Follow Up Care for ADD Medication

How often should an individual with ADD be checked once he starts medication?

image via Flickr, Kate Ter Haar

image via Flickr, Kate Ter Haar

Once the proper medication regimen has been established and the initial adjustment phase is over, my bias is that ADD individuals should participate in follow-up with a clinician at least monthly until all areas of his dysfunction are resolved or stabilized. This can be with a physician who performs brief med-checks and probes patient compliance with all parts of the treatment plan.

Alternatively, follow-up can be with a counselor, ADD coach, tutor, or other professional implementing the treatment plan and communicating to the physician about progress, persistent problems, and observed or reported medication side effects.

Regardless of the frequency of these follow-up visits, I see all of my patients for whom I am prescribing medication every three months for a more comprehensive medication review visit.

Include the Parent or Spouse

I strongly encourage both parents or the spouse to attend these visits with the ADD child or adult. At these appointments, I check height, weight, blood pressure, and heart rate and perform a targeted physical exam when there are specific health concerns. Each patient also participates in a brief reassessment of his attention using specific tests that I have developed. Sometimes we reassess attention on the current dosage of medication to document its current effectiveness. Other times, we assess attention of medication to document continuing need.

I always meet with the ADD individual to directly observe his functioning and to hear his perspective about how he is performing in each major life sphere — school, work, social involvements, home life, and daily routines and responsibilities. I also probe to be certain he is taking the medication as directed and check his perceptions regarding efficacy, side effects, or other problem areas. I then meet with his parents or spouse to discuss the same areas. As ADD individuals are notoriously inaccurate in monitoring their own performance or behavior, another person’s perspective is always helpful.

At the conclusion of these visits, I give my feedback about the progress the individual is making . . . sometimes followed by a hug or pat on the back and sometimes with a kick in the rear! Together we decide whether to keep the medication regimen the same, discontinue it, or to make changes.

Anticipate the Future and Stay in Touch

image via Flickr, in transition

image via Flickr, in transition

This visit also provides me with an opportunity to provide anticipatory guidance about problems that are likely to emerge in the near future as the expectations in the individual’s life change. When appropriate, I also share my treatment recommendations with the other professionals who are working with the individual.

As individuals continue in treatment, do well, and remain stable for a long period of time, occasionally, these visits out to occur twice a year rather than quarterly.

However, this is rare; I have learned over the years that a lot can happen in an ADD individual’s life in three months, let alone six months, that can head him in the wrong direction.

More often than not, the ADD individual is not fully aware of a change in direction or has used ineffective problem solving that complicated matters rather than solved a problem. I prefer more contact rather than less when it comes to management of ADD and so do most of my patients.


Catch up on all of the discussion topics in the Pay Attention! series.


Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

Help for someone resistant to ADD treatment

add treatment, family, the being well center

What can be done to help someone who is resistant accept treatment?

How we can best deal with a family member’s resistance to evaluation and treatment varies dependent upon the individual’s age. In younger children, we rarely see resistance. Once they see the positive impact of medication and other strategies on their school experience, social interactions, and home life, most young children are happy and, actually, excited about treatment.

add treatment, family, the being well centerThere is much more resistance pre-pubertal children and young adolescents who frequently struggle with the notion that ADD and its treatment make them different from their peers. This is a developmentally appropriate response for children this age who can react intensely to anything that sets them apart . . . a pimple on the forehead, not enough pubic hair, or having to take a pill in order to pay attention. Parents of these children can promote acceptance by being empathetic and providing educational materials that demystify ADD and its treatment. In my experience, however, it is important that parents of the resistant young adolescent take charge by setting clear limits about taking medication and participating in follow-up counseling. Typically, resistance and struggles with acceptance at this age fade relatively quickly as the child matures and begins to appreciate that we are all different in some way.

When dealing with older adolescents and young adults, addressing resistance is often more challenging. We frequently see older adolescents or young adults who have struggled for years, been accused of being lazy or stupid, or been told that they could do it if they just tried harder. After years of failure, many of these young people develop a hard exterior shell, an “I don’t give a damn” attitude to cover up a very low and damaged self-esteem, and intense resistance to help. While educational materials and frank discussions about ADD and its long-term consequences can sometimes help to overcome the resistance, it is often necessary for parents to focus on establishing firm limits and to stop enabling in order to motivate the older adolescent or young adult to comply with treatment. This may mean taking away the car, refusing to provide spending money or, in the case of the young adult, withdrawing the comfort and support of continuing to live at home.

