Does Your Age Matter in ADD Medications?

At what age can you start using ADD/ADHD medications?

image via Flickr, David Robert Bliwas

image via Flickr, David Robert Bliwas

None of these medications have a formal “indication” (i.e., approval by the FDA) for use in children under the age of 6 years. However, experienced physicians like myself are frequently called upon to evaluate and treat preschoolers. Oftentimes, these are some of the most challenging situations.

Children who present with ADD at this age often have profound attentional weaknesses that are associated with extreme temperamental traits and significant developmental delays.

In my experience, if the attentional component of these children’s problems is not treated with medication, it is unlikely progress can be made to correct or remediate other associated difficulties.

Therefore, in many of these circumstances, I have carefully and successfully used the stimulants and the non-stimulant, Strattera. I have had particular success using the stimulants Dexedrine and Dextrostat in ADD preschoolers who have associated language delays. Because children at this age generally can’t swallow pills, it may be necessary to use medications like Metadate that can be sprinkled on food. It is my opinion that only the most experienced clinicians should take on this difficult population.

Equally challenging are those ADD preschoolers whose behaviors are difficult to distinguish from normal. Some degree of distractibility, short attention span, and impulsivity can be the norm in children 3 to 6 years.

When is it a problem?

Do we just wait and hope he grows out of it?

Does failure to identify and begin treatment put the child at risk for learning failure, behavior control difficulty, poor peer relationships, and low self-esteem?

These are difficult questions. Again, my bias is that they require the expertise of a physician highly experienced with ADD. If, after a thorough evaluation, such a clinician is able to make the diagnosis of ADD, then there is no good reason to delay treatment with these medications.

Can these medications be used in adults with ADD?

image via Flickr, Steve Wilson

image via Flickr, Steve Wilson

All of the medications used to treat ADD are just as effective in adults as they are in children and adolescents. The underlying biological differences that cause the symptoms of ADD remain relatively stable from childhood through adult life.

Therefore, it makes sense that if the medications can help correct these differences in childhood, they should be able to do the same in adults.

At the present time, Strattera is the only medication that has a formal indication for use in adults. However, all of the stimulants have been used safely for many years in the treatment of ADD adults.

Obviously, the dosage levels required for adults are often different from those that are effective for children. Similarly, some of the side effects children and adults experience are different. In all other respects, however, use of these medications is the same in adults and children.


You’re not alone if you’re nervous about ADD/ADHD medication.  Public debate, often fueled by bias and misinformation, has stirred up a cloud of fear around effective medication treatment options.  In our practice, we’ve seen time and again that medication can be a powerful tool in treating ADD.  Don’t miss 7 Keys to Successful (and Safe) Medication Treatment for ADD!

Succeed in the Workplace in Spite of ADD

Are there jobs that are particularly good for the ADD adult?

image via Flickr, Nana B Agyei

image via Flickr, Nana B Agyei

It may seem that the presence of certain ADD traits make the ADD adult better suited for some jobs than others. However, we can find successful ADD adults in almost all jobs and all kinds of work.

Each person with ADD has a unique set of strengths and weaknesses that work together in a complex way to create ‘fits’ in world of work.

It is simplistic to think that an individual’s attentional characteristics, in isolation, should influence his career choice over the careful consideration of all parts of who he is.

What can an adult with ADD do in the workplace when ADD is interfering with job performance?

ADD can interfere with job performance in countless ways. Productivity problems, poor performance reviews, or probationary status may be indications that attention weaknesses are negatively impacting in the workplace.

When this occurs, the adult with ADD may invoke the Americans with Disabilities Act (ADA). Under this law, employers may be required to make accommodations that allow the person with a disability to be successful on the job.

In my experience, calling upon the ADA should be done cautiously and only when employment is at risk. When, upon considering the risks involved in sharing personal medical information with an employer, the adult with ADD chooses to invoke the ADA, he may begin by discussing with his employer, his disability, its impact upon job performance, and his request for accommodations.

