Concern over Concerta

If you or a loved one are currently taking Concerta for ADD/ADHD treatment, you need to know about this change from pharmaceutical manufacturers.  Terri West, PA-C, Associate Medical Director with the Being Well Center, shares everything you need to know to discuss further with your doctor to protect the reliable treatment you know and trust.

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The FDA recently approved 3 new generics for Concerta from the following pharmaceutical manufacturers:

• Trigen Laboratory
• Mylan Laboratory
• Impax Laboratory

Effective January 1, 2018, many big chain pharmacies have made the decision to carry only one of the 3 new generic Concerta options.  After these pharmacies deplete their current supply of Actavis, they will no longer carry the “authorized” generic Concerta with the unique OROS delivery system.  We recommend the OROS delivery system because many years of clinical experience have taught us it is the most effective methylphenidate treatment for ADD.

Pharmacists and medical professionals who are unaware of the unique properties of the OROS system used in brand Concerta and the “authorized” or “true” generic form Actavis may assure patients that these new generics are the same as Concerta and may substitute your prescription with any of the three new products despite our directions that state, “OROS Delivery System Only, Actavis generic only” on our written or electronic prescriptions.

Health insurance plans or their associated Prescription Benefits Managers (PBMs) determine which brand or generic medications are on your formulary and whether they are “preferred” or “non-preferred.”  Prescriptions must be written as “brand” if brand is preferred on your formulary. When plans list “generics” as “preferred” on your formulary, the prescription may be filled by a pharmacist with any FDA AB rated (meaning it has the same active ingredient as the brand) approved generic medication unless the prescribing provider specifies OROS Delivery System Only by Actavis.  It is the OROS delivery system that sets Concerta apart from other stimulant medications.

Insurance plans do not stipulate which generic your pharmacist gives you or if the generic has the OROS delivery system.  To be certain that you receive the “authentic generic,” the prescription must specify “OROS Delivery System Only” by Actavis and your pharmacy must carry the generic by Actavis, or an osmotic delivery system that is equivalent to brand Concerta.

At this point, we have no way of knowing if any of the 3 new generics have the OROS delivery system equivalent to the brand Concerta or the Actavis generic.  Therefore, we do not know if the efficacy and duration of the new generic products are equivalent to the brand or the “authorized” generic by Actavis.   Some patients given the new generics may find that they work well, while others may experience decreased efficacy or have unpleasant side effects.

The bottom line is that the “authorized” generic by Actavis may no longer be an option at your pharmacy or through mail-order services if the pharmacy does not carry the Actavis generic.  The Actavis Laboratory continues to manufacture their “authorized” OROS delivery system generic (methylphenidate Hcl ER) for Concerta and as of January 10^th, 2018, they have assured me that they will continue producing and shipping it to major distributors throughout the US.

Up until the end of 2017, most large drugstore chains carried the Actavis “authorized” generic Concerta.

At that time, some of the chains had corporate policy changes mandating their pharmacies to exclusively carry only one of the 3 newer generics.  We know that the major pharmacies in the Tri-State area exclusively carry the following new generic extended release methylphenidate products:

• CVS: Trigen generic
• CVS Caremark mail-order: Trigen generic
• Rite Aid: Mylan generic
• (no local pharmacies): Impax generic

The local Pittsburgh pharmacies that still carry the “authorized” generic OROS by Actavis include:

• Walgreens has the “true” generic OROS by Actavis
• Walmart has the “true” generic OROS by Actavis
• Medicine Shoppe, Ingomar, PA has the “true” generic OROS  by Actavis
• Independent pharmacies  may or may not carry the Actavis generic

The Medicine Shoppe in Ingomar, owned and operated by Dave Wessel, R Ph., continues to carry the Actavis generic Concerta.  However, restrictions from pharmacy distributors may soon limit The Medicine Shoppe and other independent pharmacies who carry the Actavis product from being able to keep an adequate supply in stock for patients when their prescriptions are due.

If your pharmacist has given you one of the new generic substitutions for brand Concerta or Actavis  OROS generic, please alert our office staff ASAP so that we can document the name of the new manufacturer (Mylan, Impax,Trigen) and monitor the efficacy of your treatment regimen. 

If you experience any side effects or problems on the new generic or feel that the effectiveness or duration is not the same as your prior medication, please contact your insurance plan first and ask if they will cover brand Concerta because you are not tolerating the new generic substitution medication.  Then call The Being Well Center with the information so we can discuss what options may be available to you.

For all new patients doing medication trials on Concerta, we prefer that you do NOT accept any of the new generic medications until you are on a therapeutic and stable treatment plan.

The Being Well Center will continue to advocate for our patients with the goal being an individualized therapeutic treatment plan with the proper medication for all day coverage along with the necessary supports from counseling to each individual’s unique needs.

