Few things create more conflict in families with a teen or young adult diagnosed with ADHD than med management. One of the ironies of stimulant medication is that teens who don’t need medication pay $2 a pill on the street for it, while those who do need it often sell it for $2 a pill so that they won’t have to take it.
Prescriber Kelsey Daugherty, RN, MSN, PMHNP, and I are writing a book on this topic right now. It’s called ADD and Zombies: Fearless Medication Management for ADD and ADHD. The title is a tongue-in-cheek nod to the so-called “zombie effect” of stimulant medication, in which the teen with ADHD complains that the stimulants that cause non-ADHD people to stay up all night and focus intensely on things turn him into a mindless, sedated drone. Others take a less dramatic position, contending that they feel “completely different” or have “no personality” while on ADHD meds.
I see a lot of parents in my practice begging their high school and college students, correctly diagnosed with ADHD, to maximize their potential by adhering to a medication regimen. Many of those teens exercise their right to refuse medication, even as they’re failing in school, losing jobs, and, in many cases, living under their parents’ stairs while their friends go off to college, work, or trade school. The controversy over stimulant usage hasn’t helped. It’s easy to criticize mental health professionals for following the established standard of practice. It’s harder to prove that non-medical treatments will stem a neurological impairment.
Here are a few strategies to help parents convince reluctant teens to get with (and stay with) the medication program:
> Find the right prescriber/therapist team. By “team,” I mean providers who actually practice together and communicate about their cases. The standard of care for treating ADHD is a combination of medication and therapy, not one or the other or a disconnected hodgepodge. Yet this approach is rare. If your teen hasn’t tried integrated treatment yet, you haven’t done all you can to deal with his or her ADHD.
> Enlist your teen to lead the team. A lot of kids feel that medication is something being done to them. In my practice, I always invite teens to be part of the team, preferably its leader. It is their choice as to whether they take medication, and sometimes the answer is “no.” However, by listening and working together to craft a medication regimen, med-related annoyances and side effects can usually be minimized, allowing the benefits to shine through. In most cases, when I see medication failure, I’m seeing a lack of teamwork.
> Be MythBusters. Adam Savage and Jamie Hyneman, hosts of the Discovery Channel’s MythBusters, have probably done more to promote the scientific method than an army of science teachers. My wife, who is a science teacher, agrees. Take a page from their playbook in helping teens understand that medicating ADHD is a big science experiment. This turns the frustration that kids feel at being “guinea pigs” into a lesson in empiricism. This mindset makes it tolerable to try various medications and dosages until you get it right, or to prove that medication isn’t the answer — in which case, it is wise to go back and reconsider the original diagnosis.