You might have noticed an increasing buzz about ADHD (Attention Deficit Hyperactivity Disorder). Whether you have a personal connection to ADHD, know someone who does, or are just curious, it’s clear ADHD is getting a lot of attention. Rightfully so! There are a lot of misconceptions out there about it being overdiagnosed, however, the truth is it is actually very commonly misdiagnosed and or underdiagnosed.
ADHD is most commonly known amongst children and teens, but does continue into adulthood, as one does not “outgrow” ADHD. It’s more frequently diagnosed in boys than girls, partly because girls tend to be more ‘inattentive’ rather than ‘hyperactive’ making their symptoms less noticeable in school and often flying under the radar (check out our blog ‘Beyond the Stereotype: ADHD in Women and Girls’ to learn more about what ADHD looks like in females).
There are three main types of ADHD: combined (all symptoms), inattentive (mainly troubles with attention), and hyperactive-impulsive (mainly hyperactivity and impulsivity). Apart from the core symptoms, ADHD also impacts executive functions like working memory, impulse control, and the ability to switch between tasks as well as emotional regulation. Without appropriate intervention, ADHD can lead to significant challenges in school, relationships, employment, self-esteem, and even higher risks of substance abuse and mental health issues. Individuals with ADHD are more likely to engage in high-risk behaviours and are nearly twice as likely to develop an alcohol use disorder or other substance abuse problem. In a school environment in particular, a child's self-esteem often suffers when they are labelled as “naughty”, “lazy” or are being criticised for not meeting expectations when in reality, their brain wiring makes some things much harder for them than it is for their peers. This is why understanding ADHD, its implications if left untreated and how medication works, is vital.
Despite the well-researched benefits of ADHD medication, many parents and individuals hesitate to use it. We believe this hesitation often stems from misconceptions and stigma around medication. The ADHD stimulant medications that are currently prescribed in Australia are dexamphetamine, lisdexamfetamine and methylphenidate. Methylphenidate is available as a short-acting preparation (eg. Ritalin), and as a long-acting or extended release preparation (eg. Ritalin LA or Concerta). Short-acting Ritalin generally is effective for around 4 hours, whereas Ritalin LA and Concerta are effective for around 8-10 hours. Lisdexamfetamine is available as Vyvance in Australia, and is noted to be one of the longest acting medication on the Australian market. Stimulant medication is the first line of treatment for ADHD. These medications don’t ‘cure’ ADHD, but ‘effectively reduce’ core symptoms. They are effective for approximately 90% of people who try them. This is not to say that we shouldn’t explore alternative options, or seek to understand what else may be going on for yourself or your child but so far, the research has shown consistently that medication works better than other forms of treatments.
How does ADHD medication work?
Please note: In this explanation, we have simplified the technical terminology a lot for us all to understand - because who wants to read scientific jargon?!
Imagine your brain's neurons as students passing notes in class. In most people, neurotransmitters travel across the gap between nerve cells, called the synapse, and attach to receptors on the next cell. This process continues from one neuron to another, enabling you to think, feel, and act. For instance, one neuron signals, 'I need to do my washing,' and the message travels to the next neuron, helping you complete the task. In individuals with ADHD, this communication is disrupted as the neurons struggle to receive messages from other neurons effectively, due to a lack of neurotransmitters available - in particular dopamine and norepinephrine. Dopamine specifically is linked to reward, motivation and pleasure, while norepinephrine affects attention and the stress response. As individuals with ADHD have lower levels of these neurotransmitters (dopamine and norepinephrine), it especially affects brain areas responsible for self-control and executive functions, like the prefrontal cortex, making it harder to remember tasks or stay focused.
Stimulant medication works by increasing the levels of dopamine and norepinephrine in the brain. This increase helps neurons communicate better, improving attention, focus and impulse control. Going back to the example of “I need to do my washing”, for individuals with ADHD, when one neuron fires to say “I need to do my washing” - when not medicated, is not received by the other neuron to follow through on that task- therefore the information hasn’t been communicated effectively. If we think of this with our kids, imagine you ask them to pack away their clothes. Without medication, the neurons might not effectively pass on the message, leading to you having to remind them 10 times to pack away their clothes. With medication, the message is clearly communicated e.g. mum said I need to pack away my clothes, okay now I am going to go pack away my clothes - helping them follow through on tasks. So, what is happening here is medication is aiding brain communication as the message actually reaches the prefrontal cortex and allows the completion of the task. It is not that they are ‘lazy’, or ‘forgetful’ - their brain just needs that extra love to function more effectively. Additionally, medication helps reduce the intense 0-100 emotional reactions by giving the brain a chance to slow down and process steps in a more orderly manner. This prevents the frustration felt by either parent, child or both due to a mismatch of communication at no fault of anyones except for the brain not receiving the same amount of dopamine and norepinephrine that is needed for it to effectively communicate with.
