The Prognosis for ADD

image via Flickr, by Ginny

image via Flickr, by Ginny

What is the prognosis when ADD is treated appropriately?

The prognosis of ADD is highly variable depending upon a multiplicity of factors. The individual’s temperament. His language skills. His intelligence. His basic academic skills. The profile and severity of attention weakness. His physical characteristics. The integrity of his nervous system. The presence of illness. Stresses in his life. His attitudes and beliefs. His self esteem. His motivation. The expectations set for him. The profile of strengths, weaknesses, and temperamental characteristics of people in his life….

For each individual, the mix of these factors is a little bit different. And for any given individual, the mix is constantly changing. This is what makes ADD such a challenge.

When all these factors are taken into account and appropriate, comprehensive treatments are put into place, the prognosis for ADD is good but guarded.

That is, the ADD individual can be helped to function successfully academically and on the job; he can have meaningful social relationships; and he can function independently.

However, as long as he continues to take on life’s challenges, there is always the possibility that the problems associated with ADD will resurface. But this really is no different from what we all face in our own personal quest for self-development.


There is no magic pill or quick fix for Attention Deficit Disorder.  That’s why Dr. Liden has dedicated over 30 years of his life to diagnosing and treating the disorder, following his patients through many life stages and challenges, helping them achieve success and independence through it all.  His collected wisdom is shared here on the BWC blog and in a number of books.  He also serves as Senior Medical Director of The Being Well Center, which offers Long Distance Services and an affordable Accurate Diagnosis Determination.

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Meet Dr. Liden, Part II

[continued from Part I]

Dr. Liden | The Being Well CenterIf I hadn’t had to live with the ramifications of Attention Deficit Disorder in my own home, I probably would have stayed with the approach [referring the management of ADD back to medical professionals with little training in ADD treatment] for a long time, thinking I was really making a difference in people’s lives.

Instead, as I faced the problem daily, I became aware of the pervasive, chronic nature of ADD and the need for a much more systematic and comprehensive treatment approach.

As a result, I left Children’s Hospital and organized a team of professionals including teachers, speech-language pathologists, psychologists, counselors, nurses, and others to begin TRANSACT Health Systems, now known as The Being Well Center.

Located near Pittsburgh, Pennsylvania, The Being Well Center provides diagnostic and treatment services for individuals with a variety of developmental, learning, and behavior problems — again, the most common being ADD.

At The Being Well Center, our initial focus was children and adolescents with these problems. However, it has become more and more apparent to us that there are large numbers of adults who continue to struggle with problems like ADD. Many of them are the parents and grandparents of the children we see. We have expanded our services to meet their needs as well.

Dr. Craig Liden | The Being Well CenterAs Senior Medical Director of The Being Well Center, I have counseled thousands of patients with ADD. I have worked with their family members. I have talked to hundreds of PTA groups and community organizations. I have conducted many in-service sessions about ADD for medical and educational professionals have supervised the expansion of our TRANSACT program to the other parts of Pennsylvania and the Eastern United States.

Through my involvement in all of these endeavors, I have become impressed with how little most people know about the common problem of ADD. Even though the same questions keep coming up, no one has provided a good resource that patients, parents, teachers, and others can use to better understand ADD. That is the rationale for my books, this blog, and our online communities on Twitter, Facebook, and LinkedIn: to provide practical, down-to-earth answers to the common questions about ADD, its assessment, and its treatment.

In putting together the answers, I have tried to combine the scientific knowledge I have gained as a researcher and teacher, the insights I have developed in working with professionals from other fields, the practical experience I have acquired in caring for more than 10,000 patients with ADD, and the hopes and fears I have experienced as a parent of a child with ADD.


Read Part I of Dr. Liden’s personal and professional 30-year journey in treating more than 10,000 individuals with ADD/ADHD.

 

How To Pay for ADD Treatment

image via Flickr, Bill Brooks

image via Flickr, Bill Brooks

What can be done when finances interfere with pursuing proper treatment for ADD?

In many states across the United States, children diagnosed with ADD are eligible for financial assistance for medical care through the medical assistance program.

