Attention-deficit hyperactivity disorder (ADHD or ADD) is a behavior disorder characterized by attention difficulty, hyperactivity, and impulsiveness.  These symptoms usually occur together, however, one may occur without the other. ADHD is generally diagnosed and treated by your in-person primary care doctor, often with the help of psychiatrists and psychologists.

Symptoms of ADHD typically begin before age 12, have lasted six months or more, and occur in two or more different settings (such as both at home and at work). In many cases, people who’ve had symptoms most of their life don’t get tested or diagnosed until adulthood.

Telemedicine care of ADHD has important limitations. If you have already been assessed and diagnosed with ADHD by your in-person primary care doctor and are successfully taking only non-stimulant medication such as Strattera (atomoxetine), Wellbutrin (bupropion), or Norpramin (desipramine), you can make an appointment with a HealthTap online primary care doctor to ask about refills or medication follow-up. Because stimulant ADHD medications are controlled substances, HealthTap cannot process refills on these.

HealthTap’s online 24/7 Urgent Care clinic, however, is not for ADHD issues or medications. It is geared more for concerns related to illness or acute pain that occur outside of typical office hours. Most importantly, you should see your in-person doctor outside of HealthTap if you need an initial evaluation or psychological testing for suspected ADHD symptoms.

General information about the three categories of ADHD:

Inattentive ADHD – a person has six or more of the following symptoms:

• Making careless mistakes or overlooking details in homework, work, or other activities
• Difficulty holding attention to tasks
• Difficulty listening when spoken to directly
• Difficulty following through on instructions or failing to finish tasks
• Disorganization
• Avoiding or disliking tasks that require "sustained mental effort"
• Losing things
• High distractibility by external stimuli or thoughts
• Forgetfulness in activities

Hyperactive-impulsive ADHD – a person has six or more of the following symptoms:

• Fidgeting or squirming
• Leaving their seat at inappropriate times
• Running or climbing at inappropriate times
• Making noise when working or playing
• Moving as if they are "on the go" or "driven by a motor"
• Talking excessively
• Blurting out answers before someone finishes their question
• Difficulty waiting their turn
• Interrupting in conversations

Combined-type ADHD – a person meets the criteria for both inattentive-type and hyperactive/impulsive-type ADHD

ADHD Treatment: Stimulant and Non-stimulant Medications

Stimulants (methylphenidate and amphetamines) 

These are the main type of medications for treating ADHD. They are considered controlled substances, which is why they are not available from HealthTap.

• Methylphenidate stimulants (Ritalin, Metadate and Concerta) are either prescribed in short-acting or long-acting (sustained release) forms. In addition to oral forms, a methylphenidate patch is available.

• *Amphetamine stimulants (Adderall and Vyvanse) can both be either short-acting (immediate release) or long-acting.

Non-stimulants (atomoxetine, bupropion, tricyclic antidepressants, and alpha agonists) 

These medications are less effective in treating ADHD than stimulants. The non-stimulants may be prescribed in HealthTap’s Primary Care clinic when medically appropriate.

• Atomoxetine (Strattera) is an ADHD medication with little or no abuse potential, in contrast to stimulant medications. Atomoxetine decreases the inattention and hyperactivity-impulsivity symptoms.

• Bupropion (Wellbutrin, Forfivo, Zyban) is an antidepressant that also helps treat symptoms of ADHD. Unlike stimulants, the improvements from bupropion may take up to several weeks to appear. Because bupropion is useful for the treatment of depression or smoking cessation, it is a good choice for adults with ADHD plus depression and nicotine addiction.

• Tricyclic antidepressants (TCAs) such as desipramine (Norpramin) are useful in treating patients with ADHD, especially in patients with ADHD plus depression or anxiety disorders. However, TCAs are less effective than stimulants and, due to some possible side effects, are tolerated less well than stimulants, atomoxetine or bupropion.

• Alpha-2 adrenergic agonists — clonidine and guanfacine seem to be helpful in children and adolescents with ADHD and is a “third choice” medication after the stimulants and non-stimulants mentioned above. The effectiveness of clonidine (Catapres) or guanfacine (Intunive) in treating adults with ADHD is uncertain. Clonidine has some abuse potential, so it is best managed by a patient’s in-person doctor instead of online.

Psychological Testing or Talk Therapy Outside of HealthTap

If you think you may have ADHD and haven’t been diagnosed, you can speak with your in-person primary care doctor about a neuropsychological test. Currently, HealthTap does not offer this test.

Talk therapy, such as counseling with a psychologist or psychiatrist, may be helpful in understanding ADHD symptoms. Your in-person primary care doctor may be hable to make recommendations, or you can search for a doctor on your own. Counseling is not available on HealthTap, but we do offer an introductory discount coupon for Talkspace.com – an online mental health provider.