Four Steps to Managing ADD/ADHD Effectively with Medication

Managing ADHD Effectively with Medication | The Being Well Center's 4-Step ApproachIn our specialty practice, we have now had the opportunity to care for more than 10,000 patients with ADD/ADHD over the past 35 years. Our youngest patient is 3 years old and our oldest well into her 90’s.

We have had the unique opportunity to watch ADD/ADHD across the lifespan from early childhood to late adolescence, from young adult life to mid-adult life, and from mid-adult life to the senior years. We know of very few individuals or medical practices in the world who have had the same extensive clinical experience with ADD/ADHD and the stimulant medications as we have had.

Several years ago, Dr. Liden was asked to present a peer reviewed paper at the first International Conference on Attention Deficit Disorders in Jerusalem, Israel sponsored by the Hebrew University of Jerusalem, entitled: “TRANSACT: Toward a Standard of Care for ADD.” Our approach to diagnosis and treatment including the use of medication was the only multidisciplinary clinical program selected for presentation at this first International Conference on ADD/ADHD. We received uniformly positive feedback from other physicians attending this conference.

Since 1980, we have conducted hundreds of lectures and workshops for physicians and other health related professionals from across the country and around the world regarding ADD/ADHD and the use of medication. Dr. Liden has presented testimony to the U.S. Congressional Oversight Committee regarding the proper use of medication in ADHD. He has also sat on advisory boards for several pharmaceutical companies and has served on the board of ADDA, the national advocacy group for adults with ADD/ ADHD.

Based upon years of clinical experience and research and a review of the medical literature, we have developed a highly systematic protocol for the use of stimulants in treating patients with ADD/ADHD. The following are key features of our approach:

Managing ADHD Effectively with Medication | The Being Well Center's 4-Step ApproachStep One: A Comprehensive, Multidisciplinary Evaluation

All patients must first have a comprehensive, multidisciplinary evaluation (3 hours) that includes use of parent, child, and school questionnaires that survey the presenting concerns, efforts to address them, key life arenas where problems are appearing along with a review of the patients’ temperamental traits, readiness skills, attention and executive functioning, current and past health and mental health status, family history, attitudes, values and beliefs and a delineation of current daily routines for sleep, exercise, eating, stress management and other activities of daily living.

This is supplemented with a structured interview that probes areas of uncertainty from the questionnaire and delineates the course of the problem(s) over time.

All new patients participate in a neurodevelopmental survey of neuromaturational functioning, attention/executive functioning, expressive, receptive and pragmatic language skills, memory, problem-solving, and basic academic skills in reading, spelling, math, and written language.

All new patients undergo a targeted physical examination during which their mental status is also assessed.

At the conclusion of testing, patients/families meet with one of our medical directors to establish the ADD/ADHD diagnosis (if appropriate), identify any co-existing problems and generate a holistic profile of the individual’s strengths and weaknesses physically, emotionally, behaviorally, and educationally that helps develop a comprehensive treatment plan of which medication is only one part.

All patients receiving the ADD/ADHD diagnosis meet the DSM criteria at a minimum but also our refined criteria: chronic inattention and executive dysfunction, inattention and executive dysfunction apparent in multiple life spheres, evidence of attentional weaknesses and/or executive dysfunction on objective testing and the presence of neuromaturational delay (by history or through direct assessment using a standardized battery of “soft” neurological signs).

Managing ADHD Effectively with Medication | The Being Well Center's 4-Step ApproachStep Two: Ongoing Sessions with a Counselor

All patients who are prescribed medication must be involved with ongoing follow-up sessions with a professional counselor that are directed at improving self-awareness and self-control, establishing healthy daily routines, developing compensating strategies, and providing on-going emotional support. We never prescribe stimulant medication in isolation or as the sole mode of treatment for ADD/ADHD. We insist that our patients participate in the supportive follow- up visits on at least a monthly basis (or more frequently as needed) as a prerequisite for us to continue to write prescriptions for their ADD/ADHD medications.

Managing ADHD Effectively with Medication | The Being Well Center's 4-Step ApproachStep Three: Medication Trial Testing

After the initial comprehensive evaluation, all patients for whom stimulant medication is indicated are required to go through systematic medication trial testing in our office. This involves taking a dose of medication at home and coming into the office for an appointment at a time that corresponds to when the effect of that dose should be at its peak. While in the office, they undergo objective testing of attention using the FACES, a distinctive feature analysis task we have developed, or other objective measures of attention.

