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.).

Dr. Liden’s Prescription for Success with ADHD

Dr. Liden presented this past weekend at the Annual International Conference on ADD/ADHD.

As part of the weekend, Dr. Liden appeared on WWL-TV4 News in New Orleans, sharing his insights on why he believes we need more medication for ADD/ADHD.  Watch as he outlines the responsible use of stimulant medications in treating Attention Deficit Disorder and shares how he responsibly and clinically prescribes medication as part of the treatment plans at The Being Well Center.

The Most Important Thing You Can Do This Summer: Read 10+5+5

Best Tip for Summer Reading | The Being Well Center

By mid-July, it happens. Soccer camp, popsicles by the pool, and road trips have ruled the days. But now, that first nagging thought blossoms: “Back to School is coming.” And with that comes fear of the Summer Slide.

Summer Slide happens as kids take a three-month break from reading, writing, and arithmetic. The school skills pursued so diligently over the year backslide from lack of use. All of us (kids, moms, dads, and even family pets) need a breather from the familiar tears-over-homework-at-the-kitchen-table scene, and summer can be that rejuvenating break for everyone. But is there a way to enjoy summer, avoid the dreaded Summer Slide, and head toward school success instead of catch-up?

Over our years of counseling kids and families through the Summer Slide to a successful transition into school, we’ve found one simple tip makes a huge difference: The Read 10+5+5 Summer Strategy.

Best Tip for Summer Reading | The Being Well Center

The Read 10+5+5 Summer Strategy

Reading skills need relatively little maintenance to stay fresh over summer, but neglecting the reading could have noticeable consequences at the start of the school year.

You’ll be amazed at how investing just 20 minutes a day, 3-5 times a week, in enjoying and discussing reading will have your child ready to jump right back into school.

The 10+5+5 formula is simple: 10 minutes of independent reading (or reading to younger, emerging readers), plus 5 minutes of writing about what’s been read, plus 5 minutes of discussing the reading with a grown-up.

10 Minutes Reading

Best Tip for Summer Reading | The Being Well Center

image via Flickr by EvelynGiggles

Require your children to read 10 minutes a day, 3-5 days a week or more. Make it a fun, relaxed time—pick cozy reading spots indoors or out, take a reading “field trip” to a coffee shop, or rearrange the bedroom to include a special reading chair or bean bag. Maybe your child has to finish his 10 minutes reading before video games. Maybe she can settle in to read while dinner’s being prepped. The time of day doesn’t matter, just the habit.

How to Find Books that Hold Interest

Especially for struggling readers, even 10 minutes of reading time can seem like an eternity and lead to power struggles. Fresh, interesting reading material can make all the difference. For ideas on great books specific to your child’s interests, age, and reading level, consult the expertise of your local librarian or peruse these expert guides:

What to Read When by Pam Allyn

The Read Aloud Handbook by Jim Trelease

Guys Read: Funny Business by Jon Scieszka

121 Books: A Very Subjective Guide to the Best Kid Books of All Time by Andy Ward

Summer Reading for 7-9 year olds by Tsh Oxenreider

Summer Reading for 10-12 year olds by Tsh Oxenreider

Relax it for summer: It’s summer, not school, so shoot for fun, interactive reading materials. Expand your definition of “books” to include things like magazines, graphic novels, comics, picture books, and newspapers. If it’s interesting to your child and can qualify as written material, let them explore it. The only rule here is that they have to spend 10 dedicated minutes reading.

5 Minutes Writing

 Once your child has finished 10 minutes reading, they should immediately turn to writing for 5 minutes about what they’ve read. The goal in this step is to encourage reading comprehension and enhance understanding.

If your child eagerly dives into writing about what he’s read, let him run with it.

