7 Keys to Successful (and Safe) Medication Treatment for ADD

image via Flickr, Purple Sherbet Photography

image via Flickr, Purple Sherbet Photography

Medication is often needed to help individuals optimally manage their ADD.

Without the aide of medication, it is almost impossible for most individuals with ADD to function to the best of their abilities and take advantage of other intervention strategies.

Yet, fear of medication, much of it unfounded, stands as a major barrier for many people to even take the step to get evaluated for ADD, let alone begin treatment for it.  Based upon more than 30 years of experience with over 10,000 patients with ADD, I’ve found there are seven keys to a successful and safe experience with medication.

  1. Find the right physician.

    Successful management of ADD requires that prescribing physicians have had specific ADD training and lots of experience working with ADD and the medications used to treat it.  They should have strong communication skills, the willingness to listen to your concerns and address them in a timely manner and a commitment to providing regular long-term follow-up. Critically evaluate your physician and his/her approach before you commit to medication treatment.

  1. Get an accurate diagnosis.

    Most knowledgeable physicians follow systematic procedures to arrive at an accurate diagnosis.  This may include the use of checklists, questionnaires, structured interviews, and ideally, some objective testing of attention abilities.  It’s one thing to hear about symptoms from a patient or significant other, but actually observing the individual’s attention during testing raises the reliability and validity of a physician’s ability to diagnose ADD to a whole different level.  Objective testing helps sort out individuals who don’t really have ADD and weed out those who might be drug seeking.  It also provides a baseline that can be used to accurately judge responsiveness to medication treatment. Response to a trial of medication should never be used as a diagnostic test!

  1. Make sure someone looks at the whole you.

    Each individual with ADD has their own unique profile…different temperaments, skills, abilities, health status, life experiences, attitudes, and beliefs.  Understanding these individual differences and their potential impact on medication treatment are critical for a successful experience.  Incorporating them into the process can help you and your physician interpret and manage apparent side effects and comply with the appropriate medication regimen.  More than 70% of individuals with ADD have co-existing mental health and/or chronic medical problems, sometimes as a consequence of untreated ADD.  If these go unrecognized or untreated, they can sabotage a successful experience with medication.

  1. Participate in objective medication trial tests.

    image via Flickr, Purple Sherbet Photography

    image via Flickr, Purple Sherbet Photography

    Judging the effectiveness of a given dosage or regimen of medication by relying on informal, unstructured observations or simple checklist/behavior ratings forms is fraught with difficulties.  Some observers don’t really understand what they should be looking for or have preconceived ideas about what should or shouldn’t happen, while others may have attitudes or beliefs about medication that color their observations.  The context of where people are making their observations can also result in great variability…monitoring effectiveness in a structured classroom is very different from watching a child play with peers in the backyard or sit in front of the TV or computer.  Asking an adult with ADD “How’s it going?” is like asking the blind to lead the blind…what it takes to make accurate self-observations is good attention and that’s the very thing they don’t have!  It is far better to find the right starting dose for a particular medication by participating in serial objective tests of attention on various doses of medication beginning with the lowest one that could make a difference and advancing as needed until an optimal dose is found.  This process helps ensure that the initial starting dose that you or your child starts taking in the real world is in the right ball park.  Then, fine tuning can be done based upon targeted observations in multiple life arenas.  The right medication, dosage, and daily regimen varies greatly from individual to individual based upon their unique attentional profile, degree of their problem, and the genetically-based way they metabolize various medications.  It is not uncommon for an optimal medication regimen to exceed the drug manufacturer’s marketing guidelines.