We will update patients/families as new information becomes available.  Please check our website www.thebeingwellcenter.com and our Facebook page for more updates regarding the OROS delivery system and the new generic substitutions for Concerta.  If you have specific questions regarding this information, please contact the BWC and ask to speak with Terri West, PA-C. 

What is the OROS Delivery System and why is it so important?

Concerta has a unique delivery system (OROS) that uses osmotic pressure to deliver methylphenidate through the small drill hole in the tablet at a controlled and predictable rate.  The outer colored coating of the hard tablet dissolves and provides the initial dose of medication within the first hour.  Water in the gastrointestinal tract permeates through the outer hard tablet shell, causing the “push” component to expand in the end of the tablet, pushing the methylphenidate out through the tiny drill hole at the opposite end of the tablet (see diagram) at a controlled rate over a 12 hour period.  The hard outer shell does not dissolve; the tablet remains intact as it passes through the gastrointestinal tract and is eliminated in the stool.  The brand Concerta and Actavis generic tablets can also be seen on plain abdominal x-ray films.

History of Concerta

Brand Concerta FDA Approved in 2000

In 2013, the manufacturer of brand Concerta made an agreement with Watson Labs to manufacture their patented Concerta OROS drug in the Watson Lab and sell it as an “authorized” or “true” generic drug for Concerta at a lower cost.  The drug was exactly the same as the brand and was available in pharmacies as a generic by Watson Labs.  Watson was later bought out by Actavis Labs who continue to manufacture the “authorized” generic for distribution.

Concerta (OROS Delivery System) = “authorized” generic by Actavis

Shortly after the “authorized” OROS generic came out, 2 other generics were released by Mallinckrodt Laboratories and Kremer Laboratories (Kremer later changed names under Kudco Labs or Lannett Labs). Both generic methylphenidate hcl ER were approved by the FDA as “AB” rated generics equivalent for Concerta.  Their product insert submitted to the FDA was essentially the same description as brand Concerta OROS delivery system, therefore, it was confusing to pharmacists when we insisted that the generic was not equivalent to the brand or Actavis generic.

The tablet shape was oblong and similar to Concerta and the color for each different mg dose corresponded to brand Concerta.  Only Individuals who were very familiar with the OROS system might have noticed that the new generics were missing a critical feature: the tiny drill hole in the tablet where the methylphenidate is released.  Instead, when this generic was exposed to water the outer coating/shell partially dissolved, exposing the methylphenidate inside to dissolve in the GI tract.  It did not have an OROS system and no hard shell was eliminated in the stool.  The active ingredient, methylphenidate was the same as in Concerta but the method of delivery and the bioavailability of the methylphenidate was clearly different.

The difference was not apparent at first as some patients had prescriptions that were filled with half of the Actavis generic and half of the Mallinkrodt or Kremers generic.Patients stable on the same Concerta dose for years were presenting to their physicians with multiple side effects that resolved when placed back on the brand or Actavis generic for Concerta.  Many physicians and patients began reporting problems with the 2 new generic medications to the FDA via phone calls or through the online FDA website.

The reports led to an FDA investigation regarding the bioequivalence of the new generics compared to brand Concerta in November of 2014.  Generic drugs have the same active ingredient as brand medications.  However, the method in which the active ingredient is released into the bloodstream (ie: dissolving tablets, extended release beads, injection, OROS system), determines the speed at which the medication is released and may affect the blood level of the active drug or alter the duration of a medication.  This is especially important in stimulant medications, when even a small change in the dose or timing of dose is critical.

If the availability and duration of effect of the drug are not the same, the generic is downgraded to a BX rating.  BX rated drugs are not to be substituted for brand name drugs.  The FDA states that pharmacists are not permitted to substitute Mallinckrodt or Kremers generics for Concerta at the pharmacy unless the prescribing physician/provider specifically requests or agrees to use the “BX” rated generic.

Unfortunately, the first 2 generics are still available at some pharmacies and prescriptions may be filled with an unacceptable substitute for Concerta, when in fact it is not.

These generics are not FDA approved for Concerta:

• Kremer/Kudco/Lannett for Concerta
• Mallinckrodt generic for Concerta

Do not accept this generic with an “M” stamped on the tablet.

Always check your prescription bottle before leaving the pharmacy!

Mallinckrodt generic

The New Generics 2017- 2018: Know the Options

All three of the new generics claim to be the same as brand Concerta, with an OROS delivery system, and they are ‘AB’ rated and approved by the FDA.  This does NOT ensure that the 3 new generics have the same unique OROS delivery system or that they are therapeutically equivalent.  The 3 manufacturers claim they have an ‘osmotic’ system, which is not to be confused with OROS Delivery System.  There is no way to know if their product delivers the medication as precisely and consistently as the OROS delivery system in brand Concerta and the “true” generic by Actavis.

