ADHD: The Stimulant Paradox

(Why ADHD stimulants work, and why they should be considered as part of a treatment program for people with ADHD.)

The conundrum

Why can someone with ADHD go from flat out, to dead calm when they’ve encountered something stimulating?

This is the question that has puzzled those with ADHD, and those who have studied this disorder.

More to the point, the lack of stimulation seems to be the key to causing hyperactivity and distraction in someone with ADHD.

And while this seems to be paradoxical, there is actually a perfectly sound explanation.

The key is dopamine

It would seem that the biggest issue that ADHD causes is a lack of dopamine, or at least a dysfunction in its use in the brain. And things that do not provide excitement leave the person with ADHD craving it.

Dopamine production is accomplished in different ways, but the quickest one is to engage in risk taking or adventure, or intensive activity.

It must be exciting to cause an adequate increase in dopamine, and if it isn’t, the behavior will escalate until it does, or until something goes wrong.

So what happens when a stimulant is administered?

The logic would suggest that a stimulant would cause the hyperactivity to increase. And yet, we know that this is not what happens. Why?

The answer lies in the the fact that people with ADHD are not hyperactive because they desire to be. They do not engage in risk taking or adventurous behavior because they like to take risks or engage in adventures necessarily. They do it because the dopamine helps them to focus, to think clearly. If anything could be said to be a true paradox about ADHD, it would be that they need the dopamine to feel calm.

Once a stimulant is administered, there is a resultant increase in dopamine. This leaves the person with ADHD not needing to do anything to increase their dopamine.

Once the need to elevate dopamine levels is removed, the person with ADHD can focus and concentrate without having to engage in hyperactive, adventurous, or risk taking behavior.

Should stimulants always be prescribed?

The answer to this question, is of course not. But they should always be considered and in most cases they should be given a trial. The sad truth is that many people with ADHD, especially youths who are enduring the additional stresses of final development and learning to fit in to their community, who do not receive a prescription will find something to substitute.

Street drugs, misused prescription drugs, alcohol, gambling, reckless driving, risky sexual behavior and sometimes criminal behavior are all stimulating substitutes for dopamine surges. It seems that youth in need of ADHD treatment who are denied medication will find a way to medicate themselves.

Be aware that dosage and type are important

It should also be noted here that one prescription of one ADHD medication at one dosage level is not an adequate test to see if ADHD medication is the answer. Some people have no response to one dosage but may have a very positive response to the next higher one. One person may experience to much stimulation on one dosage, but find just what they need in the next lower dosage. One person might also do well on Methylphenidate where another may have very little positive response to that medication. That same person who does not respond positively might find they are more receptive to Adderall.

The best approach to medication for ADHD is to arm yourself with a good doctor and an open mind. If medication doesn’t work for you, there are other treatments. But those other treatments can be explored while on medication and could be more effective while on medication.

Our advice is, if you want to be the best you that you can be, find the things that help you do that, and use them.

ADHD does not have to limit you, but you need not limit yourself either.