  1. Request a regimen that provides you all day coverage.

    ADD is a neurologically-based problem that is present 24 hours per day, 7 days a week, 365 days a year.  It affects all aspects of life functioning.  As the day proceeds, the demands for efficient attention don’t decrease, they actually increase…it’s harder to pay attention during homework time, completing chores, maintaining healthy eating habits, driving a car, controlling emotional reactions, and communicating with others than it is to pay attention at school or work.  Therefore, individuals with ADD should have medication regimens that give them good attention from as close to the moment they wake up in the morning to the time they go to bed at night.  This might require using different combinations of medications: multiple doses of a short-acting medication, a long-acting combined with a short-acting, 2 doses of a long-acting or a stimulant in combination with a non-stimulant (e.g., Strattera).  It is safe to take multiple doses of these medications during the day because their effects are not additive.  More importantly, all day coverage helps reduce the serious risks that come with untreated ADD.  All day, all week coverage actually helps reduce the frequency of more common side effects such as appetite suppression and sleep disruption.

  1. Establish and maintain a Healthy Daily Routine (HDR).

    Having a balanced HDR is probably the most important thing you can do to have a positive experience with medication treatment for ADD.  Maintaining a predictable bedtime and wake time seven days a week, eating at least three meals a day, getting daily aerobic exercise, practicing some type of mind centering every day, and setting up a structure for staying on top of daily responsibilities provide an important foundation for success with medication.  Each of the elements of a balanced HDR in and of themselves helps improve aspects of your attention and your ability to regulate your behavior.  As a result, the medication doesn’t have to work so hard to get you to where you need to be, which could mean being able to use lower doses of the medications.  A balanced HDR will also help eliminate or reduce many of the more common side effects that occasionally occur with the medications used to treat ADD.  So, Get Balance!  It’s good for ADD, it minimizes side effects, makes the medication experience go more smoothly, and it’s the right thing to do for your overall health.

  1. Never use medication as the sole form of treatment.

    image via Flickr, Purple Sherbet Photography

    image via Flickr, Purple Sherbet Photography

    Relying on medication as the sole form of treatment is a setup for problems.  Dramatic things can happen when an individual with ADD starts using a proper medication regimen.  Many positive things will happen: you’ll be more alert during the day, less impulsive, less distractible, and better able to sustain your focus.  These changes may lead to increased performance at school and work, better follow through with responsibilities, greater behavior control and improved relationships with others.  However, the medication opens up a “new world”, not only the good but also a greater awareness of problem areas.  If you’re a sensitive, intense person, there may be more things to be sensitive and intense about, you may tune into areas where you have been dropping the ball, or behaviors that are problematic and irritating to others.  Therefore, having improved attention can be difficult, anxiety producing or even depressing.  Sometimes these consequences of improved self-awareness are misinterpreted as side effects of the medication.

Most individuals starting medication need support to understand and cope with this “new world” and develop new strategies to address problems with emotional regulation, independent functioning, and social/communication difficulties that they become more aware of.  Having an experienced counselor or coach to help lead you down a path to success is critical.  They can help you process your experiences, define the contributors to your problems, brainstorm new strategies to address problems, and support acceptance of who you really are.  In addition, they can help you establish and maintain the all important HDR.  Medication treatment for ADD goes much better when you walk down this new path with an experienced guide!


Dr. Craig B. Liden | The Being Well CenterCraig B. Liden, MD  is an internationally recognized expert in the diagnosis and treatment of ADD/ADHD.  Since the 1980’s, Dr. Liden has been in private practice evaluating and treating behavior and developmental issues across the life span.   He has treated more than 10,000 patients with ADD/ADHD and related co-morbidities.  Dr. Liden  has written and lectured extensively about ADD/ADHD, education, individual differences and a variety of health problems, most recently publishing Accommodations for Success: A Guide and Workbook for Creating 504 Agreements and IEP’s for Children with ADD/ADHD and ADD/ADHD Basics 101: How to Be A Good Consumer of Diagnostic and Treatment Services for ADD/ADHD.   Dr. Liden is the Founder and Medical Director of The Being Well Center located in Pittsburgh, PA.  He is available for speaking engagements, workshops, and interviews.