When the request for accommodations are “reasonable” and will not cause the employer “undue hardship” or alter the job basic requirements, the employer is required to make those or similar accommodations.


Don’t miss our prior discussion about when and how much to share with your employer about ADD!

Behavior Change for the Adult with ADD

How does the adult with ADD work toward positive behavior change?

image via Flickr, Esther Gibbons

image via Flickr, Esther Gibbons

In my experience, the journey toward positive behavior change for the ADD adult begins with an experienced professional leading him through the same steps we encourage parents, teachers and childcare providers to use in managing behavior in children with ADD. That is, we help the adult with ADD to do the following:

  • Know who he is. It is important that he understand and accept his temperamental characteristics, his skills and abilities, his attentional abilities, his physical abilities, the stresses in his life, his attitudes and beliefs, and his self-esteem. He must understand which of these are changeable and which are not.
  • Set realistic expectations for himself. Based upon his understanding of his own unique profile of strengths and weaknesses, he defines behaviors are achievable for him.
  • Determine the factors contributing to an unproductive behavior and/or situation when it occurs.   In doing this, he asks himself the following questions:

◦ What is the expectation that is not being met?

◦ What are all the contributors to this failure?

◦ What role do I play in this?

◦ What role do factors outside of me play?

◦ What contributing factors are changeable and which are unchangeable or out of my control?

  • Develop a plan and put it into action. He refines the expectation as needed, and defines thoughts, actions, words and strategies that address all the factors that are under his control to maximize success at realizing the expectation, and tries it out in the real world.
  • Refine the plan when necessary. He reflects upon the success of the plan, and makes changes in the plan by modifying the expectation, the thoughts, words, action, and/or strategies.

In repeatedly guiding the adult with ADD through this sequence, the professional gives the adult progressively more responsibility. Ultimately, the adult becomes an independent problem-solver able to critically evaluate and modify his behavior in nearly any situation. In my experience, my adult patients who are open and committed to learning about themselves and how to effectively solve problems grow wise and become confident in their ability to deal with whatever is thrown their way.

How do limiting setting and use of consequences work with adults?

image via Flickr, Kaitlyn Rose

image via Flickr, Kaitlyn Rose

In adult life, limits and consequences are not generally defined in treatment or by supportive parents and teachers. Usually, it is our employer, our spouse, our friends, the police, the IRS, the bank, etc. who impose them.

Further, the limits are not always clearly defined and the consequences are often very serious. Treatment activities with the ADD adult involve clarifying the reality of the limits, defining strategies that promote success in meeting expectations, supporting and brainstorming plans when consequences do occur, and working with spouses, friends, and parents to help them allow the sometimes serious consequences to occur.


ADD/ADHD creates life challenges unique to each life stage.  Seek out care providers who have an appreciation for the challenges specific to adult expectations.  For help identifying a qualified care provider in your area, download Dr. Liden’s book, ADD/ADHD Basics 101.

How ADD Messes Up Marriage

image via Flickr, kylesteed

image via Flickr, kylesteed

What is the impact of ADD on marriage?

The impact of ADD on marriage is often profound. Over the years, in working with couples I have found extremely common events occur over and over and over again.

ADD and the Impulse Spouse

Frequently, marital difficulties begin before the wedding: the impulsive ADD individual meets someone; he quickly gets caught up in feeling—feeling loved, feeling sexual, feeling connected; with all the intensity of feeling, thinking does not occur; before the two really know each other, they get married. Maybe in a week, or a month, or six months, but very soon, one or the other and, often, both know they have made a terrible mistake.   Years later, they are in my office trying figure out what to do now.

ADD and the Child-Spouse

For couples that chose to marry after getting to know each other, the key issues are different. Frequently, I see them when the spouse who does not have ADD has reached his limit.   When they married, he loved her but now he has had enough. He is tired of getting her out of bed with a morning phone call or two or three, tired having to walk through an obstacle course of stuff to get to the shower, tired of ordering pizza for dinner, tired of the of the impulsive spending, tired of paying late fees because the bills were lost, tired of folding the laundry at midnight . . . he wanted a partner and feeling resentful that he has a child.

