ADHD Medications Rarely Work Perfectly on the First Try
Finding the most effective ADHD medication for your particular brain chemistry is — unfortunately — still a process of trial and error. It’s rough, but don’t give up — at least not without reading these solutions to common problems with ADHD medication.
Taking medication is usually the first step in treating attention deficit disorder. But what do you do when the ADHD medication does not work? Or when ADHD symptoms grow worse? Or when you or your child experience side effects from medication?
Read on for solutions to common ADHD medication problems that adults, children, and their parents face.
Problem: ADHD Medication Doesn’t Work
When starting medication, some adults and parents claim that there is no improvement. The most common reason for this lack of response is an incorrect ADHD diagnosis. Maybe your child’s behaviors are caused by an academic problem, such as a learning disability (LD) — maybe you suffer from a mood disorder or an anxiety disorder, not adult ADHD. Many patients tell their doctor that they or their child can’t sit still or pay attention to everyday tasks. Without asking questions or conducting tests, the physician writes a prescription. The ADHD diagnosis is not that simple. Specific criteria must be met before an attention deficit disorder diagnosis is made: establishing that the behaviors have been chronic (existed since early childhood) and pervasive (at home, at work, at school).
In some cases, the ADHD diagnosis may be correct, but the prescribed dosage may be incorrect. Determining the right dosage is not based on age or body mass, but on how quickly the medication is absorbed into the bloodstream and passed into the brain. A 250-pound adult may need 5 mg., while a 60-pound child may require 20 mg. Since the dose needed is specific to the patient, medication should be started low, at 5 mg. If no benefits are seen, the dose should be increased, by 5 mg., every five to seven days until the correct dose is determined.
Finally, many people with ADHD have additional problems, alongside their ADHD diagnosis. The most frequent are learning disabilities, anxiety disorders, mood disorders, anger control problems, or obsessive-compulsive disorder (OCD). Stimulants manage ADHD symptoms, but don’t address symptoms caused by related disorders.
Problem: ADHD Medication Doesn’t Work All The Time
If mornings are difficult: Think about how you or your child act when you’re on ADHD medication and when you’re not. Most problems occur before the medication starts working or when the dose doesn’t last the full four or eight hours noted on the label.
To keep yourself or your child calm and focused in the morning, try to wake up an hour earlier than usual to take the ADHD medication. Then, go back to sleep. For children, if going back to sleep is difficult, discuss using Daytrana, a methylphenidate patch, with your doctor. Apply the patch to your child’s thigh while she’s asleep, and the medication will start to work within an hour. (If you do this, an earlier afternoon dose may be needed.)
If you or your child crashes in the afternoon: Maybe there is a dip in coverage around noon, and difficulties arise between 12 and 1. Maybe you begin to feel unfocused around 4 p.m., or completely wired and hyperactive around 8 p.m. Play detective to determine when ADHD symptoms worsen. Maybe the four-hour tablet lasts only three hours with you or your child. Perhaps the eight-hour capsule you are giving your son is not releasing evenly. Tell your physician when medication doesn’t work — and he can reconfigure the dosage schedule or change the medication.
Problem: ADHD Medication Causes Side Effects
Side effect: loss of appetite: While some ADHD medications suppress appetite, a healthy appetite often returns in several weeks. If not, try delaying the first dose until after breakfast. Lunch is often a bigger challenge. A nontraditional lunch, such as a food supplement milkshake, like Ensure, or a high-protein energy bar, might provide nutrients while appetite isn’t strong. To increase appetite at dinnertime, hold off on the 4 p.m. tablet until after dinner. If none of these suggestions work, ask your doctor for a referral to a nutritionist who has experience working with ADHD. If your or your child’s appetite doesn’t return, talk with your doctor about switching to another stimulant or to a nonstimulant.
Side effect: sleep problems: Stimulants affect the area of the brain that induces sleep. Skipping the 4 p.m. dose may help — but not at the cost of symptoms becoming unmanageable. If you find that this is the case, try this experiment. With your doctor’s permission, add an 8 p.m. four-hour tablet. A small dose of stimulant helps some ADHD patients fall asleep. If the experiment fails and you or your child still can’t fall asleep, your doctor might suggest Benadryl. Many find that a small dose of melatonin helps with sleep.
Other side effects: Thirty to fifty percent of individuals with ADHD have a co-occurring condition. In some cases, stimulant medication exacerbates these disorders or causes the disorders to become clinically apparent. If you notice that you or your child becomes more anxious or fearful, unhappy, or angry on stimulants — but that the symptoms stop when you’re off the medication — talk with your doctor.
It is essential that emotional-regulation problems be treated promptly. A doctor will often prescribe a selective serotonin reuptake inhibitor (SSRI) to treat these disorders. Then the stimulant medication can be reintroduced without causing difficulties. Medication might be needed to address tic disorders as well.
Parenting Problem: Your Child Resists or Refuses to Take Medication
Educate your child about the medication he is taking: Don’t tell him it’s a vitamin pill. You will have a hard time building trust later, when he finds out the truth. Explain what ADHD is and how it affects his life. Tell him how the medication decreases ADHD symptoms. Explain that he might experience side effects, but that they will be dealt with by you and his doctor. Your child will be more cooperative if he participates in the process.
Problem: You and Your Partner Disagree About ADHD Medication
In the case of a child with ADHD, if one parent feels strongly that she shouldn’t be taking ADHD medication and expresses that to your child, there may be a serious problem. If the child has conflicting views about the benefits of medication, he might stop taking it or question why he has to take it. If you’re an adult with ADHD and your partner doesn’t believe you need medication, it can create tension in your relationship or cause you to suffer difficulties in other areas of your life. Set up an appointment with your doctor to discuss the ADHD diagnosis and the value of medication with your partner.
Larry Silver, M.D., is a member of ADDitude’s ADHD Medical Review Panel.