I am going to start a series of posts on how Inattentive ADD (ADHD-I) is different from , combined type ADHD (ADHD-C), the more common form of ADHD. I get many private messages regarding treatment, medication, classroom help, work problems, parenting advice, etc and I decided today that it might be helpful to write some review posts on what happens when:
- People with Inattentive ADD do not respond well to ADHD medication.
- ADHD classroom interventions for ADHD Combined type do not help inattentive kids.
- Parenting advice for a combined type child do not help the Inattentive ADD child.
- The overall treatment goals for combined type ADHD do not address the core problems of the person with ADHD-I.
I answer, on average, one private email a day regarding medication for Inattentive ADD. I thought it would be appropriate then for my first review post to be about about medicating ADHD-I. First let me say that I learn so much from the emails that I receive from readers so thank you for asking these questions!! Ninety percent of the emails about medication come from readers who have had a bad reaction to stimulants. In order of side effects, the most common complaints from my readers include:
- "Zombie" like symptoms or depression.
- Appetitive problems.
- Sleep Problems.
- No help for improving attention or focus.
If you read the side effects listed on the package inserts that come with any Ritalin type medication (Concerta, Focalin, Ritalin SR, etc) or the package insert that comes with any Adderall like preparation (Vyvanse, Adderall LA, etc) you will find that these drugs can commonly cause appetite and sleep problems but that side effects such as anxiety, depression or "zombie" like symptoms are not listed.
The reason that I get emails and the reason that people with Inattentive ADD have these symptoms is related to the fact that their response to the stimulants is sometimes different from the response of people who are hyperactive/impulsive. Medical studies are being performed to try to figure out how what is happening in the brains of people with ADHD-I is different from what is happening in the brains of people with ADHD-C but the jury is not yet out on the exact neurological similarities and differences between the types of ADHD. So what do people with ADHD-I do when side effects to the stimulants are so bad that taking them is worse than being inattentive???
Usually people will give other medications a try. The second medication that is most commonly used is Strattera or atomoxetine. Atomoxetine has been found to be helpful with focus and attention and it is especially helpful in people with ADHD-I and anxiety. Atomoxetine reaches its full therapeutic potential in about six weeks. Strattera has worked wonderfully for many of my readers but unfortunately, atomoxetine can cause side effects as well. Some of these side effects go away over time and some do not. About ten percent of people will have side effects that are so severe that they will have to stop their medication. Some of the most common side effects that my readers report include dry mouth and sleep disturbances but these often improve over time. The side effects that tend to persist and require stopping the medication can include upset stomach, decreased appetite and nausea or vomiting.
So what does someone with ADHD-I do when neither the stimulants or atomoxetine can be tolerated? The next non-stimulant medication to try in Intuniv or guanfacine. In my experience, Intuniv is really helpful for people with ADHD and impulsive behavior, oppositional behavior or sleep problems and less helpful for inattention though, in theory, it should be really helpful in improving attention.
What happens when none of these medicines help? I did not really have an answer for the readers of this blog that asked that question and that is the reason why I spent so much time researching and writing Commanding Attention, a book about non-drug treatments for ADHD.
Leave a comment or shoot me a message to let me know what medication or treatment is working well for you and thanks for reading!