ADD and the Insensitive Spouse

There are still other couples that make their way to my office when the partner without ADD feels that her spouse is just not as connected to her as she had hoped. While he is a nice guy, he seems insensitive to her emotions, oblivious to her stresses, and in his own little world from after dinner to bedtime when she needs to talk.   Her conclusion is that she either has married an insensitive jerk or he doesn’t love her anymore. My experience with these couples is that, most often, neither of these is true. Rather, she has married a good man with ADD who still loves her. His poor attention, however, interferes with his ability to read between the lines, tune into nonverbal cues, and monitor his own lack of responsiveness.


Have you had relationships struggle or fail and now suspect the roots trace back to ADD’s challenges?  Looking for a change?  Get started with Dr. Liden’s book, ADD Basics 101, currently available as a free download e-book.

ADD: High Risk for Poor Communication?

ADD and Poor Communication | The Being Well Center

image via Flickr, Jesper Sachmann

Good attention is critical for efficient communication. In order to understand a message–to break it down and to process the elements–we must first pay attention to it. Similarly, to generate a response, we must focus on our own thoughts, translate them into words and sentences, organize them into a coherent message, and reflect on their appropriateness.

Attentional weaknesses, therefore, place the individual with ADD at high risk for poor communication skills.

The requirements for effective communication are at odds with the characteristics of ADD. Poor focus, distractibility, and short attention span lead the person with ADD to miss, get only part of, or totally misinterpret messages. The result is that he is frequently in a position where he must ask for repetition, request clarification, fake his understanding, or present himself as “out in left field.” Further, impulsivity, distractibility, and poor monitoring lead the person with ADD to produce messages that are disorganized, incomplete, and characterized by on-going revision.

Throughout the process of communicating, we must forever monitor our language and our behavior in order to be certain that we adhere to the unstated rules of communication such as being polite and using appropriate body language. This represents one of the biggest challenges for the person with ADD as these rules are rarely, if ever, explicitly taught.

Generally, we learn communication rules by paying attention!

We watch the people around us follow the rules and see the subtle signals we get when we break the rules. These critical rules include the following:

  • Take turns while you talk.
  • Do not monopolize the conversation.
  • Look at the person to whom you are listening or talking.
  • Talk on the topic.
  • Talk politely to adults.
  • Do not interrupt.
  • When changing the topic, introduce the change.
  • Let the person who is talking know that you are listening, that you understand, and that you are interested.
  • Carry your share of the conversation.
ADD and Poor communication | The Being Well Center

image via Flickr, Bruce Wunderlich

Because he has failed to learn the rules of the game, a person with ADD is frequently behind the eight ball even before the conversation begins!

For a person with ADD who has learned the rules, the challenge is no less–following the rules of communication, even when they are known, requires constant and efficient impulse control, filtering, and monitoring.


Successful treatment of ADD includes addressing all areas of an individual’s life, including communication.  Dr. Liden has been helping patients overcome the challenges of ADD through conscientious medication and creative approaches to life coaching for the past 30 years.  A more in-depth exploration of ADD/ADHD can be found in Dr. Liden’s best-selling book, Pay Attention!

 

Boost Creativity by Treating ADD

Are people with ADD more creative and does medication treatment interfere with creativity?

 

image via Flickr, telmo32

image via Flickr, telmo32

There is a fine line between creativity and impulsivity and distractibility.

When it comes to having new and unique ideas, there is something to say for the ADD population.

The rub, however, is that the impulsivity and distractibility that work together to promote the free flow of ideas usually combine with poor focus, inefficient monitoring, and short attention span to prevent even the best ideas from going anywhere.

In my experience, successful treatment allows the creative ADD mind to be focused, reflective, purposeful and planful enough so that the ideas it generates have a chance to become something in the real world.

To illustrate the difference successful treatment can make in the life of someone with ADD, let us introduce you to one of our patients, who we will call “Kory.”

