The clinical representation and the response to the treatments of ADHD are the same regardless of cultural origin. It is impressive to note how treatments and techniques of adaptation can help to reduce the handicaps associated with this disorder.
The Collège des médecins du Québec as well as the Ordre des psychologues du Québec issued guidelines on ADHD and the use of stimulants « Le trouble déficit de l'attention/ hyperactivité et l'usage de stimulants du système nerveux central ». In 2006, they published a revision of those guidelines taking into account the new pharmacological treatments options now available. In Canada, the Canadian ADHD Resource Alliance (CADDRA) has also published guidelines on the assessment and treatment of ADHD. Those are reviewed periodically and are available online.
However, in Canada and the United States, as in many other places in the world, ADHD is still the target of "misinformation". Some have the impression that there is an epidemic of ADHD. This is not the case, but as we now have better tools to detect and help those who suffer from it, the public awareness of this disorder has largely increased in the last years.
ADHD treatment begins with confirmation of the diagnosis followed by an educational effort. It is essential that the person affected and their family members understand what ADHD is. Often, the mere fact of "finally knowing" is a tremendous relief.
Practical tips for children as well as practical tips for adults for adults for time management, task organization (e.g., memos, agenda, lists) and problem solving is vital for all, but this often requires specialized external help (e.g., psychologist, educator and occupational therapist).
Psychotherapeutic support may also be proposed, if needed. The approach must be structured, concrete and applied to daily life (e.g., cognitive-behavioural psychotherapy). Access to specific resources, be it for an assessment or for specialized coaching, is currently being developed in the Canadian public healthcare system and in other countries.
When a person continues to be incapacitated by their ADHD symptoms, medication may be offered. If so, the physician must take into consideration the presence of any associated conditions. Medication acts somewhat like a pair of biological glasses that help improve the brain's ability to focus. It fosters better information transmission, as though traffic officers were placed at strategic intersections, and the ignition and brake system of an automobile were enhanced.
THE TREATMENTS DESCRIBED HEREAFTER ARE THOSE CURRENTLY AVAILABLE IN CANADA AND MUST BE PRESCRIBED UNDER MEDICAL SUPERVISION.
Standard pharmacological treatment consists in taking psychostimulants, either amphetamine-based (AdderallXRTM, DexedrineTM , VyvanseTM - VyvanseTM will be available in 2010-) or methylphenidate-based (BiphentinTM, ConcertaTM, RitalinTM). A non-stimulant drug is also available for ADHD treatment: atomoxetine (StratteraTM). Doses must be adjusted progressively under medical supervision. When the right dosage is reached, the clinical response is noticeable within a few days for psychostimulants and within one or more weeks for the non-stimulant. Certain products are short-acting, while others can have an all-day effect. To summarize those informations, you will find here an ADHD Medication Table - Québec and an ADHD Medication Table - Canada (updated October 2009).
If a comorbid mood or anxiety disorder is present, it must be taken into account in the treatment plan. Psychostimulants can aggravate certain anxiety disorders. Several antidepressants act on noradrenaline or dopamine and are theoretically of interest for ADHD: buproprion (WellbutrinSTM, WellbutrinXLTM or ZybanTM), venlafaxine (EffexorXRTM, PristiqTM), duloxetine (CymbaltaTM) and mirtazapine (RemeronTM). However, few clinical studies have explored the effects of these products specifically for adult ADHD. In the presence of ADHD with comorbid depression or anxiety disorder, physicians could propose a therapeutic trial with such agents before implementing an ADHD-specific treatment. Ideally, the treatment will then consist of a single agent or a mix of these aimed at achieving the utmost efficacy and the least possible adverse effects.
These pharmacological ADHD treatments have an efficacy rate of 50% to 70%. Although these are generally well tolerated, all drugs can produce side effects. Discuss any treatment being considered beforehand with your doctor or pharmacist.
New treatments like medications acting on adrenergic alpha-2 receptors (IntuniveTM) and a methylphenidate administered in a dermal patch (DaytranaTM) should be soon available in Canada and are currently available in the United States. Other pharmacological options can be tried, but exceed the framework of a general information site like this one.