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.
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.
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!
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.
Participate in objective medication trial tests.
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.
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.
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.
Never use medication as the sole form of treatment.
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!
Craig 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.