If your child isn’t sure where to begin, you might write a question at the top of her reader’s journal page to prompt her thinking. Here are some strategy questions that stimulate responses to reading:

  • Summarizing: Leave the top of the page blank for an illustration of what has been read and the bottom half lined for a short written summary of what happened in the story.
  • Connecting: “This reminds me of…”
  • Questioning: Write down a quote from what you read and answer, “This makes me wonder/question…” or “I’m confused…”
  • Visualizing: Write down a quote from what you read and answer (or illustrate), “I get a picture in my head…”
  • Determining Importance: “This is really important…”
  • Synthesizing: “I get it! This reading makes me think about…”

Younger readers can participate in 5 Minutes Writing too—illustrating a scene from the story is as valid a response as writing words about it. They’re still thinking, summarizing, and expressing what they’ve understood. Goal accomplished!

Relax it for summer: Don’t worry about grammar, spelling, or editing in this writing step. Make the process fun by purchasing a new notebook for a Reader’s Journal. Buy a new pen or pencil. Find a dedicated spot in your house to keep the reading materials so they’re easy to locate when reading time rolls around.

5 Minutes Discussing

image via Flickr by Paul Hamilton

image via Flickr by Paul Hamilton

You may be the most critical part of your child’s summer reading experience. At some point after your children have finished their 10 Minutes Reading and 5 Minute Writing, take 5 minutes to discuss with them what they’ve read and thought about.

Your questions can be open ended or scripted. What matters is that your interest in your child, her activity, and her thoughts is sincere.   You may wait until bedtime when the house is quiet to discuss. You may bring it up while lounging at the pool. You may make a ritual of sitting with a glass of lemonade for 5 minutes of undivided attention when you get home from work. Or, you may outsource and call the grandparents for a telephone book report!

Relax it for summer: Be a listener, not a teacher. You are under no pressure to teach, guide, instruct, or assess. This is summer, the days are long and lazy, and you’re simply providing an interested, open audience to listen to your child’s thoughts. Some questions you might use to prompt the discussion:

  • What was most interesting?
  • What did it remind you of?
  • What did you wonder about as you were reading?
  • What part do you think I would enjoy reading?

Parents Can Read 10+5+5 too!

The most powerful move you can make to prevent summer slide is to model Read 10+5+5 for your kids. Why should kids have all the reading fun? Read 10+5+5 could be a great initiative to kickstart your summer reading list! Read 10+5+5 is an amazingly powerful way to connect with your kids and give yourself some well-deserved relaxation and meditation time in the process. Pick up a book and read alongside them! Pick up a pen and journal with them! Take 5 minutes to tell them what you’ve been reading and thinking.


Are You a Helicopter College Parent?

image via Flickr, J.K. Califf

image via Flickr, J.K. Califf

For many college students, going away to school represents the first real opportunity to be on their own…some relish it, some fear it!  For many parents, this is a time when they may struggle to let go and allow their child to demonstrate self mastery, to show responsibility in meeting multiple new expectations, and to dig down deep to grow, achieve and, ultimately, graduate!

The Difference Between Encouraging Dependency and Facilitating Independence

Large numbers of parents can’t negotiate the difficult transition from encouraging dependency to facilitating independence.

As a result, they become “helicopter parents,” hovering over every aspect of their college student’s life…daily “how are you doing” phone calls, repeated text reminders, wake-up calls, go to bed admonitions, daily grade checks on the college website, over the phone sobriety checks, tightly managing the bank account, and not so subtle threats about what will happen if he or she messes up!

It never ceases to amaze us how far co-dependent parents will go to protect their child from the reality of college life challenges.

One young man who recently came to us for help because he was struggling to meet expectations (i.e., submitting monthly reports, generating narratives to describe sales calls, etc.) in a job he secured with a Fortune 500 Technology Company after graduation.  As it turns out, these were demands he never really had to face at college.  “I never wrote one paper at college.  I would send the syllabus or the rubric for an assignment to my Mom who would do the whole thing and send it back to me to give to my professor!”

Co-Dependency Starts Young

Most parents sense that this degree of co-dependency is wrong but persist because the pattern is deeply ingrained.