While the criteria vary from state to state, eligibility, generally, is not dependent upon family income. Certain adults with ADD may be eligible for medical assistance as well; frequently, however, employment and income criteria apply.

Medical assistance is accessed through local Department of Public Welfare or Social Security Offices.

Children and adults whose functioning is severely compromised by ADD and whose incomes (or parents’ income) fall below establish guidelines may also be eligible for Supplemental Social Security Income (SSI), financial assistance available through the Social Security Office.

In my experience, a family’s success in pursuing these kinds of aid requires lots of paperwork, patience, focus, and persistence.


The costs of treating a chronic condition like Attention Deficit Disorder can be high, but the costs of the consequences of NOT treating it are even higher!  Take a look at the cost comparison between treated and untreated ADD/ADHD.  It will give you a needed boost of energy to tackle the insurance companies or government program red tape today!

30 days or 30 years? How Long People with ADD Should Take Medication

image via Flickr, Pink Sherbet Photography

image via Flickr, Pink Sherbet Photography

People with ADD show a great deal of variability in the length of time that they require medication as an aid to control weak attention. Because ADD is a biologically-based, constitutional problem that people do not out grow, some individuals require use of the medication for a lifetime.

Fifteen years ago, I more was more optimistic about helping individuals get to the place where they could be independent of the medication. With lots more experience, I now know that independence from medication is the exception rather than the rule.

Over the years, I have become particularly cautious about my patients’ being off medication when I know they will be behind the wheel of a car or in social situations where their decision-making has potentially serious ramifications.

When we look closely at all areas of life functioning, more than 75% of my patients continue to demonstrate a need for the aid of medication in adult life.

Pre-Requisites for Going Off ADD Medications

Some individuals do reach a point where they can “do it on their own” for varying periods of time. I have found that the key pre-requisites for a patient’s getting to this place include:

  • a firmly established balanced healthy daily routines
  • a keen awareness of what his problems are and how to control them, and
  • an ability to see at risk situations in advance and make the necessary adjustments.

My patients who are most likely to meet these pre-requisites generally have:

  • ADD that is moderate in its severity
  • a number of strengths that can be mobilized to compensate for attentional weaknesses, and
  • a history of close involvement with professionals

The Benefits of a Great Support Team

image via Flickr, Bruce McKay

image via Flickr, Bruce McKay

Additionally, my most successful patients who tackle ADD challenges without medication usually fully accept their differences, are highly motivated, and are surrounded by supportive family members, friends, teachers, and others.

The shortest period of time a person I have treated has needed the assistance of the medication has been three months. More commonly, individuals with ADD require medication for at least several years before they are able to function effectively without it at least for a brief period of time.

How We Transition Patients Off Medication

In my practice, when a patient appears to be ready for an extended trial off of medication based upon parent, spouse, teacher and other feedback, I have him stop medication for a couple of days and come into the office where we determine via testing and structured observation his readiness to discontinue the medication.

When everything suggests that he will be successful off medication, I have him remain off the medication for an additional 1-2 weeks. For the patient who is in school we notify teachers of the plan. I then have the patient come back to the office in two weeks to assess how he has performed day in and day out off of the medication. When he has done well, I see him monthly for six months, then quarterly.

Don’t Hesitate to Resume Medication When Needed!

Whenever I see signs of increased attentional problems that result in a significant life dysfunction, I resume the medication.  I’ve outlined my thoughts on a successful medication experience in 7 Keys to Successful (and Safe) Medication Treatment for ADD.


Dr. Liden’s clinic, The Being Well Center, offers free resources for people working through the challenges of living with ADD, both on medication and off.  Don’t miss the BWC resources page for free downloads and ideas that could help you or a friend today!

ADD Medications Reduce Drug Addiction Rates

image via Flickr, Alan Cleaver

image via Flickr, Alan Cleaver

Can the use of ADD/ADHD medications lead to drug addiction?

ADD medications, with the exception of Strattera, are controlled substances that can potentially be abused. This can be a source of concern because we use them in ADD individuals who are at a significantly higher risk for the development of alcoholism and drug addiction.

Interestingly, research now shows that when individuals with ADD are properly diagnosed and treated with these medications, their risk for substance use disorders is reduced to that of the general population.