Results are compared to a previous baseline performance without medication. At the time of the medication trial visit, a physical assessment including vital signs and behavioral observations are made while the patient is on the medication to monitor for any adverse effects.

In conducting these trial tests, we use a set of prescribing guidelines from the American Academy of Pediatrics (2000) based on mg of generic, short-acting methylphenidate/kg body weight/dose, not on unsubstantiated absolute dosage limits as a starting point to select the initial dose for in-office trial testing. Using this basic formula, we calculate the equivalent mg/kg ratio for other medications that are not short-acting methylphenidate (e.g., Concerta, 18 mg = 5 mg methylphenidate, b.i.d.). The Academy’s position on medication is a reflection of many clinician’s experiences and the medical literature which shows increasing positive attention benefits as one moves up in the mg/ kg ratio (i.e., .7 mg/kg dose has a greater positive effect then .3 mg/kg dose). These guidelines have been signed off by all the major professional organizations including the FDA.

We inform all of our patients when the dosage we recommend via the Academy’s guidelines exceed the FDA approved manufacturer’s marketing guidelines and have them sign an informed consent.

Generally, we conduct the first trial test with a dose of the medication that falls around 0.3 mg/kg body weight with allowances made for the severity of the patient’s ADD/ADHD, his/her specific profile of attentional weaknesses, the presence of co-morbid conditions, and his/her previous experience with medication among other things. We repeat trial tests in the office until we find the lowest possible dose that gives significant positive objective benefits without adverse side effects.

Once the medication trials are complete, we have patients begin a 1-2 week clinical trial on what appears to be the optimal dose in order to assess the effectiveness of the medication in the real world and its duration of action. We may elect to begin the clinical trial with what was determined to be the “optimal dose” during the trials or we may elect to start at a lower dose and gradually titrate upwards using the “optimal dose” from the trials as a final “target.”

Three days into the clinical trial we have a brief phone follow-up with the patient or significant other to assess the initial response to the medication and identify any untoward effects that need to be addressed.

At the end of the 2-week clinical trial period, we receive feedback from patients, parents, spouses, teachers, and/or employers, as the case may be, during in-office interviews and through objective feedback forms sent to schools. We make adjustments in the medication regimen accordingly to ensure optimal coverage for the waking day and to eliminate or reduce any negative side effects.

Using this approach, the overwhelming majority of our patients take doses of the medicine that fall within the 2000 AAP Guidelines (i.e., 0.3 to 0.8 mg/kg/dose). Interestingly, many of these same doses which are within the Academy’s Guidelines fall outside the FDA approved manufacturers, non-scientifically-based marketing recommendations.

Many other specialists in the treatment of ADD/ADHD have shared with us that they have had similar experiences. For example, Dr. Til Davy from the Toronto Sick Children’s Hospital, a world class pediatric facility, has published a lead article in the Journal of Developmental and Behavioral Pediatrics, a specialty journal, describing his experience. Dr. Davy summarizes some of the key issues with stimulant dosing and states that in his experience some children with attention weaknesses require doses of Ritalin in excess of 300 mg per day and tolerate them well. He adds that there is no reason to view this as a maximum.

We are seeing an increasing number of adults with ADD/ADHD and they participate in the same structured protocol as above. In general, it has been our experience that adults with ADD/ADHD uniformly require higher absolute doses of medication compared to children though the mg/kg ratio per dose is oftentimes somewhat lower. We find that while weight can help point one in the right direction (perhaps as a reflection of brain size) it is the severity of the individual’s attentional problem that seems to have the biggest impact on determining the most appropriate dose.

Other specialists treating ADD/ADHD adults have also found the need to use higher doses than the manufacturer’s recommendations. Dr. Daniel Amen, a nationally recognized researcher and clinician in the area of ADD/ADHD, has written to us describing his experience with medication doses and it is very similar to the one that we have experienced. Similarly, Drs. Marc and Nicolas Schwartz who see large numbers of adults with ADD/ADHD have studied optimal stimulant dosing in their private practice and have found adults require optimal doses of all stimulants that fall above FDA-approved manufacturers’ guidelines.