Pay Attention!  5 Things You Need to Know (but don’t) About ADD/ADHD

Dr. Craig Liden | The Being Well Center

Based on my observations and studies treating ADD for the past 30 years, it’s fair to say that ADD touches upward of 20% of our population.  More than ever, we need to understand this often misunderstood, misaligned disorder.

People who are treating their ADD are living and thriving.  Let’s make the path to accurate diagnosis and effective treatment plans clear for all.

5 Things Everyone Should Know About ADD/ADHD:

1.    Attention Deficit Disorder is very common in adults. It is suspected that 1 in 25 adults has ADD.  However, only half have been properly diagnosed and less than a quarter are being properly treated.

2.    Untreated adult ADD can result in many chronic issues: obesity, chronic bowel problems, addiction disorders, depression/anxiety, and college failure, not to mention failed relationships, accidents, or poor job performance.  Properly diagnosing and treating ADD could have a huge impact on our society and health care system.

3.    Proper treatment of ADD with medication and counseling always starts with a comprehensive, diagnostic evaluation that includes objective testing, feedback from various members of the patient’s life, and a look at the whole person.

4.    Risks associated with correct medication use are minimal compared to the risks of untreated ADD.  Medication is often necessary but never sufficient and should always be paired with supportive counseling.  Stimulant medications used to treat ADD are generally very safe and are not addictive.

5.    The preferred name for ADD/ADHD is ADD since “Hyperactivity” is only one of many symptoms of ADD patients and shows up in less than 10% of those diagnosed.

Dr. Craig Liden is the Founder and Medical Director of The Being Well Center, an ADD/ADHD diagnostic and treatment center in Pittsburgh, PA that has helped more than 10,000 people worldwide living with ADD.

TRANShealth Inc. is sponsoring a free download of Dr. Liden’s book, ADD/ADHD Basics 101, in which Dr. Liden gives 10 steps to securing a diagnosis and treatment plan you can trust. 

 

What Happens After ADD/ADHD Medication?

What actually happens when a person starts taking ADD/ADHD medications?

At a most basic level, ADD/ADHD medications work to increase an individual’s arousal level to some greater or lesser degree. In addition to becoming more alert, he becomes more reflective, less distractible, and better able to focus and sustain his concentration for longer periods of time. He begins to tune in to the impact of his behavior and the quality of his performance.

image via Flickr, devinf

image via Flickr, devinf

As a result of these improvements in attention, the person’s overall awareness of himself improves; he begins to think – to use that little voice in his head. This, in turn, makes for improved self-control and more effective problem-solving.

How these dramatic changes in attention actually affect individuals with ADD varies considerably depending upon their underlying temperament, status of their skills and abilities, and the circumstances of their lives. For the majority of individuals, at least initially, this can be an awe inspiring experience similar to that which I went through when I first got my glasses: “Wow, there are leaves on the trees.” I was obsessed for several days with looking at people’s faces, enthralled with the features I had not noticed for years and I rejoiced that I really didn’t need to buy a new TV . . . the picture was sharp and clear!

I have had many individuals express this same type of wonderment about their new world when starting medication. Some voraciously read for hours at a time, some started obsessively cleaning the house, some marveled at their ability to think clearly, and some talked incessantly sharing ideas that had been bottled up for years.

On the other hand, for some, the honeymoon is short lived. That’s because everything that happens when someone starts paying attention for the first time is not necessarily positive. For a child, this might mean a sudden realization that he is flunking at school, is behind the 8-ball at home, and that others have been laughing at him, not with him. Similarly, with an adult, it can be devastating for her to tune into the fact that she has $40,000 in credit card debt, is 50 pounds overweight, and is in a relationship based on need, not love.

Such sudden realizations of the circumstances of life and ADD’s impact can precipitate the emergence of new problems like depression and anxiety, which require support, management and, sometimes, other medical treatments. This is one of the key reasons I believe the medications should never be used by themselves, but always in combination with other supportive therapies.


