When Your Teen Refuses to Take ADHD Medication
ADHD medication adherence is a common — and potentially dangerous — behavior among teens exerting their independence. This makes parents worry — not just about grades and safety, but about their long-term health. Here is treatment advice that carefully weighs all considerations
“My son used to do extremely well on ADHD medication, but has refused to take it since he started middle school. His grades are dropping and he’s getting into trouble. What should I do?”
We hear questions every week like this one from parents who are begging their teenagers, correctly diagnosed with attention deficit hyperactivity disorder (ADHD or ADD), to maximize their potential by adhering to a medication regimen. It’s heartbreaking for parents to watch a teen struggling in school or missing career opportunities as they exercise their right to stop taking their ADHD medication.
ADHD treatment should be long term: Studies show that ADHD is a chronic condition — children diagnosed with ADHD will continue to feel the impacts of its symptoms through adolescence and into adulthood. It is unlikely, though possible, that a teen will outgrow ADHD. It is far more common for fluctuating hormones during the teenage years to exacerbate symptoms and require adjustments to ADHD medications and/or dosages. Still, ADHD treatment with medication is still the most effective way to achieve symptom control in adolescence. So why, then, is your teen suddenly refusing medication?
Why ADHD Medication Adherence Drops Off for Teens
Refusing Medication Due to ADHD Stigma
Preteens and teenagers want to feel like “part of the group,” so they often resist anything that makes them feel different — like tutoring or treatment. ADHD medication, then, to a self-conscious adolescent, becomes a physical manifestation of their differences; tactile ‘proof’ that there is something ‘wrong’ with them.
It is not uncommon for the student with ADHD to be cooperative about taking medication until reaching middle school, and then refuse to do so. Though you might see your child’s behaviors as a paradox — why would your child all of a sudden refuse much-deserved help — these actions actually satisfy a preteen or teenager’s desire to eliminate any ‘otherness’ they carry.
Refusing Medication Due to ADHD Denial
Preteens and teenagers feel like they are destroying evidence of their disorder by refusing pills or throwing them away. They find being different so painful and so unacceptable to their friends that they deny any problems, even at the price of causing themselves more difficulty. One parent reported to me that her 14-year-old son refused to respond to any questions about his ADHD, whether from herself or his pediatrician. Instead of talking about his ADHD, he opted to sit in silence. (By refusing to discuss his ADHD, this teenager denied ADHD diagnosis validity.)
It is important to be sure that your child understands and accepts their ADHD diagnosis. When I prescribe medication to a child, I explain what ADHD is, how the medication works, and why it is important to take it. Answering children’s questions and resolving their fears in this way seems to help them feel better about taking medication. If your doctor didn’t do this, ask if he or she’d be willing to have this talk.
Contrary to popular belief, ADHD doesn’t usually go away with age. So, ironically, stopping medication could make your child’s differences stand out more and lead to further social problems.
Refusing Medication to Exert Independence
It’s not unusual for teens with ADHD to rebel by refusing to take their medication as an unhealthy attempt to establish independence or as a response to feeling “controlled” by their parents. Teens and young adults in most states have a legal right to refuse treatment, however parents also have a right to insist that their children accept necessary medical attention. One of the most important lessons parents can teach their teens is that, when they make a treatment decision for themselves, they also decide for everyone around them.
Often, teens are often more willing to listen or open up to a third party. So, it’s no surprise if you’ve already tried talking and your teen and he or she won’t listen. I’d suggest finding a therapist who specializes in adolescents with attention deficit. With good counseling, your teen should come to see what his problems are in time. Until he does, make sure he knows you’re going to stand by him as a support.
Refusing Medication Due to Health Concerns
Some side effects of ADHD medicine can be exacerbated by puberty in the preteen and teenage years. For instance, your preteen son may have never had a passing thought about how much he eats, but now he is conscious of the way that stimulant medication reduces his appetite in the school cafeteria.
ADHD medicine is known to suppress appetite, but it should not be so intense as to discontinue medication use. To put on mass and muscle, create “windows of opportunity.” Encourage your teen to eat a huge breakfast before their first dose of ADHD medication in the morning. Let them eat a hamburger or pizza if you want; there’s no law that breakfast has to be cereal and toast.
The next ‘window of opportunity’ can be dinner. Help your teen or preteen time their medication so that it wears off between 4:00 and 6:00 pm. Their appetite should return and they can enjoy a hearty dinner, even though they may not be able to do homework at this time. Tell them they can take a final dose after dinner if they need it to concentrate. If this timing isn’t practical, tell your child they can be excused from eating earlier and that you save your plate for later, when their medication wears off.
If your child still cannot put on pounds, discuss with their doctor the possibility of switching to another medication that does not affect appetite. In any event, tell your child not to worry. While medication may slow their growth somewhat, studies show it has little or no effect on ultimate height.
Refusing Medication Due to Sleep Loss
Likewise, sleep disturbance is a stimulant side effect for some patients. Missing out on valuable sleep is a serious issue for teenagers — regardless of ADHD compresence — and should not be taken lightly.
Take sleep seriously. If your child wants to stop taking their medication because they complain that it impacts their sleep, first monitor their behavior when they prepare for sleep. Then, develop a plan based on what you find. If your child is using the computer at night, move it out of their bedroom.