I have never had a patient become addicted to one of the stimulants nor am I aware of any reports in the medical literature of someone developing addiction to a medication prescribed therapeutically for ADD.

I have had a rare patient who abused his medication, sold his medication, or was intimidated into giving his medication to a friend who wanted to crush and snort it. I would have to say that I am somewhat skeptical about what kind of “high” someone really gets from what turns out to be relatively mild stimulants.

Furthermore, when used properly, individuals do not develop a tolerance for the medications that require them to take ever-increasing dosages in order to obtain the same beneficial effects.

In fact, once the optimal dose is determined, there are only a few conditions under which a dose may need to be increased:

  • When substantial weight gain occurs in a growing child or adult, an increased dose may be necessary.
  • Similarly, refined feedback from significant others, over time, may indicate the need for further fine-tuning of the dosage level.
  • Finally, if there is a significant jump in expectations necessitating a further degree of refined attention, then a dosage increase might be necessary.

Can people with addictive disorders take these medications safely?

image via Flickr, Blake Danger Bentley

image via Flickr, Blake Danger Bentley

Interestingly enough, I have taken care of many adolescent and adult alcoholics and drug addicts who have ADD and who might not have “hit bottom” had they been involved in comprehensive treatment that included ADD medication and strategies to improve self-awareness, self-control, and problem-solving at an earlier age.

I currently use all of these medications in treating ADD individuals who have co-morbid addictive disorders, provided they participate in frequent follow-up visits to monitor their medication use.

I also insist that they are involved in counseling and a 12-step program such as Alcoholics Anonymous, Narcotics Anonymous, and Overeaters Anonymous. This careful approach has been very successful in addressing a key component to the addictive disorders of my patients. For some of them, medication use seems to be a critical factor in their success in establishing and maintaining sobriety.

Stattera does not have any abuse potential. For this reason, since it has become available, I preferentially select it as the first line of treatment in ADD patients struggling with substance use disorders.

I would not, however, hesitate to switch to one of the stimulants if I was not achieving therapeutic efficacy with Strattera.

I have learned that when they are managed properly, stimulants can be effectively and safely used in patients with addictive disorders.


Want more insights you can trust on effective ADD/ADHD treatment?  Dr. Liden shares a deeper, more clinical examination of proper use and administration of ADD/ADHD Drugs in ADD Basics 301: Rationale for Clinically Necessary Off-Label Use of Stimulant Medications in the Treatment of Attention Deficit Disorder / Attention Deficit Hyperactivity Disorder (ADD/ADHD).  Currently available as a free download ebook!

Did My Personality Change, or Did I Just Take ADD Medication?

image via Flickr, Wewiorka Wagner

image via Flickr, Wewiorka Wagner

Do ADD/ADHD medications cause personality changes?

It is not uncommon to see new and different behaviors in the individuals starting ADD/ADHD medications. However, ADD medications are not really mood altering or personality changing drugs.

Commonly, upon beginning medication, most individuals report feeling more aware of what is going on around them. As a result of this increased awareness, some people, understandably, become sad or depressed as they, for the first time, tune into the mess that ADD has caused in their lives: failure in school, social isolation, financial difficulty, marital problems, etc.

For some individuals, this new appreciation of reality can be overwhelming. Without effective problem-solving skills, they often have no mechanism to make things better. Without adequate support, feelings of sadness can intensify and turn into depression.

Hitting Bottom Motivates Change

It can be disconcerting to parents, teachers, spouses, and friends to watch from the sidelines while someone they love goes through this period of “being down.” It is important to keep in mind that this hitting bottom can be a source of motivation for change provided that parents, teachers, spouses, doctors, counselors, and others are supportive and provide guidance. 

The significant behavioral and personality changes that can accompany the use of these medications can be misinterpreted when we fail to appreciate the powerful impact of weak attention.

“Tuned Out” Masks True Personality

The untreated ADD individual often misses many of the things that cause most of us to respond emotionally. When he fails to show an outward response (because he has failed to tune into the event), we make assumptions about his temperament or personality. The possibility that he has not tuned into the event does not usually enter into the equation.

image via Flickr, Jim Larrison

image via Flickr, Jim Larrison

Enhanced awareness often uncovers temperamental characteristics that may have always been present in the ADD person.