Kory’s Story

medication add diagnosisWe first met Kory when he was 8 years old and in the second grade. At that time, he was making life miserable for his family, his teacher, and his peers. His parents described life with him as “bedlam.” Chaos and disruption seemed to happen whenever he was around. The same scenario seemed to play itself out at each and every social event Kory and his family attended. Without apparent reason, Kory started to “act-up.” His parents quietly scolded him. As Kory continued, his parents repeated their reprimand with hushed intensity. Kory explosively retaliated, physically and verbally. Startled, others stared in their direction. Angry and embarrassed, the family prematurely called it an evening. In response to this recurring scenario, family members began to walk on eggshells, hoping to avoid setting off Kory’s violent reactions.

Kory’s parents complained that getting him to assume any responsibility was nearly impossible. He required constant nagging to get anything done whether that was bringing his homework home, practicing his piano, or getting up in the morning. His parents resented Kory tremendously for the black cloud that seemed to be hanging over the family.

Kory’s teacher reported that he was not working to his potential. He was not following classroom rules, not listening to directions, and not being courteous to anyone. Reportedly, Kory attempted to take over all interactions with his peers. He was always punching, pinching, pushing, or tripping someone. Needless to say, Kory had no friends. His parents were worried about Kory’s future–they actually feared that he might end up in prison.

Kory is now in the sixth grade. For four years, Kory, his family, and his teachers have been involved in a comprehensive treatment program that we developed after a thorough evaluation. Life with Kory is no longer chaotic. His parents feel comfortable taking him nearly anywhere. Moreover, they are beginning to actually appreciate what Kory brings to the family. Generally, Kory is able to express his feelings appropriately now and is genuinely open to feedback concerning his behavior.

Kory, independently completes his homework and studies for upcoming tests on a daily basis. He is earning A’s and B’s in school. He has excelled in music and practices his piano and trumpet every morning without a hassle.

Kory is working hard to dispel his bad reputation with his peers. In fact, he has succeeded in establishing a few very nice friendships.

Kory continues to have his rough edges. However, for a 12 year old, he has a wisdom about him. He knows his strengths and weaknesses. He knows himself better than most of us do and because of this, when life’s challenges come his way, he will be able to creatively, responsibly, and wisely tackle them.


The Being Well Center treats individuals with ADD/ADHD from ages 3 to 93.  For more guidance on how to find successful treatment for ADD/ADHD, download Dr. Liden‘s guide ADD Basics 1o1.

Living on the ADD Edge

Why do so many people with ADD live life on the edge?

image via Flickr, Riccardo Palazzani

image via Flickr, Riccardo Palazzani

Living life on the edge: procrastinating and procrastinating only to complete the task, once again, at the eleventh hour, pushing the limits of the car’s maneuverability at 75 miles per hour, scheduling ten meetings in a five-meeting block of time, attacking the black diamond slope with beginner’s skills.

Each of these events provides the ADD individual with a “rush”—an adrenalin rush that is a consequence of the stress response. For all of us, the perception of danger sets off this response resulting in increased arousal; this allows us to hyperfocus.

By hyperfocusing in times of danger, we are more likely to save ourselves.

This series of events is clearly helpful for the ADD individual who struggles with focus otherwise.   By using the stress response, the competent individual with ADD is able to pull it all off again and again, making procrastination an art form.

The rush allows him to experience intense focus and, in this way, pull it off at 2:00 AM the morning it’s due, behind the wheel of the car, during meeting number four, and on the ski slope.

There is a rub to all this however; the stress response also results in elevated heart rate, increased blood pressure, and chronic anxiety.

The ADD individual living life on the edge thinking he has, time and time again, successfully avoided disaster in his life is actually a time bomb waiting to detonate.


What helps you hyperfocus?  Is it living “on the edge,” or have other strategies worked for you?  Dr. Liden discusses other ways to avoid the “ticking time bomb” approach in his best-selling book, Pay Attention! Answers to common questions about the diagnosis and treatment of Attention Deficit Disorder.