Stimulant Strategies, Part 3
Rule #3: Try medication 7 days a week, 12 hours a day.
Although some studies suggest that skipping medication on weekends — called drug holidays — may reduce side effects without increasing symptoms, the experts we spoke with disagreed. They say that the disruptive symptoms of the condition extend beyond the classroom or office. "ADHD is a life problem, not just an academic or workplace problem," says Dr. Copps. "The appropriate treatment is as important to relationships and social competency as it is to academic and vocational endeavors."
Taking medication that extends beyond the school or work day has many advantages, including increased focus doing homework and during after-work activities. For children, it's not necessary to medicate during sleeping hours, but it helps if the medicine is active at bedtime.
Some doctors recommend combining a short- and longer-acting stimulant. According to some experts, some of the longer-acting medications last only eight or nine hours, not 12. Dr. Copps compensates for that shortfall by recommending that his patients take a short-acting Ritalin in the early morning or late afternoon.
Rule #4: Keep tabs on how the medication is working.
Parents can help the doctor arrive at the right dosage for their child by tracking the child's response to the medication. A doctor should offer parents a structured way to monitor their child's symptoms. Behavior rating scales are very effective.
The SNAP-IV Scale (named for the doctors Swanson, Nolan, and Pelham, who created it), for instance, can help parents assess a child's behavior throughout the day and detect patterns and problems with medication. (You can download the form for free from ADHD.net. The scale gauges the frequency of 90 physical symptoms and emotional behaviors at home and in the classroom. A doctor can evaluate any troubling patterns and adjust the dosage or switch to another stimulant (or class of drugs) to correct them.
Adults can use the same patterns to detect problems with medication. If you notice that you becomes irritable and anxious at, say, 5 p.m. every day, for instance, your medication may be wearing off too soon. In this case, another dose might help. On the other hand, if anxiety and irritability occur a few hours after taking the medication, perhaps the dosage needs to be lowered.
For parents of ADHD children, the Conners' Rating Scales-Revised (CRS-R) is another worthwhile tool. Each of the three versions — parent, teacher, and adolescent — comes in a short and long form. Dr. Boorady recommends that parents use the long form themselves and reserve the short form for their child's teacher(s), who probably has less time to fill out the evaluation. "Whichever you choose, use the same form for all of the evaluations to ensure consistency," he adds. The CRS-R is available from Multi-health Systems, Inc., P.O. Box 950, North Tonawanda, New York, 14120.
Rule #5: Consider diet and medications.
Diet can affect the efficacy of any drug. If you or your child is taking Adderall XR, Metadate CD, or Ritalin LA, for instance, a high-fat breakfast can compromise its effectiveness, delaying the drug's absorption. Instead of the drug working within the usual 20 to 30 minutes, it could take one to two hours. Use common sense and avoid such high-fat dishes as a bacon, egg, and cheese sandwich; donuts; bagels with cream cheese; and full-fat muffins.
Similarly, drinks rich in ascorbic acid/vitamin C or citric acid (orange, grapefruit, and other drinks supplemented with vitamin C) may interfere with the absorption of Ritalin. Citric acid breaks down the medication before it has a chance to be absorbed by the body. As a result, some doctors recommend avoiding such drinks, as well as multivitamin supplements and high-vitamin cereals, an hour before and after taking the medication. Others disagree, claiming there's not enough citric acid in orange juice or fortified cereals to warrant passing them up.
Some doctors insist that patients on stimulants also avoid cold/sinus/hay fever medications that contain decongestants (antihistamines without decongestants are okay); over-the-counter or prescription weight control medications; steroids, taken orally or injected; and asthma medications containing albuterol or theophylline. All of these may produce a mildly unpleasant "buzz."
Carol Fitzgerald and her son, Gregory, now 14, have had many ups and downs in the nine years he's been on medication. But they both agree it's been worth the effort. "We've found something that enables my son to feel good about himself," she says. "That, to me, is the most important thing in the world you can do for your child."
This article appears in the October/November issue of ADDitude.
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To share strategies for managing ADHD symptoms, visit the ADHD Medications support group on ADDConnect.