For example, the seemingly outgoing, happy-go-lucky child may suddenly become subdued and fearful; the easy-going child may suddenly appear to be more strong-willed, and the insensitive spouse starts crying for no apparent reason.

Uncover the Underlying Traits

None of these changes represent alterations of personality, rather, the uncovering of underlying traits such as low threshold, high intensity of response, slow adaptability, or withdrawal response to new situations that were always there. Prior to medication, these life events and circumstances that provide opportunities to understand an individual’s personality went unnoticed.

Such effects of medications are sometimes mistakenly seen as negative side effects of medication and parents or the ADD individual may choose to discontinue the medication rather than take the opportunity to work on controlling these intrinsic temperamental traits.

 Switch Medications if Temperament Issues Persist

In some cases, the enhanced manifestation of these temperamental characteristics can be so profound that it interferes with the individual’s learning better self-control.

In such circumstances, I have found it is wise to switch to a different medication.

In my experience, this more frequently occurs with the stimulants. I have rarely felt it necessary to switch from the non-stimulant, Strattera, in response to a patient’s struggles with his temperament.

It suffices to say there can be great individual variability among individuals and medications when it comes to the apparent impact on personality.


Dr. Liden and The Being Well Center believe strongly in treating the Whole Person.  That means we believe there’s a lot more to dealing with ADD/ADHD than just getting the medication right.  You might find our post on Temperament helpful in providing more guidance on personality.  Or browse the various topics in our popular Pay Attention! series.  We’re here to help you untangle the tricky problems present with ADD/ADHD, one knot at a time.  

 

5 Ways to Remember to Take ADD/ADHD Medication

5 Ways to Remember ADD Medication | The Being Well Center

image via Flickr, Tim Pierce

1.  Depend on Grown-up Support Already in Place

Remembering to take medication every day or multiple times during the day can be a challenge for anyone and is even more so for the individual with ADD. When treating young children, it is not generally a big issue because parents, teachers, and school nurses take on the responsibility of giving the medication.

2.  Medicate Parents First

The exception is when one or both parents also have ADD and then forgetting to have their children take the medication becomes another symptom of untreated ADD. This is one of the reasons I prefer to diagnose and treat the parents first when a parent-child combo comes to my office for help.

3.  Give Adolescents FULL Responsibility

As children get older and move into adolescence and adulthood, assuming full responsibility for remembering to take the medication needs to be a top priority. I often encourage parents to use responsible taking of the medication as a “ticket of admission” to other important big life privileges like driving a car or going out with friends. In fact, my words to my own son were: “If I can’t trust you to take the medication without reminders, then how can I trust you to make the difficult right decisions out in the world?”

4.  Develop an Established Daily Routine

image via Flickr, Santiago Nicolau

image via Flickr, Santiago Nicolau

The single most important tool in remembering to take medication is helping the ADD individual to develop an established daily routine for sleeping, eating, exercise, and other activities of daily living. In the context of a structured daily routine, it becomes easy to find times to consistently take medication. For example, a three-times-a-day medication regimen of short-acting stimulants can be tied to mealtimes. A once-a-day medication like Strattera can always be taken with breakfast or dinner. The most difficult medication administration schedules to structure are the twice-a-day regimen required for the long-acting stimulants. The key again is to try to tie taking the medication into another regularly occurring activity.

One suggestion often made to ADD individuals is to use devices such as timers, watches, or pill containers with timers and buzzers. In theory, these tools should work, but our experience has been that they often become just one more thing to deal with, lose, or forget. Ultimately, the successful use of these tools is also dependent on the establishment of a structured daily routine – to set the timer, fill the container, etc. So, we put the focus on the establishment of a daily routine.

5.  Commit to Using Medication

Finally, when it comes to consistently taking the medication, it is critical that the individual is truly committed to the use of medication. Sometimes what appears to be a problem remembering to take medication is really a problem with acceptance of the ADD diagnosis and the need to take medication in order to function effectively and behave appropriately. Under such circumstances, support with acceptance is more important than any reminder system.


What tips, tricks, reminders, or advice help you remember your ADD/ADHD medication?