Managing ADHD Effectively with Medication | The Being Well Center's 4-Step ApproachStep Four: Medication Review Visits

Once we have started patients on medication, we conduct a one-hour medication review visit every three to four months. At these visits, we re-assess attention either on or off medication
to document continued efficacy, monitor improvement and verify the need for continued use of the medicine. We also conduct an interview with the patient and significant others to monitor progress, identify problems, and respond to concerns. A targeted physical assessment including vital signs is conducted to monitor for any adverse effects. At the end of this visit, decisions are made about the medication (dosage, schedule, etc.) and the overall treatment plan is revised.

We look for every opportunity, if possible, to discontinue medication, but, not surprisingly, most of our patients seem to have significant problems which require long-term medication treatment. In carefully monitoring our patients, we have not identified any significant negative side effects with the stimulants that could be conclusively attributed to an off-label dosage/dosage regimen of medication prescribed.

We have found that most of the common side effects that occur with stimulants can be mitigated by adjusting the timing of medication, switching to another attention medication, helping patients establish and maintain balanced healthy daily routines, and providing ongoing supportive counseling in parallel with the medication.

The Cutting Edge of ADD/ADHD Management

We take our responsibility as health care providers extremely seriously and when applied to the management of ADD/ADHD, we feel that we are on the cutting edge. We have taken care to do things properly and have even submitted our approach to the State of Pennsylvania Medical Board, which found it to be in accordance with appropriate medical practice as defined by state statutes. We feel very confident and comfortable with the approach that we take with our ADD/ADHD patients.


If you’re new to Dr. Liden’s blog, you might want to Start Here to pick his brain on all topics ADD.  If you’re looking for a way to get a diagnosis and treatment plan you can trust, check out The Being Well Center’s Accurate Diagnosis Determination (A.D.D.).

Straight Facts on ADHD and Medication (Part 2)

Straight Facts on ADD Medication Part 2 | The Being Well CenterIn Part 1, we explored the essential key facts of ADD/ADHD and the unfounded fears surrounding medication treatment.  Today, we dig deeper into physician application of medication and why more, not less, medication, may be best for your situation.

State-of-the-art care may require more, not less, medication

State of the art care for Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ ADHD) frequently requires doses/dosage regimens of stimulant medications that are at variance with FDA approved manufacturer’s guidelines (i.e., off-label).

Lack of training and experience about ADD/ADHD and its pervasive nature, limited experience with the medications used to treat it, and a misunderstanding/ misinterpretation of the intent of the FDA approved guidelines promotes fear of off-label use of stimulant medications in patients and many professionals.

As a result, many patients who could greatly benefit from proper treatment receive sub-therapeutic dosage regimens or no treatment at all.

The medical literature provides ample support for the safe use of off-label doses/dosage regimens of stimulants in children and adults with ADD/ADHD when tailored to a patient’s individual needs. A national survey of family physicians, pediatricians, developmental pediatricians, and child/adult psychiatrists has shown that greater than 45% have prescribed stimulant mediations for ADD/ADHD off-label.

Technically speaking: Digging into the medical literature supporting off-label regimens

In general, the medical literature demonstrates that for most patients there is a linear dose-response curve with regards to stimulant medications. This means the higher the dose the greater the response. Other patients show no response at lower doses but require substantially more robust doses before they show any positive benefits.

These differences in medication responsiveness appear to reflect genetically-based individual differences in factors that affect how an individual metabolizes these drugs. We now have genetic testing that can facilitate a better understanding of why certain patients appear to be outliers when it comes to medication effectiveness and adverse effects.

Straight Facts on ADHD Medication | The Being Well CenterTherefore, in the presence of continued dysfunction in an ADD/ADHD individual, medication can legitimately be increased to the point that all day clinical efficacy is achieved or side effects become intolerable or unmanageable.

In our experience, this later issue is oftentimes very complicated. Clearly, the ADD/ADHD field could benefit from much more research into the use of medication and dosage levels in particular.

We feel that the major limitation of current medical literature is the significant heterogeneity of the ADD/ADHD population in terms of the degree of their problem and profile of underlying attentional weaknesses and executive dysfunctions along with the presence of individual differences in temperament and/or co-morbid conditions that have not been accounted for in study designs.

For supporting resource articles, click here (see page 10 of ADD/ADHD Basics 301).

