5 Rules for Using ADHD Medications Effectively
Deciding to treat ADHD symptoms with medication is not a cop out or a quick fix. Determining the right dosage of the right prescription is hard work. Follow these rules for dialing in the best treatment possible with the fewest side effects.
Using medication for ADHD to treat your child’s symptoms isn’t as simple as filling a prescription and living happily ever after.
William W. Dodson, M.D., a Denver-based psychiatrist specializing in ADHD, wishes more parents would be patient about side effects. “There’s a tendency for people to throw up their hands at the first difficulty instead of working with the physician as they would with the treatment of any other disorder,” says Dr. Dodson. “Getting ADHD meds to work to their optimal benefit requires patience.”
Here are five key steps for using stimulants effectively, as well as advice on managing some potential side effects.
Rule 1: Monitor the Meds
Find a doctor who will closely monitor your child’s medication.
The American Academy of Pediatrics suggests that parents of children with ADHD start with a general pediatrician to treat their attention deficit disorder. If your child has a comorbid condition, such as a mood disorder or ADHD learning disabilities, or if she doesn’t respond to initial drug therapy, a parent should consider seeking specialized care.
A developmental pediatrician, child neurologist, or child psychiatrist can offer a deeper working knowledge of the newest medications and more experience with drug therapy, as well as the time available to work with your child.
A doctor should be willing to see your child at least every two to four weeks during the first couple of months. He should ask the following questions:
- How the meds are working?
- Are there any troubling side effects?
- Are the meds affecting the child’s height or weight?
Rule 2: Adjust the Dosage
Start at the lowest dose possible and adjust it upward if necessary.
Doctors start at the lowest dose to provide a baseline for how much more (if any) of the ADHD medicaiton the child needs. Because everyone has a unique response to medication and metabolizes it at a different rate, a physician may need to increase the dosage to arrive at an optimal dose.
Did You Know: Doctors typically adjust medication dosages every three to seven days.
Gender, height, and age aren’t reliable gauges as to how a child will respond to medication — nor is weight. Physicians do use weight as a starting point, though.
Starter Dosage: Kids who weigh under 60 pounds should start at 2.5 mg (half a tablet) of Ritalin two to three times per day, says Stephen C. Copps, M.D., director of Central Georgia’s Institute for Developmental Medicine in Macon, Georgia. Anyone over 60 pounds will start with 5 mg two to three times a day, four hours apart.
Rule 3: Medicate at School and Home
Try medication 7 days a week, 12 hours a day.
Although some studies suggest that skipping ADHD 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.
While taking ADHD medication at school helps a child behave in the classroom, extending medication beyond the school day has many advantages, including increased focus doing homework and during after-school activities, such as sports.
Did You Know: It’s not necessary to medicate a child 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
Work with teachers and doctors to chart how — or if — 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. ADHD behavior rating scales are very effective.
The SNAP-IV Scale gauges 90 physical symptoms and emotional behaviors at home and in the classroom. The scale can help parents assess a child’s behavior throughout the day and detect patterns and problems with medication.
The Conners’ Rating Scales-Revised (CRS-R) comes in a short and long form. Experts recommend 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.
Rule 5: Eat Right
Consider a child’s diet and medications.
Children who eat a typical ADHD diet may not be getting all the benefits of medication. If 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.
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.
Did You Know: Cold/sinus/hay fever medications that contain decongestants (antihistamines without decongestants are okay) may cause a child on medication to experience a mildly unpleasant “buzz.” Over-the-counter or prescription weight-control medications, steroids, and asthma medications containing albuterol or theophylline can have the same effect.