The American Academic of Pediatrics (AAP) recommends medication as a primary tool in the treatment of ADHD in patients age 6 and older. Education about ADHD and training in behavioral strategies are also recommended. While other approaches (e.g., exercise, mindfulness practices) are often used as well, we simply do not have research findings yet to support their effectiveness. Today, there are a number of FDA-approved medications for children, teens and adults with ADHD. While this gives medical providers more options, it can also require them to carefully titrate a prescription over time to determine the right medication at the right dose. Effective titration is supported by accurate feedback from the patient, family members and others (e.g., teachers).
Recent research, however, indicates that teenagers with ADHD may struggle to notice when an ADHD medication is working. The Journal of Attention Disorders (Pelham et al., 2017, vol. 21, pp. 129-136) reports a study with 46 teenagers who took methylphenidate (Ritalin) or a placebo daily during summer school. They were asked to rate their behavior and academic performance each day. Their teachers and counselors also rated these areas in students. While both outcomes were noticeably improved when teenagers had taken the stimulant medication, the students had difficulty telling the difference. Instead, they attributed a “good” day to their own efforts and a “bad” day to not being treated fairly. This research helps us understand why many teenagers want to stop taking stimulant medication early on, based on their perception that it is not helping. Teenagers and families are encouraged to talk two or three times a week to briefly note any positive differences or negative side effects. Record these and share with your medical provider at the follow-up visit. Identify specific benefits you hope the medication can help with, such as greater ability to listen to the teacher during class, easier time getting started on homework, and improved motivation for staying caught up with assignments. Teenagers can find it easier to notice improvements when they have specific behaviors or experiences to look for as their titration unfolds.
Note: This blog was based on a posting from Dr. David Rabiner at Duke University. To stay current with Dr. Rabiner’s review of ADHD research, sign up for his free postings at firstname.lastname@example.org.