Dr. Liden is the Founder and Medical Director of The Being Well Center, located in Pittsburgh, PA.  For more of his 30-years’-expertise insights into effective treatment of ADD, download ADD/ADHD Basics 101.  Join our discussion on the 7 Keys to Successful (and Safe) Medication Treatment

5 Ways to Remember to Take ADD/ADHD Medication

5 Ways to Remember ADD Medication | The Being Well Center

image via Flickr, Tim Pierce

1.  Depend on Grown-up Support Already in Place

Remembering to take medication every day or multiple times during the day can be a challenge for anyone and is even more so for the individual with ADD. When treating young children, it is not generally a big issue because parents, teachers, and school nurses take on the responsibility of giving the medication.

2.  Medicate Parents First

The exception is when one or both parents also have ADD and then forgetting to have their children take the medication becomes another symptom of untreated ADD. This is one of the reasons I prefer to diagnose and treat the parents first when a parent-child combo comes to my office for help.

3.  Give Adolescents FULL Responsibility

As children get older and move into adolescence and adulthood, assuming full responsibility for remembering to take the medication needs to be a top priority. I often encourage parents to use responsible taking of the medication as a “ticket of admission” to other important big life privileges like driving a car or going out with friends. In fact, my words to my own son were: “If I can’t trust you to take the medication without reminders, then how can I trust you to make the difficult right decisions out in the world?”

4.  Develop an Established Daily Routine

image via Flickr, Santiago Nicolau

image via Flickr, Santiago Nicolau

The single most important tool in remembering to take medication is helping the ADD individual to develop an established daily routine for sleeping, eating, exercise, and other activities of daily living. In the context of a structured daily routine, it becomes easy to find times to consistently take medication. For example, a three-times-a-day medication regimen of short-acting stimulants can be tied to mealtimes. A once-a-day medication like Strattera can always be taken with breakfast or dinner. The most difficult medication administration schedules to structure are the twice-a-day regimen required for the long-acting stimulants. The key again is to try to tie taking the medication into another regularly occurring activity.

One suggestion often made to ADD individuals is to use devices such as timers, watches, or pill containers with timers and buzzers. In theory, these tools should work, but our experience has been that they often become just one more thing to deal with, lose, or forget. Ultimately, the successful use of these tools is also dependent on the establishment of a structured daily routine – to set the timer, fill the container, etc. So, we put the focus on the establishment of a daily routine.

5.  Commit to Using Medication

Finally, when it comes to consistently taking the medication, it is critical that the individual is truly committed to the use of medication. Sometimes what appears to be a problem remembering to take medication is really a problem with acceptance of the ADD diagnosis and the need to take medication in order to function effectively and behave appropriately. Under such circumstances, support with acceptance is more important than any reminder system.


What tips, tricks, reminders, or advice help you remember your ADD/ADHD medication?

 

Does Your Age Matter in ADD Medications?

At what age can you start using ADD/ADHD medications?

image via Flickr, David Robert Bliwas

image via Flickr, David Robert Bliwas

None of these medications have a formal “indication” (i.e., approval by the FDA) for use in children under the age of 6 years. However, experienced physicians like myself are frequently called upon to evaluate and treat preschoolers. Oftentimes, these are some of the most challenging situations.

Children who present with ADD at this age often have profound attentional weaknesses that are associated with extreme temperamental traits and significant developmental delays.

In my experience, if the attentional component of these children’s problems is not treated with medication, it is unlikely progress can be made to correct or remediate other associated difficulties.

Therefore, in many of these circumstances, I have carefully and successfully used the stimulants and the non-stimulant, Strattera. I have had particular success using the stimulants Dexedrine and Dextrostat in ADD preschoolers who have associated language delays. Because children at this age generally can’t swallow pills, it may be necessary to use medications like Metadate that can be sprinkled on food. It is my opinion that only the most experienced clinicians should take on this difficult population.

