How often should an individual with ADD be checked once he starts medication?
Once the proper medication regimen has been established and the initial adjustment phase is over, my bias is that ADD individuals should participate in follow-up with a clinician at least monthly until all areas of his dysfunction are resolved or stabilized. This can be with a physician who performs brief med-checks and probes patient compliance with all parts of the treatment plan.
Alternatively, follow-up can be with a counselor, ADD coach, tutor, or other professional implementing the treatment plan and communicating to the physician about progress, persistent problems, and observed or reported medication side effects.
Regardless of the frequency of these follow-up visits, I see all of my patients for whom I am prescribing medication every three months for a more comprehensive medication review visit.
Include the Parent or Spouse
I strongly encourage both parents or the spouse to attend these visits with the ADD child or adult. At these appointments, I check height, weight, blood pressure, and heart rate and perform a targeted physical exam when there are specific health concerns. Each patient also participates in a brief reassessment of his attention using specific tests that I have developed. Sometimes we reassess attention on the current dosage of medication to document its current effectiveness. Other times, we assess attention of medication to document continuing need.
I always meet with the ADD individual to directly observe his functioning and to hear his perspective about how he is performing in each major life sphere — school, work, social involvements, home life, and daily routines and responsibilities. I also probe to be certain he is taking the medication as directed and check his perceptions regarding efficacy, side effects, or other problem areas. I then meet with his parents or spouse to discuss the same areas. As ADD individuals are notoriously inaccurate in monitoring their own performance or behavior, another person’s perspective is always helpful.
At the conclusion of these visits, I give my feedback about the progress the individual is making . . . sometimes followed by a hug or pat on the back and sometimes with a kick in the rear! Together we decide whether to keep the medication regimen the same, discontinue it, or to make changes.
Anticipate the Future and Stay in Touch
This visit also provides me with an opportunity to provide anticipatory guidance about problems that are likely to emerge in the near future as the expectations in the individual’s life change. When appropriate, I also share my treatment recommendations with the other professionals who are working with the individual.
As individuals continue in treatment, do well, and remain stable for a long period of time, occasionally, these visits out to occur twice a year rather than quarterly.
However, this is rare; I have learned over the years that a lot can happen in an ADD individual’s life in three months, let alone six months, that can head him in the wrong direction.
More often than not, the ADD individual is not fully aware of a change in direction or has used ineffective problem solving that complicated matters rather than solved a problem. I prefer more contact rather than less when it comes to management of ADD and so do most of my patients.
Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.