 

Mylan* Generic

Trigen Generic

   Mylan generic*                                              Trigen generic

 *Note that 8 of the 18 pills do not have drill holes

This is a picture of the Mylan generic from a patient who experienced an adverse reaction.

MedWatch Reporting of Adverse Events

 Reporting adverse events (problems related to a medication) to the FDA is important for both patient/parent and healthcare providers.  It is the most effective way to demonstrate a variability or problems with a new or generic medication.  The reports must be accurate and all parts of the form must be completed in order for the FDA to utilize the information in their data bank and to determine whether the adverse event meets the criteria for further investigation.  In regard to Concerta generics, reporting will also help to alert and educate both consumers and medical professionals who are unaware of the importance of the OROS delivery system in Concerta and the “authorized” Actavis generic.

PLEASE take the time to report any problems with the generic medication.

Please go to the FDA website and search for MedWatch to locate the form: “Consumer Reporting of Adverse Events 3500”

Complete the online report and submit it to the FDA or download the form to complete and mail in.  For our Being Well Center patients: Please bring the form to the BWC if you would like help in completing the report.  Our staff can quickly help you to complete the paperwork, make a copy for your records, and mail it to the FDA.

The form is easy to complete.  Aside from a description of what you experienced while taking the medication you will also need the following information to complete the MedWatch form:

1. Name of medication as it appears on the bottle
2. Name of company or manufacturer of drug
3. Date on bottle
4. Date medication filled
5. Quantity of pills on prescription label
6. Mg dose of tablet/capsule
7. Lot number (call pharmacist to inquire about the lot # that your prescription was filled)

 

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ABOUT THE AUTHOR: Terri West is a NCCPA board certified Physician Assistant who received her training at Gannon University. She has over 20 years of experience in working with patients across the lifespan in a variety of settings including pediatrics, family practice, gynecology, surgery, and a breast cancer specialty practice, where she gained a keen insight into women’s health issues.

Terri’s diverse experience coupled with her leadership and teaching skills ideally matches with The Being Well Center’s commitment to identify and manage the health consequences of undiagnosed or improperly treated ADHD, its integration of preventative care into a continuous support model, and its goal to support patients in independently managing their health.

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

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.

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

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

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

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

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

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

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.

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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:

Should Your ADHD Child Help Pay for College?

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.

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!

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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

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!

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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.

Is ADHD Behind “Freshman 15” Weight Gain?

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!

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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!

Sleepy Students at Risk for College Failure

When we think about ADD/ADHD in a college student, we can easily imagine how impulsivity, distractibility, short attention span, problems with following through with directions, poor organizational skills, weak task/time management and procrastination, can wreak havoc on her success.

What may not come to mind, however, is one of the most common attentional weaknesses that contribute to college failure – low arousal level.

So what is Low Arousal level anyway?

Well, at a very basic level, we must maintain a certain level of alertness in order to pay attention and regulate our behavior.  Arousal level refers to how awake and alert we are at any point in time.  

Based upon our clinical experience with thousands of patients, we have found that many individuals with ADD/ADHD have a low arousal level; they are not alert and sufficiently awake to pay optimal attention.

This statement can be confusing to some people who presume that because some individuals with ADD/ADHD are “hyperactive” that they are hyperaroused when, in reality, the opposite is probably true!

The Low Arousal Student Profile

A student with low arousal level can demonstrate a wide range of behaviors.  She may become fatigued during mundane activities (like listening to lecture or completing a 60-page reading assignment), yawn excessively, have a glazed look in her eyes, or actually fall asleep at her desk.

Commonly, ADD/ADHD students blame these behaviors on the task, the subject matter or the professor . . . “too boring.”

Can Low Arousal Look Like Hyperactivity?

On the other hand, some ADD/ADHD students who are under-aroused demonstrate “hyperactivity” ranging from leg bouncing, wiggling in the chair, fidgeting, aimlessly playing with materials, and stretching or actually getting out of their seat and wandering around.

Our clinical experience suggests that these “hyperactive behaviors” are actually unconscious attempts by the ADD/ADHD student to self-stimulate herself in order to increase or sustain her arousal in a learning (or should we say “boring”) situation.

Underlying Conditions Can Magnify Low Arousal

Other conditions or co-morbidities can magnify an ADD/ADHD student’s struggle with alertness or arousal including sleep deprivation, obstructive sleep apnea, iron deficiency anemia, poor nutritional habits (like skipping meals, pigging out, or self medicating with carbohydrates), depression and certain temperamental extremes (such as low frustration tolerance or short persistence) to name a few.  All of these conditions are very common in students with ADD/ADHD.  Sometimes these conditions even mimic ADD/ADHD in students who don’t have the diagnosis.