A National Survey of Physicians Concurs

We have conducted a national survey of physicians regarding their prescribing practices with regards to ADD/ADHD. We obtained randomized samples (including geographic area) of membership lists from the American Academy of Family Practitioners (AAFP), the American Academy of Pediatrics (AAP), the American Psychiatric Association (APA), the Society of Developmental and Behavioral Pediatrics (SDBP), and the American Academy of Child and Adolescent Psychiatry (AACAP). Each physician was asked to complete a detailed questionnaire designed by a research psychologist with a strong background in marketing surveys.

ADD/ADHD Basics 301Results indicate that approximately 45% of all physicians responding had used stimulants in treating ADD/ ADHD at dosages greater than the FDA approved manufacturer’s marketing guidelines. Furthermore, as training and experience with ADD/ADHD increases, the percentage of physicians using higher doses increases (see tables on page 13 of ADD/ADHD Basics 301).

Our interpretation would be that as physicians get more training and more experience with ADD/ADHD, they come to recognize that it is frequently necessary to exceed FDA approved manufacturer’s marketing guidelines for stimulants in order to properly manage their patients in all life spheres throughout the working day.

Medication in Context of Multi-Modal Treatment

By using a systematic protocol that involves a comprehensive multidisciplinary assessment to first establish a valid ADD/ADHD diagnosis and identify related co-morbidities, objective in-office medication trial testing, and ongoing supportive counseling, we have safely incorporated off-label dosing regimens of stimulant mediations when needed to help our ADD/ADHD patients function effectively in all life spheres.

Read More:

5 Things You Need to Know About ADD/ADHD

7 Keys to Successful ADD/ADHD Medication Treatment

A Proven Formula for Success with ADD/ADHD Medication

Straight Facts on ADHD and Medication (Part I)

Key Facts about ADD and Medication | The Being Well CenterAt The Being Well Center, we have developed a particular expertise in the use of medication in the treatment of ADD/ADHD. To achieve a high degree of success when it comes to medication treatment for ADD/ADHD we have found that it is commonly necessary for us to use off-label medication doses and regimens (i.e., for any medication dosage form, dosage regimen, population, or other use presently not mentioned in the FDA approved manufacturers’ marketing guidelines). Predictably this can magnify the inherent fear many patients, family members, uninformed physicians, and pharmacists have about the stimulant medications and can put us at odds with insurance companies that are increasingly restricting their formularies for ADD/ ADHD medications by imposing arbitrary quantity limits for these medications and failing to reimburse off-label uses of stimulant medications to treat ADD/ADHD.

Key Facts for Medication and ADD

Here are some key facts that combat misinformation and fear in the use of medication to treat ADD/ADHD:

  • Manufacturer labeling including dosage guidelines for Ritalin and Dexedrine, the early forerunners of the methylphenidate and amphetamine-based stimulants of today, were initially approved by the FDA many decades ago. This was at a time prior to the more rigid approval standards used today. Original documents used by the manufacturers to support their prescribing guidelines (which were ultimately approved) provided no scientific basis for the recommendations made, but rather, anecdotal feedback from a small collection of physicians who had experience prescribing the medications at that time.
  • These approved labels including manufacturer’s prescribing guidelines were subsequently grandfathered in when the United States Federal Food, Drug and Cosmetic Act (FD&C) was updated and amended. Therefore, books, clinical articles, professional society association pamphlets, drugstore/pharmacist printouts, package inserts, and other materials which use the FDA approved manufacturer’s marketing guidelines (i.e., the PDR) as the basis for their recommendations are probably the least scientifically reliable and valid pieces of information available to physicians to use in making informed decisions about stimulant medication dosages.
  • The manufacturer of a newer methylphenidate formulation, Concerta, worked out agreements with the FDA to get approval for its labeling and dosage guidelines without having to undergo extensive and expensive dosing studies provided that it adhered to dose recommendations that were equivalent to the FDA approved, yet unscientifically-determined, dosage recommendations for Ritalin. This means that the FDA approved manufacturer’s prescribing guidelines for one of the most popular medications used to treat ADHD, Concerta, are more than 50 years out of date.
  • The FDA has set a standard for medications used to treat ADD/ADHD that, to receive approval, manufacturers must demonstrate a 30% reduction in core symptomatology in blinded controlled trials in groups of individuals with and without ADD/ADHD using responses on FDA approved questionnaires or through behavior ratings from structured observations of subjects. The goal for pharmaceutical companies is to generate data to meet this standard for approval by using the lowest dose that shows group efficacy and the lack of deleterious side effects not what was the most effective dosage for individual participants. While this standard may be appropriate for manufacturers with regards to approval for marketing their products to the masses, it is out of sync with the real world realities of finding and using the most effective dosing regimens to properly treat an individual with ADD/ADHD. Most experts now agree that clinicians treating individuals with ADD/ADHD should be striving to provide 100% symptom relief (i.e., remission) throughout the entire waking day. Logically, this means that many ADD/ADHD patients might require dosages that are at variance with FDA approved manufacturer’s marketing guidelines in order to receive optimal care.
    • Once a drug is approved for use, it would be illegal for a pharmaceutical company to market it or make recommendations that are at variance with the original FDA approved guidelines even when years of clinical practice and the medical literature might suggest significant variations are warranted. Furthermore, senior management of pharmaceutical companies have told us and others that there is no incentive, in fact, significant disincentives, (i.e., exorbitant costs of conducting additional research to meet current FDA requirements and enhanced liability exposure) for them to generate more data with costly new trials to support approval of secondary indications or expanded dosages when off-label use is so common (40-60% of all prescriptions written) and sales of these products are so strong.
    • FDA approval of manufacturer’s marketing guidelines sets the parameters by which pharmaceutical companies can market their products to physicians and the public. However, they are not intended to dictate medical care. In fact, by the provisions of the FD&C Act, once a medication is approved by the FDA for marketing, physicians can prescribe it off-label for whatever conditions and at whatever dosage schedule they deem necessary to meet a given patient’s needs. In fact, off-label use of medications is an accepted and valuable part of quality care of a patient when used by physicians ethically and according to their best knowledge and judgment. Many organizations and experts have weighed in on the off-label use of medications and the consensus would appear to be that it represents good medical practice when the following pre-requisites are meet:
      1. The prescriber has experience and familiarity with the medication and the patient being treated
      2. No other alternatives are available
      3. Sound medical evidence in the published literature and/or other expert physicians support the intended use
      4. Efficacy and safety are closely monitored and documented

    Therefore, off-label use of stimulants above or outside of the FDA approved manufacturer’s recommended dosage schedule in marketing materials by experienced healthcare providers is not only permissible, but could actually be indicated to meet certain individual patient needs when there is either justification in the medical literature or evidence that peers with similar training and experience are prescribing them in this fashion. We will provide information in this white paper that confirms that both of these criteria are met when it comes to off-label use of stimulant medications for ADD/ADHD.


    Check back later this week for more Key Facts about ADD and Medication.  Don’t miss a post! Subscribe to our blog right now! Just register your email in the upper right-hand corner of this page.  We’d love to have you with us as we discuss the truth about ADD/ADHD!

A Proven Formula for Success with ADHD and Medication

image via Flickr | Purple Sherbet Photography

image via Flickr | Purple Sherbet Photography

ADD/ADHD has been a provocative topic in lay and professional communities for decades: What is it? Does it really exist? What causes it? How is it diagnosed? Is it over-diagnosed? Is it really a significant health issue? Why are so many people being diagnosed with it?

A key driver behind many of these questions is the fact that effective treatment of ADD/ADHD more often than not necessitates the use of controlled substances to treat a problem that just does not seem that serious to many individuals.

The front-line medications for ADD/ADHD, the methylphenidate and amphetamine based stimulants, provoke strong feelings, namely, worry and fear in most patients and, unfortunately, in many professionals involved in their care.

Because of these fears, some well founded and some not, many patients with legitimate concerns go undiagnosed while others do not get treated or are treated with sub-therapeutic dosage regimens. As a result, their short and long term outcomes are not optimal and the chances of developing significant secondary co-morbidities increase.

Over the past 35 years, in our ADD/ADHD specialty practice in Pittsburgh and at various satellite locations, we have diagnosed and successfully treated more than 10,000 patients (greater then a 90% success rate).

Being Well Center | Success with Medication and ADDWe have accomplished this high degree of success by rigidly adhering to a comprehensive, multidisciplinary approach that is individualized to the needs of each patient. We have created systematic evidence-based protocols which we have refined by consistently applying them to our patients and continuously assessing their efficacy and cost effectiveness/efficiency.