Equally challenging are those ADD preschoolers whose behaviors are difficult to distinguish from normal. Some degree of distractibility, short attention span, and impulsivity can be the norm in children 3 to 6 years.

When is it a problem?

Do we just wait and hope he grows out of it?

Does failure to identify and begin treatment put the child at risk for learning failure, behavior control difficulty, poor peer relationships, and low self-esteem?

These are difficult questions. Again, my bias is that they require the expertise of a physician highly experienced with ADD. If, after a thorough evaluation, such a clinician is able to make the diagnosis of ADD, then there is no good reason to delay treatment with these medications.

Can these medications be used in adults with ADD?

image via Flickr, Steve Wilson

image via Flickr, Steve Wilson

All of the medications used to treat ADD are just as effective in adults as they are in children and adolescents. The underlying biological differences that cause the symptoms of ADD remain relatively stable from childhood through adult life.

Therefore, it makes sense that if the medications can help correct these differences in childhood, they should be able to do the same in adults.

At the present time, Strattera is the only medication that has a formal indication for use in adults. However, all of the stimulants have been used safely for many years in the treatment of ADD adults.

Obviously, the dosage levels required for adults are often different from those that are effective for children. Similarly, some of the side effects children and adults experience are different. In all other respects, however, use of these medications is the same in adults and children.


You’re not alone if you’re nervous about ADD/ADHD medication.  Public debate, often fueled by bias and misinformation, has stirred up a cloud of fear around effective medication treatment options.  In our practice, we’ve seen time and again that medication can be a powerful tool in treating ADD.  Don’t miss 7 Keys to Successful (and Safe) Medication Treatment for ADD!

No Pill, No Problem: Why I Denied My Son Had ADD/ADHD

image via Flickr, Angel Breton

image via Flickr, Angel Breton

There has been a great deal of heated public debate about the use and misuse of medication in the treatment of ADD. This debate has been clouded by intense reactions rooted in strong attitudes, beliefs, and misconceptions. As a result, many people, unnecessarily, fear the use of medication. It is my hope that an objective, comprehensive, and responsible discussion of medication will open some closed minds, dispel fears, calm anxiety, provide new perspectives, and clarify misunderstanding.

If the medications are so important, what stands in the way of people using them?

In my experience, one of the most common reasons people hesitate to use medication in the treatment of ADD is lack of acceptance.

There is no escaping the fact that you have a problem when you take a pill for it and, frankly, nobody wants to have a problem.

In my own circumstance, I saw the signs of ADD in my older son when he was 9 months old, but the words “Attention Deficit Disorder” didn’t touch my lips until he was 9 years old!  This was a reflection of my struggle with acceptance . . . he looked perfectly normal on the outside and I didn’t want him to have a problem on the inside. I wrote off his impulsivity and distractibility as immaturity or his being “all boy.”  In turn, I constantly nagged him and tightly structured every part of his life. By the time he finally got proper treatment with medication, I had inadvertently contributed to deflating his self-esteem.

When one of the most important people in your life is repeatedly saying, “You could do better if you tried harder” and despite your best efforts, you don’t measure up, you’re left thinking you must be either “lazy” or “stupid.”

So, by allowing things to get to the “last resort” before using medication, we run the risk of contributing to the development of a vicious failure cycle. The resulting low self-esteem and poor motivation make effective treatment much more difficult.

Furthermore, without the medication as an aide, the ADD individual is at high risk for over-relying on his parents, spouse, teachers, boss, and others in his life for reminders and structuring.  This promotes an unhealthy co-dependency and enables the ADD individual to avoid taking responsibility for his behavior.

Succeed in the Workplace in Spite of ADD

Are there jobs that are particularly good for the ADD adult?

image via Flickr, Nana B Agyei

image via Flickr, Nana B Agyei

It may seem that the presence of certain ADD traits make the ADD adult better suited for some jobs than others. However, we can find successful ADD adults in almost all jobs and all kinds of work.