Addressing resistance to evaluation and treatment with an adult, particularly a spouse can be tricky. Adults may have many reasons for not wanting to become involved in treatment. Some may have developed a version of that hardened, self-protective shell and, belligerently proclaim, “I’m just fine the way I am!” Many adults with ADD, as a consequence of their poor self-monitoring, truly do not see the problems that a spouse, close friend or even co-worker sees. When this is the case, it is important for significant others to provide direct feedback when problem behaviors occur and be careful to avoid enabling, co-dependent behaviors that can mask the impact of untreated ADD. Learning to detach, let go, and take care of himself are important steps for the spouse of the adult with ADD.


Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

The ADD Adolescent

ADD diagnosis teenagerWhat specific behaviors indicate that an adolescent might have ADD?

Efficient attention is required for success in all areas of life. As an ever-present filter between the individual’s external and internal worlds, it screens all incoming and outgoing information to and from the brain. In this way, attention has a profound influence on how an individual experiences events and behaves in all life spheres: school, job, home, and neighborhood. It interacts with other skills and abilities to shape the quality of social interactions, school/job performance, and independent functioning. Therefore, behaviors that suggest attentional difficulty can appear in any area of a person’s life. The following behaviors identify some of the more common red flags that might signal ADD in adolescent children ages 12 to 18 years old.

Adolescent (Twelve to Eighteen)

  • Not being able to organize free time
  • Failing to plan long-term assignments (e.g., reports, projects, and tests)
  • Failing to keep track of assignments
  • Writing disorganized compositions and reports
  • Demonstrating poor reading comprehension of higher level materials
  • Failing to pay attention to personal hygiene
  • Needing constant reminding/nagging to be responsible
  • Skipping school
  • Getting into trouble with the law; committing delinquent acts
  • Getting caught!
  • Getting off the topic in conversations
  • Interrupting and failing to take turns when talking
  • Flying off the handle and doing impulsive things
  • Behaving inappropriately in social situations without realizing it
  • Going beyond simple experimentation with drugs and/or alcohol

ADD Basics 101 | Dr. Craig LidenIf you just recognized someone you know in this list, go to ADDBasics.org and download Dr. Liden’s free guide, ADD Basics 101. In 10 clear steps, Dr. Liden will guide you to an accurate, trustworthy diagnosis and outline what you should look for in an effective treatment plan.


 

AFScovers2Maybe you already have a child identified with ADD/ADHD who is struggling in school.  Dr. Liden’s book, Accommodations for Success, is an amazing resource to help you understand your child better and get her the individualized help she needs to soar at school.

 


Check back tomorrow for red flags in adults’ behavior…

Catch up on previous posts in the Pay Attention series.

Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

The ADD School Age Child

lifespan_schoolageWhat specific behaviors indicate that a school age child might have ADD?

Efficient attention is required for success in all areas of life. As an ever-present filter between the individual’s external and internal worlds, it screens all incoming and outgoing information to and from the brain. In this way, attention has a profound influence on how an individual experiences events and behaves in all life spheres: school, job, home, and neighborhood. It interacts with other skills and abilities to shape the quality of social interactions, school/job performance, and independent functioning. Therefore, behaviors that suggest attentional difficulty can appear in any area of a person’s life. The following behaviors identify some of the more common red flags that might signal ADD in school age children ages six to twelve years old.

The ADD School Age Child (Six to Twelve Years)

  •  Quitting activities before they are completed
  • Interrupting conversations; not taking turns when talking
  • Talking off topic
  • Failing to make eye contact
  • Jumping from one play activity to another
  • Requiring constant supervision to complete chores, routines, (e.g., dressing, bathing, etc.), and independent seatwork
  • Seeming to be sleepy, drowsy, or restless during learning situations
  • Rushing through things; doing sloppy work
  • Losing one’s place during reading; skipping, omitting, or reversing letters and words during reading and writing
  • Making careless errors on simple tasks; guessing at answers
  • Failing to check over schoolwork
  • Failing to finish work; being disorganized
  • Relying on parents for studying and organizing schoolwork
  • Forgetting and losing things; not remembering assignments
  • Talking out in class
  • Saying, doing, and writing things without thinking first
  • Failing to respond to discipline
  • Getting in fights
  • Having friends who are either much older or much younger
  • Looking disheveled: zipper down, shirt tail out
  • Seeming to be “spacey” or “out of it” at times
  • Walking into walls, doors, and furniture
  • Being accident-prone; spilling and dropping things

ADD Basics 101 | Dr. Craig LidenIf your response to this list is “Oh, boy.  I know a kid like that.  Now what?”,  go to ADDBasics.org and download Dr. Liden’s free guide, ADD Basics 101. In 10 clear steps, Dr. Liden will guide you to an accurate, trustworthy diagnosis and outline what you should look for in an effective treatment plan.