Oftentimes, it developed years earlier in elementary or middle school.  Nagging about homework.  Making flash cards for their child to use to study for exams.  Obsessive editing of papers and essays.  Doing the homework.  Eliminating chores.  Tolerating underage drinking or drug use.  Minimizing problems.  Blaming the teachers.  Providing rewards for doing the basics.

Once this pattern is established, it can grow ugly in high school.  The child oftentimes is dependent upon a nag or a reminder to get things done, yet becomes resentful, disrespectful, and manipulative when they get one:  “Quit nagging me!  I’ll get it done!  Why don’t you trust me?”

Such interchanges can put parents back on their heels:  “Damned if they do” (having to tolerate an “attitude” brimming with anger, intensity and negativity” or “Damned if they don’t” (fear of their child failing, losing opportunities, and not experiencing success).

Co-Dependency at College

image via Flickr, Jose Kevo

image via Flickr, Jose Kevo

When college comes along, it all gets magnified.  Parents can justify their enabling behaviors because they are only “rightfully” protecting their financial investment!

As parents, the forces behind enabling/co-dependent behavior are particularly powerful…love, protection, empathy, fear, sensitivity, sacrifice, and guilt.  So powerful, in fact, that they can sabotage all the positive things parents can do to promote their child’s independence and chances for success.

Here are some of the things they can do to trip parents up:

  • — Interfere with their ability to take an honest look at their child’s strengths and weaknesses
  • — Make them feel defensive when their child fails to meet an expectation
  • — Blind them to their child’s role in his difficulties
  • — Lead them to do for their child rather than support him to do for himself
  • — Inhibit them from imposing necessary and appropriate consequences
  • — Encourage them to blame others when things do not go smoothly
  • — Act as a barrier that prevents them from allowing their child to take on ever increasing responsibilities for himself

Because co-dependency is so common (particularly in parents of children with ADD/ADHD) and it can be a critical barrier to success at college, we encourage parents to examine their enabling tendencies before and during their child’s college years.  In our new book, Accommodations for Success we have a simple survey called “First Things First” that can help parents assess their enabling tendencies.  Check it out!  Be honest and see where you stand!  “What’s you enabling quotient?”

How to Facilitate Independence

image via Flickr, MeganLynnette

image via Flickr, MeganLynnette

Sometimes, just being more aware of enabling tendencies helps parents reduce or control them.  However, when enabling tendencies interfere with a parent’s ability to develop and /or follow through with doing the right things to promote their child’s success parents may need to reach out for help.

This may be as simple as requesting a significant other to be a source of feedback when one demonstrates thinking and behavior that is enabling in nature.  Of course, inherent in this strategy is the need to be committed to being non-defensive and accepting of the feedback!

Some parents find that it is important to develop a support network or a buddy to regularly meet with to discuss some of these difficult issues.

Some find it most helpful to meet individually with knowledgeable professionals to help find a pathway to healthy thinking and behaving when it comes to promoting their child’s growth and development.

If you need some extra support with your co-dependent tendencies, give us a call at the Being Well Center…we’ve helped thousands of parents get their act together.

Step Out of the Way to Let Your Child Move Forward

Failure to get these enabling behaviors under control can be a major barrier to independence and success.

Sometimes parents have to step out of the way in order to allow their child/student to move forward and reach his/her full potential.

If this is hard for you, then it is important to reach out to a spouse, a co-worker, or a professional for support to meet this most difficult challenge!  Stay on guard and work to avoid allowing these tendencies to interfere with your child’s success at college.

Six Steps To Promote Self-Esteem in College Students

Self-Esteem at College | The Being Well Center

image via Flickr, CollegeDegrees360

Life has taught most of us that thinking you can accomplish a task or reach a goal is half the battle.   There is little doubt that a strong self esteem and realistic self confidence can be a key to success in many of life’s endeavors.  Success at college is no exception.

