The Decision to Medicate

When Your Teen Stops Taking Her Pills

Tired of feeling “different” or “controlled,” many teens with ADHD refuse to take their medication at some time. This makes parents worry — not just about grades and safety, but about their long-term health. How to move forward.

A teen with ADHD who has stopped taking her pills
Girl looking angrily at the camera, holding packet of pills

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 people without ADHD 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 stop taking their pills, 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.

> Family therapy is best. For many teens and young adults with ADHD, nothing is more useless than individual-only therapy. There may be good reason for individual sessions — discussions of sexuality, dating, or social relationships — but for the most part, the core intervention should be family therapy, helping everyone to learn how to deal with each other well.

> Try a little friendly cognitive restructuring. Help teens and young adults think through who they are and who they want to become. Ask your kid if he or she is really that “off-meds person” who can’t focus or get anything done. Or is that just who he or she grew up to be, minus the correct brain chemistry? Propose to teens that we are less defined by the medicine we take than the choices we make.

> Challenge the zombie hypothesis. This hypothesis is in the eye of the beholder. More than once I’ve heard kids complain, “Whenever I was on medication, all I wanted to do was sit there and read a book. It was awful.” Point out to your teen that most of us do not call that being zombie-fied. We call it studying. We all prefer being “up,” fun, or full of energy to being studious. For those of us without ADHD, the difference is that we don’t associate it with having our brains eaten away. Children and teens must be taught to value learning and education over being carefree. They may not feel as energetic, but they will be able to concentrate during the school week.

Honesty is a good starting point. The best way to sell medication to a teen or young adult is with honesty. That means understanding stimulants as a critically important pain in the butt. This information ranks right up there with “life is not fair,” which happens to be true. For most children, teens, and adults who have been correctly diagnosed with ADHD, part of accepting the condition is to accept the implications of treatment: On one hand, “We can help you,” and on the other, “Treatment is not a walk in the park.”

Teens and young adults have a moral and, in most states, legal right to refuse treatment. However, parents also have a right to insist that their children accept necessary medical attention. Resolving that conflict involves managing ADHD with medication, making good decisions, and facing the issues many of us deal with from age 13 to about 25. One of the most important lessons parents can teach their teens is that when they make a decision for themselves, they make a decision for everyone around them. That wisdom is never more critical than in medicating correctly diagnosed ADHD.

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