Medications for ADHD: When to change drug treatment

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Medications for ADHD: When to change drug treatment

Many things should be considered before changing an ADHD child’s medication. Failure to do so usually results in the child’s ADHD behavior or grades getting worse, leading to more frustration on the part of parents and teachers and even much more dread and gloom in your child.

Parents often ask how they decide and when doctors need to change their ADHD kid’s or teen’s medications. Here are a few tips to lead you in the right direction:

When it comes to your child’s ADHD behavior or grades:

  • If they have improved by at least 75%, then he or she is responding to their ADHD therapy, regardless of what type it is.
  • If they have not improved by at least 75% and they are being treated with only behavior therapy or ADHD coaching, then it’s time to consider drug therapy for their ADHD.
  • If they have not improved by at least 75% and they are on one ADHD drug, consider increasing the dose until that goal is met or unbearable side effects rear their ugly heads.
  • If that doesn’t work, some ADHD experts will change the medication to another one, even if it’s in the same class of drugs. Just because one ADHD stimulant-amphetamine doesn’t work, doesn’t mean that another won’t.
  • It’s best to use one drug at the lowest dose possible to achieve adequate treatment of your child’s ADHD. That’s the best way to avoid unwanted side effects and uncomplicated dosing schedules.
  • If increasing your child’s ADHD medication to the maximum dose or changing to another single drug therapy doesn’t work or nasty side effects show up, consider backing off on the first ADHD drug and adding an ADHD of a different type.
  • Rarely, an ADHD child might need to be on 3 or 4 different medications to reach agreed upon goals or end-points for therapy.
  • Your goal in using stimulant type ADHD therapy should not be to control hyperactivity type behavior. The non-stimulant ADHD medications work better for helping that type of behavior.
  • ADHD stimulant and non-stimulant medications work well together and usually have fewer side-effects as compared to mixing different classes of stimulants.
  • If nothing seems to be working, consider ADHD misdiagnosis as a strong possibility. Your child might really not have ADHD and instead might be suffering from one of the more than 75 things that can confuse the diagnosis of ADHD causing the misdiagnosis of ADHD behavior.

The therapy of Attention Deficit Hyperactivity Disorder is wrought with many pitfalls and potential for disaster. Most of the failures in treatment and many of the bad things that occur do so because of illogical or unnecessary changes in therapy. Examples include:

  • Changing an ADHD medication before reaching a maximum dose or before side-effects are noticed for any reason. Just like many other drugs, medications for ADHD usually require weeks or even months to become effective. In some cases, we’ve seen ADHD drug therapy take as long as three months to reach full effect. The key in those cases has been the fact that the kids were definitely improving slowly, but surely the entire time.
  • Adding additional medications before trying time-released or extended release versions to help with behavior or study later in the day.
  • Abruptly stopping an ADHD drug without discussing it with your child’s ADHD doctor.
  • Trying to advance dosages of ADHD medications too rapidly or adding multiple medications at one time.
  • Not being sure your ADHD child or teen is actually taking the medication as prescribed (I’ve known ADHD kids who didn’t really want to take their meds simply palm the pills, pretend they took them and flush them later. One 13 year-old girl actually put them in a sock and saved them for some unknown reason. She didn’t like the way they slowed her down and just didn’t want the edge taken off of her behavior!)
  • Not making sure that another disease or disorder is responsible for making your ADHD child’s behavior worse. There are many things that can occur simultaneously with ADHD (comorbid conditions), such as teacher-student mismatch, bipolar disorder, depression, anxiety and post-traumatic stress disorder. In many cases, once a comorbid condition is properly treated, your child’s ADHD behavior will improve dramatically.

As you can see, changing an ADHD child’s medication can cause many problems, some which may cause your child’s ADHD behavior or grades to get much worse. ADHD experts advise parents and doctors avoid letting others push them into making hasty, poorly thought-through decisions when it comes to re-evaluating a child’s or teen’s ADHD behavior and ADHD therapy.

Frank Barnhill, MD

 

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