The new demands that college presents to our kids require a significant degree of self confidence to successfully meet.  Academic challenges that are far beyond anything they have experienced before, meeting and establishing relationships with all types of new people from roommates to professors, advocating for themselves, remaining resolute and acting on their values, and being honest with themselves and us about how they are really doing  are a few of the biggies that require a strong self esteem.

It’s no wonder that as parents, we often go to great lengths to boost our child’s self esteem when it comes to college.  Encouraging her to “reach” for a prestigious school that will look good on the resume even though it stretches her capabilities or our finances too far.  Outfitting our child’s wardrobe and room with only the best in an attempt to ensure that he will fit in when he  arrives on campus.  Setting up bank accounts so that she always has plenty of spending money without ever establishing a budget.  Subtly promoting permissive attitudes about indulging in drinking so he fits in socially (i.e., “we know you’re going to do it so . . .”)

During the high school years ramping up to college, we (and teachers) may cut our kids breaks through easy grading or opportunities for “extra credit” to cover up an inadequate performance.  As a result, our child never has to face failure and come to grips with her strengths and weaknesses, thereby, limiting her ability to develop coping and compensating strategies.  The lack of coping strategies is compounded by many of us excessively structuring our child’s life, providing repeated reminders and hovering over them to foster success.  Accountability and its rewards are replaced with endless pep talks . . . “You’re the greatest… you can do it if you put your mind to it!”

These kinds of parental efforts provide short-term “feel goods” at best.  They fail to recognize self esteem and self confidence don’t come from pats on the back and external circumstances but are cultivated from within . . . when our child independently works hard, faces and overcomes barriers, meets a realistic expectation, and is able to proclaim, “I did it!”

Six Simple Steps to Promote Self-Esteem in College Students

So how can we promote the development of self esteem and self confidence in our college student?  Here are six simple steps:

  1. As early as possible, help your child to truly understand himself…to know his strengths as well as his weaknesses.  This involves staying tuned into our child’s academic and social life, and communicating regularly and honestly.
  2. Based upon an understanding of who your child is, help her to set realistic expectations academically, socially, and behaviorally.  This means setting expectations that are not too high or too low, but “just right” . . . ones that stretch her, maybe even involve taking a bit of a risk, but in the end are attainable with effort and hard work.
  3. Ensure that your child has a plan to meet the realistic expectations including the structure and unique supports he needs to succeed.
  4. Don’t expect perfection from the start.  Let go and allow for “practice” that might involve stumbling and falling some.  Be there to help her get back on her feet.  Debrief what happened and what went wrong.  We all learn the most about ourselves and what it takes to succeed when we are picking ourselves back up as compared to when we are cruising along smoothly.
  5. Brainstorm compensatory strategies by asking our child what he could have done, said, or thought differently to have the performance or situation turn out more successfully.  By taking the time to help him generate his own solutions rather than lecturing or dictating what he should do, we promote the development of effective problem solving skills…a cornerstone of self esteem and self confidence.
  6. To close the loop and help our child become accountable, we need to set limits and provide effective consequences when she fails to meet realistic expectations when she has the tools (i.e., plan) to do so.  Appropriate, short-term, negative consequences promote self reflection while threats, lectures, and name calling only stir up intensity, anger, resentment, self pity and fear; all barriers to success and the development of strong self esteem and self confidence.

For more of the “How To’s” check Accommodations for Success guidebook and workbook. If you need more guidance and support, call our office and set up an appointment.  We’ll walk along with you and help make sure you’re helping your child to be an independent, self esteem grower!

Catch up on other blog posts in our series:

Self-Esteem at College | The Being Well Center

Should Your ADHD Child Help Pay for College?

Should Your Child Pay for College? | The Being Well Center

image via Flickr, jamesjoel

Someone you know taking college expenses for granted?