While turning the computer off may be an effective solution for neurotypical teens and teens with ADHD alike, some ADHD patients report difficulties going to sleep at night because they “can’t turn their head off.” They are fidgety and active in bed. They hear every sound in the house and can’t ignore these sounds.
For these people, using a medication like Ritalin, Dexedrine, or Adderall at night might be a great help in getting to sleep. (Contrary to popular belief, these medications do not cause sleep problems but can help calm the ADHD brain at the end of the day.) If this is not the answer, discuss this problem with your family doctor or a child and adolescent psychiatrist. They will help you come to a decision about discontinuing ADHD medication or reducing dosage.
Refusing Medication Due to Personality Changes
One parent came to me concerned that her 18-year-old son wanted to stop taking his ADHD medication because his friends told him he was “more fun” without it. While peer pressure is rampant during the teenage years and puberty paves the way for personality change, take your teen’s friends seriously: they might be onto something. It’s possible that a stimulant dose is too high and is actually “flattening” the patient’s personality.
With their help, try to build the bigger picture: what do his teachers, his friends, his coaches, and you notice about your son’s personality, and does it change when he takes medication? Make a list of the differences others perceive in your child when he’s off medication. Give your child the list, then let your child decide whether the medication has a positive impact on his life.
I also recommend asking if your child would be comfortable if you mentioned their friends’ comments to his physician. Adjusting the dosage of ADHD medication would be a great solution for a problem like this, where all parties could come out happy
What to Do to Encourage Medication Adherence When Your Teen Refuses to Cooperate
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 tool for success. Listen to your teen’s complaints, and validate them; Managing medication is difficult, after all. 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.”
Here are a few strategies to help parents convince reluctant teens to get with (and stay with) the ADHD medication program:
1) Let Your Teen Take Ownership Over Treatment
A lot of kids feel that medication is something being done to them — when they feel ownership over their treatment regimen, they are less likely to resist taking daily pills. In my practice, I always invite teens to be part of the treatment dialogue, preferably its leader. As their parent, accept that taking medication is their choice, 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 not hearing enough from the patient himself.
2) Address Stigma by Protecting Privacy
A teenager’s ADHD diagnosis may be as private as they want it to be, and whom they choose to share this information with is up to them. Let your child know that you understand that it can be embarrassing to be seen taking meds, and talk to your child about an action plan to minimize their feelings of embarrassment.
- Switch to a long-acting medication
If you want her back on medication, it will likely have to be one that covers the full school day so she does not have to visit the school nurse and feel as if she is calling attention to herself. There are several stimulant medications that last throughout the day. There are also non-stimulant medications that last the entire school day. Discuss the possibility of changing to another medication (or another, “extended release” or “long acting”, form of the current medication) with your child’s physician.
- Silence insensitive teachers, peers, and parents
In regard to assistance in the classroom, ask teachers if your child could get help without being pulled out of class to see a tutor or speech therapist. Additionally, prepare your teen to have a discussion with their teachers about preserving their medical privacy in the classroom — this discussion may also extend to peers who they have shared their diagnosis with.There may be instances outside of school where your ADHD teen could feel insecure about taking medication — be prepared to explore ways to help her take her pills in private. For example, when your teen goes to a sleepover, you may need to explain the situation to the host parents. Let your child skip a dose, if necessary, to maintain her privacy.
3) Document the Impact (Good and Bad) of Medication
Make a list of the differences others perceive in your child when he’s off medication. Because it’s never easy to convince teens that their parents are right, solicit input from teachers, counselors, coaches, and so on. This is like data that you, your teen, and even your physician can evaluate to determine what to do concerning medication.
4) Address Family Dynamics
For many teens and young adults with ADHD, individual-only therapy is useless if their real issues stem from family relationships. There are good reasons for individual sessions — discussions of sexuality, dating, or social relationships — but sometimes, the core intervention should be family therapy, which helps everyone to learn how to deal with each other well.
5) Help Them Cultivate Their Identity
Help teens and young adults think through who they are and who they want to become. It is crucial for your teen to integrate their ADHD diagnosis into their identity in a healthy manner. Propose to teens that we are less defined by any medicine we take or diagnoses we carry than we are by the choices we make.
6) 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.
Medication may not be fun, but help your teen evaluate whether medication use has a serious negative impact on their wellbeing or if they are reacting to unpleasant but manageable side effects like mild headaches.
The Medication Adherence Experiment:
If none of these solutions work to get your kid to take medicine, get your child to agree to try the following “experiment:”
Have him take his medication in your presence for a week, then let him skip it for a week. Don’t let his teachers know when he’s off medication, but ask them for feedback about his schoolwork and behavior.
During this experiment, tell your child to keep detailed notes on how they’re doing. You’ll take your own notes on how they get along at home. These notes will supplement the teacher’s notes.
Tell your child that, if his teachers note a significant improvement when he’s on medication, he needs to reconsider taking it. Additionally, if any of the notes suggest that going off meds caused problems, your child must resume taking ADHD medication. But, if all the notes suggest that being off meds does not cause any trouble, your child will be allowed to stay off them.