We have developed a particular expertise in the use of medication in the treatment of ADD/ADHD. To achieve a high degree of success when it comes to medication treatment for ADD/ADHD we have found that it is commonly necessary for us to use off-label medication doses and regimens (i.e., for any medication dosage form, dosage regimen, population, or other use presently not mentioned in the FDA approved manufacturers’ marketing guidelines).

Predictably this differentiated use can magnify the inherent fear many patients, family members, uninformed physicians, and pharmacists have about the stimulant medications and can put us at odds with insurance companies that are increasingly restricting their formularies for ADD/ ADHD medications by imposing arbitrary quantity limits for these medications and failing to reimburse off-label uses of stimulant medications to treat ADD/ADHD.

Our sense is that appropriate treatment of ADD/ADHD with proper dosing of medication is going to emerge as a significant health care issue.

Success with ADD and Medication | The Being Well CenterWe are eager to work with others to resolve this important health care problem. We are confident that if we work together we can come up with a more appropriate set of guidelines for the use of stimulant medications in the treatment of ADD/ADHD so that these individuals can receive a higher quality of medical care and better long-term outcomes.

We believe that cost effective and efficient management of a common problem like ADD/ADHD, such as we provide with our approach, can be a cornerstone to reducing overall health care costs.


Find more honest answers and resources you can trust at TRANShealth Inc, a non-profit organization that imagines a future where accurate diagnosis and effective treatment for ADD is the norm. TRANShealth seeks to educate, inform, guide, and cheerlead individuals pursuing a path to overcome the challenges of ADD/ADHD.

Attention Deficit Disorder in the Laundromat

image via Flickr, David Goehring

image via Flickr, David Goehring

While the experience I’m about to share occurred 15 years ago, but I remember it like it was yesterday. Its message is as valid today as it was when I was blessed to have had my Laundromat experience.

As Divine Order would have it, I found myself in a laundromat two weeks ago. My plans were to run inside, quickly place my clothing in the washing machine, run to the grocery store, return to the laundromat, place my clothing in the dryer, swing by the hardware store, return to laundromat, and scurry home with my clean clothes in basket.

This, however, was not my destiny.

Rather, I spend two hours at the laundromat that night listening to a story — an all too-true story that I want to share. I hope that it will illustrate the painful truth of my reflections, the serious impact ADD has on the quality of life, and the tremendous need that we must all work to meet.

This is the story of the woman who proctors the events that occur in this laundromat. She watches the people. She cleans the washers. She wipes the tables. She sweeps the floor. And she talks…

 

She works at the laundromat part-time.

She’s been divorced twice.

Her 10-year-old son has a hard time in school.

He struggled for a long time–was held back a grade and was recently placed in the LD classroom.

He has a problem controlling his behavior.

She says she has a real hard time with him.

She says he is always getting in trouble.

He recently started a fire in the boy’s bathroom at school.

He’s been diagnosed as having ADD.

She’s on welfare.

She uses the medical assistance card for health care.

She has other children.

Her son’s father is an alcoholic— she’s certain he has ADD, too.

Her mom left home when she was very young.

Her dad was abusive.

She says that she doesn’t feel that she experienced a lot of love when she was growing up.

She says she’s depressed.

She sees a psychiatrist weekly.

She says she’s been diagnosed as being depressed as a result of a chemical imbalance.

She takes a new drug for her chemical imbalance.

She says that she really doesn’t believe her depression is because of a chemical imbalance.

She thinks she’s depressed because her life is a disaster.

She says her work at the laundromat is the only thing that keeps her going — gets her out and doing something.

But she worries about how bad things get at home when she’s not there.

She has no consistent childcare for her children.

She has seen many counselors.

She says her current psychiatrist wonders why her son does the things he does.

Over the years, she’s been given many different reasons for her son’s behavior: he just wants her attention, he’s emotionally disturbed, he’s reacting to her depression.

She doesn’t know what to think.

She makes sure every day, as her kids go off to school, to say “I love you very much” so that they’ll know no matter what, they’re loved.

She laughs and says she really thinks she has ADD, too.

She doesn’t know what to do about it.

Her son was recently in the psychiatric ward of a local hospital for six weeks.

She says he isn’t much different since coming home from the hospital.