 

AFScovers2Maybe you already have a child identified with ADD/ADHD who is struggling in school.  Dr. Liden’s book, Accommodations for Success, is an amazing resource to help you understand your child better and get her the individualized help she needs to soar at school.


 

Check back tomorrow for red flags in adolescents’ behavior…

Catch up on previous posts in the Pay Attention series.

Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

The ADD Preschooler

lifespan_preschoolWhat specific behaviors indicate that a preschooler might have ADD?

Efficient attention is required for success in all areas of life. As an ever-present filter between the individual’s external and internal worlds, it screens all incoming and outgoing information to and from the brain. In this way, attention has a profound influence on how an individual experiences events and behaves in all life spheres: school, job, home, and neighborhood. It interacts with other skills and abilities to shape the quality of social interactions, school/job performance, and independent functioning. Therefore, behaviors that suggest attentional difficulty can appear in any area of a person’s life. The following behaviors identify some of the more common red flags that might signal ADD in children ages three to six years old.

Preschooler (Three to Six Years)

  • Failing to take turns during play activities
  • Not sharing during play
  • Not being aware of dangerous situations (e.g., crossing the street)
  • Switching from one activity to another
  • Not being able to sit at the table until the family has finished
  • Not being able to maintain concentration in learning activities
  • Failing to sit still to read a story or to put together a puzzle
  • Not seeming to hear
  • Impulsively hitting, pushing, or biting others
  • Being fearless and reckless during play
  • Being asked to leave preschool/daycare
  • Struggling to control emotional reactions
  • Wandering off

If your response to this list is “Uh-oh.  Now what?”,  go to ADDBasics.org and download Dr. Liden’s free guide, ADD Basics 101. In 10 clear steps, Dr. Liden will guide you to an accurate, trustworthy diagnosis and outline what you should look for in an effective treatment plan.

Check back tomorrow for red flags in School Age children’s behavior…

Catch up on previous posts in the Pay Attention series.

Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

How does ADD affect learning?

Check out Lisa Ling‘s frank admissions of her struggles in the classroom.  Sound familiar?

Attention plays a major role in learning since all information coming into and out of a person’s brain is filtered by attention. That is, in order to acquire a new piece of information or a skill, we must first pay attention to it. In order to show that we have mastered the information or skill, we must control our impulses, monitor our behavior, filter distractions, and concentrate for a sustained period of time on the “tests” that occur in the classroom and in the real world.

Poor attention affects both incidental and “school” learning. A person who has a weakness in attention is less able to receive all of the input from the environment–structured or unstructured–that is necessary for learning. For example, he neither sees nor hears all the steps that Mom and Dad show and tell him about cleaning his room; he misses the fact that there are actually road signs that tell where to go; and he fails to get the coach’s instructions about game strategies during practice. At school, he doesn’t listen to the teacher’s instructions; he doesn’t see the assignment written on the blackboard; he doesn’t get the meaning of the stories he reads; and he doesn’t remember the steps in long division.

ADD can also interfere with a person’s ability to demonstrate what he has learned. People with ADD may have messy rooms, dirty dishes, and poor hygiene even though they know how to clean, to do the dishes, and to care for their bodies. In school, people with ADD may fail to complete all the problems or daily worksheets, add instead of subtract on achievement tests, make careless errors on intelligence tests, reverse letters when reading or writing, and forget to capitalize and punctuate in written language tasks.

Apparent difficulties in seeing, hearing, remembering, and understanding often lead to the false conclusion that individuals with ADD have auditory or visual perceptual problems or are just less intelligent. In reality, however, they are simply not alert and not reflecting, focusing, filtering, persisting, or monitoring their behavior and their schoolwork.  Brain power only goes so far.

ADD negatively affects learning. But, it never does so alone. A person’s temperament, intellectual, and learning abilities, and language skills, among other things, interact to influence how attention affects learning. It is important to remember that ADD, as a biologically based individual difference, can occur in anyone–an individual who is gifted, learning disabled, retarded, and one who has average learning ability.

Catch up on previous posts in the Pay Attention series.

Patients of all shapes, ages, and sizes come to The Being Well Center and Dr. Craig Liden for diagnoses and treatment plans they can trust. Can we help you too? Visit The Being Well Center for more information about Dr. Liden’s services.

Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.

Do people have ADD from birth?

ADD Basics FamilyAs we continue laying out the truth about ADD/ADHD, we turn to some of the most common, burning questions my patients, friends, family, and colleagues most commonly ask me.  The answers to these questions form a critical foundation to understanding the truth about Attention Deficit Disorder.

If people are born with ADD, why don’t problems show up right after birth?

ADD becomes apparent only when the inborn attentional differences interfere with the individual’s ability to meet expectations in the environment. Depending upon the severity of a person’s attentional differences, his temperament, the status of other skills and abilities, and the specific nature of environmental expectations, ADD can crop up at any point along the life span from infancy to old age. Let’s take a look at how this can happen.

Typically, individuals with ADD appear to be normal at birth. As children, they are minimally, if at all, delayed in meeting major milestones of accomplishment such as walking and talking. They generally reach school age with only minor problems in controlling their behavior and interacting with peers. The first grade classroom is often the first place where specific expectations for paying attention occur. As a result, the entry into school is one of the more common times when ADD first shows up. Other key transition points in the individual’s life where expectations for increased efficiency of attention can lead to the emergence of ADD include the following:

  • Movement to the upper elementary grades where time constraints are imposed and increased demands are placed on children to function independently
  • Movement to junior/senior high school where more refined organizational and study skills are required
  • Movement to college where fewer supports are available and the ability to function independently is essential
  • Movement into a new home away from parents where there are no supports and the ability to function independently is even more critical
  • Marrying or cohabiting with a partner where functioning impacts upon the quality of life of another person and demands for efficient problem-solving are high
  • Becoming a parent where responsibilities for keeping it all together, all the time is essential

Individuals with ADD who have strengths in other areas (e.g., strong language skills, a charming personality, intellectual giftedness) can go a long time in life without being identified as having a problem. I have seen many children go through elementary school with A’s and B’s only to have the bottom fall out upon entry to middle school or junior high school. In these circumstances, careful probing of the educational history of these children often reveals evidence of attentional weaknesses that have either been overcome with sheer brain power or been overlooked by parents and teachers because these subtle weaknesses hadn’t really led to failure.

While failure to meet increasing school demands is a very common way for ADD to be uncovered, it can also happen as a result of failure to meet increasing demands for independent functioning, social interaction, or problem-solving at home, in childcare, in the neighborhood, or on the job.

Meet Michael

Michael is a good example of this. He is a 10-year-old boy who has always done very well, academically and socially. He has learned new concepts quickly, has shown a gift for memorizing facts, has been easy to get along with, and has always been a great conversationalist.

Until two months ago, he had also functioned very well at home. At that time, however, his mother got a new job that meant she was no longer able to be with Michael after school. And, despite all of her attempts, she had been unable to find someone who would stay with Michael until her new workday ended. So, for the first time, Michael was on his own everyday from 3:00 p.m. to 6:00 p.m.

The new expectation for him was “keep yourself busy and stay out of trouble for three unsupervised, unstructured hours.” This new demand uncovered Michael’s impulsivity, distractibility, and lack of ability to think through the ramifications of his behavior. He broke a living room lamp by rough housing in “off-limits territory”; he burned a hole in the new family room couch while “fooling around” with a butane lighter; and he soaked the bathroom carpet when he ran to answer the telephone, forgetting to first turn off the faucet.

Without his mom around to help him structure his time, to remind him of the house rules, and to watch over his activities, Michael had become dysfunctional.

Meet Emma

Emma’s story is similar. She is a 22-year first year elementary school teacher who has just married. Emma is gifted, kind, funny, sensitive, and very hardworking. Until now she has done well in almost every sphere of her life, but she has never been asked to establish her own home, to share finances, nights, and laundry with someone else, to complete daily lesson plans for five subjects, to effectively manage thirty fifth-grade children for six hours every day, and to negotiate unclear work politics all at the same time.

Emma is a mess. Despite her intelligence, her hard work, her sense of humor and her likeability, she is not experiencing success anywhere in her life.

Catch up on previous posts in the Pay Attention series.

Patients of all shapes, ages, and sizes come to The Being Well Center and Dr. Craig Liden for diagnoses and treatment plans they can trust. Can we help you too? Visit The Being Well Center for more information about Dr. Liden’s services.

Our current blog series is excerpted from Dr. Liden’s best-selling book, Pay Attention!: Answers to Common Questions About the Diagnosis and Treatment of Attention Deficit Disorder.