Each person with ADD has a unique set of strengths and weaknesses that work together in a complex way to create ‘fits’ in world of work.

It is simplistic to think that an individual’s attentional characteristics, in isolation, should influence his career choice over the careful consideration of all parts of who he is.

What can an adult with ADD do in the workplace when ADD is interfering with job performance?

ADD can interfere with job performance in countless ways. Productivity problems, poor performance reviews, or probationary status may be indications that attention weaknesses are negatively impacting in the workplace.

When this occurs, the adult with ADD may invoke the Americans with Disabilities Act (ADA). Under this law, employers may be required to make accommodations that allow the person with a disability to be successful on the job.

In my experience, calling upon the ADA should be done cautiously and only when employment is at risk. When, upon considering the risks involved in sharing personal medical information with an employer, the adult with ADD chooses to invoke the ADA, he may begin by discussing with his employer, his disability, its impact upon job performance, and his request for accommodations.

When the request for accommodations are “reasonable” and will not cause the employer “undue hardship” or alter the job basic requirements, the employer is required to make those or similar accommodations.


Don’t miss our prior discussion about when and how much to share with your employer about ADD!

Behavior Change for the Adult with ADD

How does the adult with ADD work toward positive behavior change?

image via Flickr, Esther Gibbons

image via Flickr, Esther Gibbons

In my experience, the journey toward positive behavior change for the ADD adult begins with an experienced professional leading him through the same steps we encourage parents, teachers and childcare providers to use in managing behavior in children with ADD. That is, we help the adult with ADD to do the following:

  • Know who he is. It is important that he understand and accept his temperamental characteristics, his skills and abilities, his attentional abilities, his physical abilities, the stresses in his life, his attitudes and beliefs, and his self-esteem. He must understand which of these are changeable and which are not.
  • Set realistic expectations for himself. Based upon his understanding of his own unique profile of strengths and weaknesses, he defines behaviors are achievable for him.
  • Determine the factors contributing to an unproductive behavior and/or situation when it occurs.   In doing this, he asks himself the following questions:

◦ What is the expectation that is not being met?

◦ What are all the contributors to this failure?

◦ What role do I play in this?

◦ What role do factors outside of me play?

◦ What contributing factors are changeable and which are unchangeable or out of my control?

  • Develop a plan and put it into action. He refines the expectation as needed, and defines thoughts, actions, words and strategies that address all the factors that are under his control to maximize success at realizing the expectation, and tries it out in the real world.
  • Refine the plan when necessary. He reflects upon the success of the plan, and makes changes in the plan by modifying the expectation, the thoughts, words, action, and/or strategies.

In repeatedly guiding the adult with ADD through this sequence, the professional gives the adult progressively more responsibility. Ultimately, the adult becomes an independent problem-solver able to critically evaluate and modify his behavior in nearly any situation. In my experience, my adult patients who are open and committed to learning about themselves and how to effectively solve problems grow wise and become confident in their ability to deal with whatever is thrown their way.

How do limiting setting and use of consequences work with adults?

image via Flickr, Kaitlyn Rose

image via Flickr, Kaitlyn Rose

In adult life, limits and consequences are not generally defined in treatment or by supportive parents and teachers. Usually, it is our employer, our spouse, our friends, the police, the IRS, the bank, etc. who impose them.

Further, the limits are not always clearly defined and the consequences are often very serious. Treatment activities with the ADD adult involve clarifying the reality of the limits, defining strategies that promote success in meeting expectations, supporting and brainstorming plans when consequences do occur, and working with spouses, friends, and parents to help them allow the sometimes serious consequences to occur.


ADD/ADHD creates life challenges unique to each life stage.  Seek out care providers who have an appreciation for the challenges specific to adult expectations.  For help identifying a qualified care provider in your area, download Dr. Liden’s book, ADD/ADHD Basics 101.