Medication Can Fix Low Arousal

Commonly, low arousal can signal the possible need for medication treatment in a student with ADD/ADHD.

In those students already taking medication, it can indicate the need to refine the dosage level (generally it means there is a need for more) or dosage regimen (adding medication dosage(s) to provide all-day coverage into the evening when most students study and read those “boring” text books!)

Healthy Daily Routines Can Fix Low Arousal

At the very least, the tendency toward low arousal suggests the need to establish and maintain healthy daily routines for sleeping, eating, exercise and relaxation.

It should be obvious that unmanaged low arousal can be a major risk factor for college failure.  Dealing with it means getting a comprehensive evaluation to determine all the possible contributors and then developing a targeted, individual treatment plan to address each contributing factor.  That’s what we do at the BWC!  Contact us today so we can help your child “wake up” and start experiencing the success he or she is capable of!

If any of this resonated with you, take the next step to pinpoint if Low Arousal is throwing roadblocks in your path to college success.  Click here to download our Confidence@College success screeners for a quick, easy, and free quiz.

Why Problems with Writing Spell Problems at College

The second part in our series looking at The Whole You to identify risk factors for college success.

Depending upon the student’s major, the average college student writes about 15 papers a year.  This doesn’t count journal entries, logs, and other short written assignments professors use to ensure completion of readings or to track progress on major group projects.  And, don’t forget those mid-term or final exam Bluebooks with their “Compare and Contrast . . . “, “Apply the theory of . . .”, or “Give a contemporary example of . . . and elaborate” essays!

It is unclear how it has happened but we do know that it is multifactorial…our kids are not learning how to write!

Problem: Kids Don’t Know the Writing Process

Few of the students who enter our Confidence@College Program have been taught (or retained) a systematic process to apply when completing written assignments like: “brainstorm, outline, write a rough draft, edit, and complete a final copy.”  More commonly, they sit down at the computer at the 11th hour and just begin typing away and insist that it works for them until they flunk their third college essay.

(After the first one, they blame the professor; after the second one, they say they did not have enough time; by the third, the reality of their weakness sets in.)

Problem: Kids Don’t Feel Independent or Empowered to Write

image via Flickr, CollegeDegrees360

Too often, we find that many students have become overly dependent upon teachers, tutors, parents, or fellow students to help them generate ideas, and then plan, organize, research, structure and complete a paper.

In fact, many parents admit to us that they have actually written some of their child’s papers in high school, obsessively edited them, or “put the finishing touches on them” at the keyboard while their child slept on the couch.  Hardly ways to prepare for the rigors of college!

This is a huge problem as being able to write a coherent, well-organized paper is a prerequisite to success at college.

Problem: Strong Temperaments Get in the Way

Weakness in this area becomes magnified when students also have temperamental extremes and attentional weaknesses which can contribute to poor time/task management, procrastination, low frustration tolerance, poor stress management, poor self-monitoring (not learning from mistakes) and weak self-advocacy skills that interfere with asking for and taking advantage of help.

Problem: Poor Writing is a Slippery Slope toward Life Struggles

Often, problems at writing papers is a stepping off point for kids getting behind the 8-ball at college.  It has a cascading effect impacting their ability to cope with and manage the whole college experience.

Some difficulty in learning how to be a good writer is to be expected; but in the end, mastery of this skill can be a key to success in life after college:  filling out job applications, composing emails and letters, developing proposals, submitting bids, completing sales reports, developing marketing materials, and answering a customer’s complaints are all places where strong writing skills are necessary in the workplace.

Employers tell us that poor writing skills are common in new hires and are a major barrier to effectively collaborating with co-workers and being considered for advancement opportunities.

Solution: Find a College Success Program

Confidence@College | A College Success Support Program from The Being Well Center

If your child has rough edges in his/her writing skills, reach out to our Confidence@College Program to identify the contributors and come up with a plan to remediate, refine, and produce high quality written products.

Solution: Identify (and Address) Risk Areas Early in College Career

To accomplish this, take a few minutes to answer a quick Confidence@College “Is My Kid Ready for College?” checklist to see if there are aspects of your child’s TRANSACT Profile that place him/her at risk for college failure.   The checklist is free to use and share and has helped so many parents pinpoint areas of concern to address before and during college.  Knowing the potential problems can turn your child onto the path of success!  Check out the “Is My Kid Ready for College?” checklist now!

We also urge you to contact us and set up a Discovery Session at The Being Well Center so we can start moving things along a path to success.

How Confidence@College Can Help You!