Over the last 10 years, as we have seen increasing numbers of new patients enter our Confidence@College program, we have been shocked by the number of kids who take parental financial support for college expenses for granted.

Tuition, room and board, meal tickets, books, new computer, dorm furnishings, toiletries, laundry, pizza, and beer . . . It all adds up to the second biggest investment parents will make in their lives.  Most college-age kids we’ve met don’t really have a clue!

Parents sure do, and the expense is one of the major sources of angst when their kid heads off to college . . . “will he make good on this huge investment?”

Lack of finances is the number one reason for falling graduation rates in the U.S.

It’s easy for kids to be sheltered from the expensive reality of college when most parents see a college education or post-high school training as a necessity in today’s world and feel it is their responsibility to make it happen.  In today’s economy, large numbers of parents actually can’t fulfill this responsibility; in fact, lack of finances is the number one reason for falling graduation rates in the U.S.  Other more fortunate families take a “do whatever it takes approach”, including:

  • Work an extra job
  • Long-term savings plan
  • 529 accounts
  • Selling assets
  • Home equity loans
  • Grant or other aid from colleges
  • Gov’t sponsored loans
  • Hunt for scholarship opportunities
  • Gift from family and grandparents

Parents are writing the college essays for their children

More often than not, these financial efforts exclude their child.  At most, the parent has to nag him/her about completing an essay for a scholarship application.  A significant number of the parents we work with have actually written part or all of college essays out of the frustration or the need to meet a deadline!

Student loan crisis could be our next big financial disaster

Some parents set the expectation that their child will sign a promissory note and commit to paying back all of the loan money if they fail to graduate.  For most of the kids we see, this large negative consequence may strike some fear initially but is seen by most as something in the distant future that they’ll deal with if they have to.

Trouble is, without some type of degree or certificate the likelihood of getting a decent paying job that will make it possible to repay this obligation is small.  It should be no surprise that the highest rate of college loan defaults is in situations where the student fails to graduate.  Escalating college costs have pushed the student loan crisis into position to become our next big national financial disaster.

Should Your Child Help Pay for College? | The Being Well Center

image via Flickr, Charlie Kaijo

Take a baby step and ask your child to contribute financially

Many parents take a baby step in the right direction when they ask their child throw something into the pot.  Maybe it is a chunk of their savings account built up from mowing lawns, babysitting, having a part-time job, or from birthday and graduation gifts.

Kids often push back and negotiations often end in them having to cover the costs of their books or their monthly entertainment.

In our experience, this is rarely coupled with the establishment of a monthly budget for expenditures and we’ve seen many kids spend their contributions for the year in one month buying pizza and drinks for everybody at midnight, buying a new Xbox, or frequently going out with new friends to party!  Then, what are parents to do?  Certainly most give an irate lecture, but it’s pretty unrealistic for them to say that they’re not going to give their child any more money for the rest of the semester.

Make the student pay a “ticket of admission”

In reality, helping kids meet the demands of financial responsibility that come with college is a serious and complex issue that requires targeted attention and ongoing support particularly for students with ADD/ADHD.

We’ve found that one relatively simple, yet profound, step that parents can take is to set an expectation for the student to give the parents a set amount of money before the start of each college year.  Payment of some amount by the child represents the purchase price of a “ticket of admission” to the parent’s checkbook or signature on a loan.

The actual dollar amount of this down payment isn’t critical but it should be enough to stretch the student to some degree . . . something in the ballpark of $750-$1500 is about right.

For most students this means getting (and keeping) a full-time job (or two part-time jobs), saving money rather than impulsively spending it on food, entertainment, etc. and making sacrifices.  To save this amount of money and contribute it by a certain date requires some of the same life skills it takes to be successful at college.

Pay the price, feel the pride

When kids meet this expectation they feel the pride of accomplishment, feel more mature and take a more serious approach to college. 

This “skin in the game” often helps them choose the pain of self-discipline over the pain of regret when temptations arise to kick back rather than bear down.