Things to be aware of if you are on stimulant medication and have a menstrual cycle:
Your ADHD symptoms can change throughout your menstrual cycle due to hormone fluctuations. Estrogen is a hormone that increases dopamine levels in the brain and increases the brain's sensitivity to dopamine, which varies during your cycle. For example, Estrogen is lowest during week 1 (early follicular phase, right before your period) and week 4 (late luteal, right after your period) of your menstrual cycle. During these times, you might notice that your ADHD symptoms increase or feel more ‘severe’, and there is often a stark decrease in energy and an increase in depressive symptoms. This is why some women are diagnosed, or misdiagnosed with, Premenstrual Dysphoric Disorder (PMDD).
And, if you are on stimulant medication to manage your ADHD, it may feel like the medication is just not working during these low estrogen weeks. Why is this the case?
Well, that stimulant medication that you take every day actually works differently through the phases of your menstrual cycle - and it may not ‘work’ like it does in other weeks - especially in weeks 1 and weeks 4 (when estrogen is low). Estrogen helps your brain use dopamine effectively, and stimulants work essentially by increasing dopamine levels. But when estrogen is low, it doesn’t matter how much dopamine is present - it won’t be doing its job as effectively. So, in a nutshell - when estrogen is low, your brain may not use dopamine as efficiently, making the medication less effective.
Because of this, women with ADHD have articulated to benefit from what’s called ‘cyclical dosing’ - which is essentially adjusting medication doses at different times in your cycle, like increasing the dose before and after your period. However as with any changes to medication, you should always consult your treating psychiatrist or paediatirican first.
But what about the side effects?
If you are feeling worried or hesitant about treating your ADHD with medication, whether for yourself, your teen, or your child, we completely understand. There’s a lot of misunderstanding around how stimulant medication actually works. While common side effects like decreased appetite, sleep difficulties, and increased blood pressure are often minor and short-lived, we understand that the research on both long term effectiveness and long term side effects of stimulant medication is limited, and individuals should be evaluated for risk factors prior to initiating stimulant medication.
However with anything, it’s essential to explore all options and choose the best course of action because everyone is different! Although given the evidence supporting medication for treating ADHD, we do question the stigma around it. Therefore understanding how ADHD medication works can help break the stigma as stimulant medication aids in brain communication, essentially uncovering your or your loved one’s potential. Consider this - just as someone with diabetes takes insulin to manage their condition because they require it to function, an individual with ADHD may similarly need to take their medication to help their brain function more effectively.
For example, a 8yr old girl who was struggling with frequent soiling because her brain was having difficulty processing the need to stop an activity that she was so engaged with and use the bathroom to go to the toilet. Once medicated, her brain was better able to manage this basic function of connecting all of the dots. Her family reported “I wouldn’t have believed you a month ago if you said we would go from daily soiling to no soiling.” A 7yr old boy who was always in trouble for getting into everything, making noise constantly and not following instructions was able to do schoolwork and his parents reported they now felt able to take him to restaurants and family events without worrying about him disrupting everyone. Multiple adults not diagnosed until their 30s describe suddenly being able to stay on top of daily tasks like dishes, laundry and paying bills on time as well as cope with the demands of work and family life without becoming overwhelmed or burnt out and feeling like a “failure”.
Often, the benefits of finding the right medication far outweigh any potential side effects. When you take medication that helps your brain function at its best, you can finally achieve what once felt just out of reach. Medication can be an effective tool in helping your brain thrive. We understand the hesitancy surrounding medication, but we believe it's important to challenge the stigma and promote education about how medication truly works. Unlike some other treatments, stimulants start working immediately, so you can easily trial them for a few weeks to see if they’re the right fit for you or your child and if they're not, they're not and that’s okay.
Disclaimer: Medication advice should always be followed under the guidance of a qualified Pediatrician or Psychiatrist. This blog is not intended to replace professional medical advice. Instead, its purpose is to provide a simplified explanation—without the scientific jargon—of how medication affects the brain and how it can support improved functioning.
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