The hospital bill was $38,000.

She didn’t have to pay for any of it.

She says that our tax money paid for all of it.

She’s grateful for that.

She doesn’t know how other people ever get any help.

She thinks that people on welfare get the best medical care in the country.

She says she has a friend who works in the welfare office; he can’t afford to get help for his daughter who has the same problems.

She says her son has been on Ritalin for a while.

When he was in the hospital there was in increase in his dose.

She doesn’t understand why.

She doesn’t really know what ADD is.

She doesn’t know what’s going to happen to her son.

She says she’s frightened for him.

Weekly, he sees a psychiatrist whom she says she met one time for 10 minutes.

She doesn’t know what the psychiatrist talks with him about.

He used to see a different psychiatrist.

She didn’t know what they talked about either.

She says she feels that she’s learned a lot about life from her experiences.

She’s at a loss for how to turn her life around.

Meanwhile, she says she’ll continue to do her best with what’s been offered.

 

At 8 o’clock, the laundromat closed, but I am sure her story goes on and on. Don’t trick yourself into thinking that this is just the story of a welfare mother in a laundromat.

If you have an open ear and an accepting attitude, I have learned that you can hear a similar story from your neighbor, your cousin, your hairdresser, you minister, your grocer, and even from your doctor.


What is your life story with ADD/ADHD?  We’re listening…

The Prognosis for ADD

image via Flickr, by Ginny

image via Flickr, by Ginny

What is the prognosis when ADD is treated appropriately?

The prognosis of ADD is highly variable depending upon a multiplicity of factors. The individual’s temperament. His language skills. His intelligence. His basic academic skills. The profile and severity of attention weakness. His physical characteristics. The integrity of his nervous system. The presence of illness. Stresses in his life. His attitudes and beliefs. His self esteem. His motivation. The expectations set for him. The profile of strengths, weaknesses, and temperamental characteristics of people in his life….

For each individual, the mix of these factors is a little bit different. And for any given individual, the mix is constantly changing. This is what makes ADD such a challenge.

When all these factors are taken into account and appropriate, comprehensive treatments are put into place, the prognosis for ADD is good but guarded.

That is, the ADD individual can be helped to function successfully academically and on the job; he can have meaningful social relationships; and he can function independently.

However, as long as he continues to take on life’s challenges, there is always the possibility that the problems associated with ADD will resurface. But this really is no different from what we all face in our own personal quest for self-development.


There is no magic pill or quick fix for Attention Deficit Disorder.  That’s why Dr. Liden has dedicated over 30 years of his life to diagnosing and treating the disorder, following his patients through many life stages and challenges, helping them achieve success and independence through it all.  His collected wisdom is shared here on the BWC blog and in a number of books.  He also serves as Senior Medical Director of The Being Well Center, which offers Long Distance Services and an affordable Accurate Diagnosis Determination.

The Greatest Challenge of Being an ADD Doctor

Dr. Craig Liden | The Being Well CenterThere are many things that clinicians, healthcare professionals, and educators can do to help the individual with ADD and his family to improve the quality of their lives. The satisfaction of participating in this process is unbelievable.

However, the biggest challenge of working with Attention Deficit Disorder is that it is so unpredictable. Just when we think that, together, we have made it over the hump–that now it’s licked–invariably (maybe it’s next week, maybe it’s next month, or maybe it is in a year or so) the bottom falls out again. A new expectation comes along and the road for the person with ADD gets bumpy again.

While we all can intellectually appreciate that ADD is a chronic, biologically-based difference that results in recurrent dysfunction, it is a whole different thing for professionals to accept this emotionally.

It is common for professionals to experience a sense of failure and feel disappointed when significant problems resurface in a patient after a sustained period of apparent normal functioning.

In addition to grappling with his own emotions, the clinician must face the challenge of supporting the ADD individual and his family in their coming to grips with the chronic nature of ADD. This can be particularly difficult when what everyone really wants is a simple, easy answer.

Finally, with the persistence of the problem, inevitably comes the guilt on the part of parents, teachers, and clinicians who think, “if only I had…”


Are you a doctor, clinician, educator or parent who has thought, “If only I had…”?  

Want the inside scoop and honest answers about other ADD topics?  Start here for some of our most popular posts, or go right ahead and buy a copy of Dr. Liden’s bestseller, Pay Attention!