It’s not a perfect solution but it moves things in the right direction.

Re-invest for your child’s future success

Some parents use the contribution as the starting point to establish a monthly budget for their child and develop a plan to redistribute the money back to the student in agreed amounts during the school year.

Others simply take the money, quietly invest it and then return it (with dividends) to the student when they earn a diploma . . . it can be the down payment on a car or condo/home to jump start their future!

Your Child Should Pay for College | The Being Well Center

At Confidence@College we have lots of strategies to help protect parents’ investment!  Our committed staff always has a “skin in the game” and goes the extra mile to ensure success.  Call us now to set up a Discovery Session and experience the confidence we can give you and your child.

ADHD Medication is Key to College Success

image via Flickr, CollegeDegrees360

image via Flickr, CollegeDegrees360

When students arrive on campus, the demands for efficient attention and self management skills (that is executive functioning) immediately soar . . . challenging academics, consistent study habits, maintenance of healthy daily routines for sleep, eating and exercise, money management, and more complex social decision making.

Meeting college demands is particularly challenging for students with ADD/ADHD and for the overwhelming majority of them, this means having the aid of a medication regimen that provides benefits throughout the whole day.

An all-day medication regimen is a key to college success

We’ve learned from our experience in our Confidence@College program that college is a bad time to try to “fly on my own” and go without medication treatment.

In fact, in our C@C patient population, we have found that acceptance of the need for medication and compliance with an appropriate all-day medication regimen is near the top of the list of factors that contribute our 81% success rate.

For some ADD/ADHD individuals who have been able to get by without medication in the past, entrance into college with its increased demands means having to seriously consider the use of medication for the first time.

For others who have been able to get by with a medication regimen geared to get them through the school day, it means revising their regimen to provide coverage into the evening hours.  And for others, it means committing to taking the medication 7 days a week!

Don’t let an improper use or lack of medication keep you or your student from success at college!

A specific, individualized success plan leads to college success

At The Being Well Center, patients who enroll in our Confidence@College program always start with a Discovery Session where we identify the key problem areas and survey the whole person so we can pinpoint the barriers to success and uncover strengths we can mobilize to meet these new challenges.

We then develop an individualized Success Plan.  When medication is a part of the success plan we conduct systematic medication trial testing using objective testing procedures to find the right medication and a treatment regimen that provides efficient attention throughout the waking day.

Before students arrive on campus we brainstorm with them and their parents how they are going to get their medication and how to securely store it.  We go over the logistics of when they will take the medication based upon their weekly schedule.  In addition, we review the dangers of diversion of the medication and make sure we have a mechanism in place to closely track the quantity of medication we provide them.

Follow-up support at school leads to college success

Once students are on campus, we use innovative technologies and support from our staff through our GuideU video counseling sessions to ensure the student complies with the medication regimen and maintains healthy daily routines, the foundation for a successful medication experience.  We identify signs of sub-therapeutic treatment and possible side effects quickly and our medical staff fine tunes the treatment regimen as needed.

We’re there to ensure success during the whole college experience not just in the classroom, library or study carrel.  We make sure our patients are aware of the importance of taking the medication during evening hours and weekends where social activities provide high risk challenges for un-medicated ADD/ADHD students.

Avoid “unmedicated” fun consequences

Impulsivity, poor self awareness, weak self monitoring and ineffective problem solving can lead to social decisions that can be disastrous . . . alcohol intoxication, substance abuse, unprotected sex leading to unplanned pregnancy or STD, or illegal activities.  One night of un-medicated “fun” can lead to expulsion from school and life-long consequences.

Compliance with the right medication regime leads to college success

If you’re at the top of your game, college can be an exciting and enriching experience intellectually, developmentally, and socially, and can provide you with what it takes to independently fulfill your dreams and aspirations through life.  Compliance with the right medication regimen helps this become a reality for students with ADD/ADHD!

