADHD2.
Stimulant Controversy
Stimulant drugs are often highly effective in improving concentration, reducing hyperactivity and impulsivity, and stabilising mood. It’s important to note that stimulant drugs improve these symptoms in anyone. Using stimulants is just as effective at helping someone engage with their work if they have ADHD as it is when someone engages with work if they’re tired or in a job they don’t enjoy. So, it’s important to consider that stimulant effectiveness doesn’t confirm a diagnosis.
There is particular contention around the use of stimulants such as dextroamphetamine due to their similarity to illicit stimulants. Dextroamphetamine is chemically very similar to methamphetamine—commonly referred to as speed or ice—only different by a single CH3 group. It has a similar function, promoting focus, while also increasing insomnia and lowering appetite. This makes the use of stimulant medication as a first-line treatment controversial in children, as lowered appetite can lead to stunted growth.
Furthermore, liberal dextroamphetamine use on a “whenever needed to focus” basis can lead to overuse. For example, dextroamphetamine may disrupt sleep, increasing long-term tiredness and lack of focus, leading to increased usage over time. Furthermore, overuse and consistently elevated dopamine levels can lead to dopamine receptor desensitisation, in which progressively larger amounts are required to achieve the same effect.
To assist, ADHD drugs such as Lysdexamfetamine (Vyvance) have been created, which slowly convert to dextroamphetamine throughout the day as the molecules slowly lose their lysine tails. This allows the medication to be taken once per day and without the risk of misuse.
Should We Be Medicating ADHD?
It’s common for individuals to look back at the inclusion of cocaine in cough syrup in the 19th century as shocking. We may look at the widespread prescription of amphetamines in the 21st century in a similar way. However, there is a range of illicit ‘recreational’ drugs, including cannabis (marijuana), psilocybin (magic mushrooms), and MDMA (ecstasy), which are beginning to be trialled for a range of psychiatric conditions. Perhaps society is just moving through an adjustment period to the changing landscape of medicine?
Instead of thinking of ADHD medication as fixing a disorder, we can consider it as providing an opportunity for ADHDers who want to assimilate in more neurotypical settings. An ADHDer’s dream job may require consistent focus or stillness, or a cherished relationship may require strong emotional regulation. If this is the case, why deprive them of something that could make them fulfilled?