Be confident with your child’s success at college . . . call us at the BWC and set up an appointment to participate in our Confidence@College program.  We’ll make sure your child has all the tools, including an optimal medication regimen if needed, to succeed at college.

Confidence@College | The Being Well Center

Is ADHD Behind “Freshman 15” Weight Gain?

ADHD and college weight gain | The Being Well Center

image via Flickr, COD Newsroom

We’ve all heard about them… the dreaded “freshman 15!”   Good old dorm food where the only choices that taste good to you seem to be those with high fat and carbohydrate content.  A huge stash of of high calorie snacks only an arm’s reach away in your dorm room.  Late night delivery pizza or runs to the sub shop with your new found friends.  Beer!

It all adds up pretty quickly and many a parent has been shocked at semester break to see that their kid’s cheeks are a little bit fuller and their jeans a bit tighter.

Healthy eating is harder with ADHD

While most students face the challenge of avoiding the “freshman 15″, the task can be particularly daunting for the college student with ADHD. 

They struggle to get up and out of bed in the morning, often at the last minute, skipping breakfast and making it to class just in the nick of time.  Lunch can also be a catch as catch can experience…something always gets in the way… too little time between classes, last minute cramming for a test, frisbee with friends, flirting with that cute guy from English class.

The brain interprets these  day long fasts as starvation and in response it slows down the metabolic rate so that even if they eat the normal number of calories for dinner (which rarely happens) all the extra calories are sent to the fat cells to prepare for starvation again tomorrow.  This is how eating less can actually contribute to weight gain!

Students with ADHD notoriously make poor food choices

ADHD individuals notoriously make poor food choices, eat impulsively and fail to exert portion control, and choose high calorie drinks when they are thirsty. 

These unhealthy eating habits are even more likely to occur when Mom is no longer around to set limits and nag!

These concerns are magnified when the student moves out of the dorm and into an apartment.  Many don’t have much of an idea of how to prepare healthy meals so they don’t go grocery shopping with a meal plan in mind and instead rely on prepared food or frozen dinners that are often calorically dense!

Despite the best intentions, it’s hard to get to the fitness center for a workout and structured sports are gone for most.  Some colleges still mandate a physical education course or two for graduation but many don’t.  Free time is usually spent hanging out with friends playing video games and eating chips.

Food as a self-medicating coping strategy

As the stresses mount during the semester,  many ADHD students turn to food as a self medicating coping strategy to either enhance their focus or to reduce their anxiety or depression.  One candy bar may do the trick for 20 minutes but then there is the crash and a need to “dose up” again!

This is all laid on a backdrop of an increasing awareness we have that ADHD is a significant contributor to the obesity epidemic.

While it may seem counterintuitive, we now know that “hyperactive” kids are at high risk for being overweight as adults. 

Studies have shown that more than 40% of adults participating in weight management clinics have unrecognized or untreated ADHD!  In our experience, leaving home and heading off to college is the first step down the road to a lifetime struggle weight management.

A lifetime battle against obesity can begin at college

For many, the slow steady progression toward obesity and all its challenges and risks begins with the “freshmen 15″…we all know that once it’s on it’s really hard to get off!

It doesn’t have to be this way…with a comprehensive success plan including a structured schedule for study time, a healthy daily routine for eating, exercise, sleep, and relaxation, targeted accommodations, and compliance with a proper medication regimen along with ongoing support from an experienced professional, ADHD students can experience success in the classroom AND in the other spheres of life!

ADHD and Weight Gain at College | The Being Well Center

Worried that your child is struggling with weight issues and Attention Deficit Disorder?  We can help you find answers.  Call our office today (724.443.4120) to talk to someone who cares, or download our College Success Screener to take the first step in identifying college problems.

If you’re an adult with ADHD who can relate to these issues and struggles with weight management, there is help for you, too.  Contact the Being Well Center and ask about getting involved with our TRANSforming U Program.  Let us help you become a healthier U!