If your child has been successfully treated with medication in the past, your medication management plan should be carefully reviewed as adolescence begins. There is no hard-andfast rule about the changing medication needs of teenagers. It used to be thought that children “outgrow” ADHD sometime in their teenage years, and medication was often stopped at that time. We now know that although hyperactivity often becomes less of a problem, impulsive behavior and inattention usually persist. The commonly used stimulant medications have been found to provide benefits for most teenagers with ADHD, and are effective in both teenage boys and girls.
Teenagers do not necessarily need changes in their medication dosage even after the large growth spurts that adolescence brings. Your teenager’s dose, however, may need to be increased or lowered on the basis of his ability to function well academically, behaviorally, and socially. Medication dosing needs sometimes change because of increased homework demands, or complex schedules. If your teenager leaves for school at 7:30 in the morning, has soccer practice after school, and does not get to his homework until 8:00 pm, even a 12-hour preparation of stimulant medication may have worn off by that time. Some teenagers solve this by going back to an 8-hour preparation for the school day, and then synchronizing a shorter-acting (4-hour) dose to cover their homework time.
Your teenager craves independence, yet the presence of ADHD means he will probably need extra structure and support from you. At times, he may resist taking his ADHD medication and he may argue about following your and your doctor’s guidelines for managing medication. Be honest with him about your concerns, and ask for his help in designing a medication routine that will best address his needs as well as your concerns. You might agree, for example, that he will be responsible for remembering to take his medication, unless more than 10% of his pills remain untaken on a weekly pill count.
If conflicts arise over the balance between limits and personal freedom, ask your teenager’s pediatrician, psychologist, or school counselor to help mediate or contribute ideas. Some teenagers dislike taking medication, stating that they don’t feel “themselves.” This can be viewed the same as a side effect and you may need to work to try to adjust the dose of medication to minimize that. This gives teenagers power and input into their medication. When they refuse to take medication or want a trial off medication this should be viewed as a positive, and taken seriously. If your teenager feels that he can succeed without medication, encourage him to set up an alternative plan that works. Going back on medication may become the default option. Remember, you don’t want them to take medications; you want them to succeed whether it’s on or off medication.
So if your teenager continues to question the effectiveness of stimulant medication, or states a desire to discontinue medication altogether, his pediatrician might help him set up a carefully monitored “trial” on and off medication that will include careful teacher observations of relevant academic, behavioral, or social concerns for a specified period. The teacher will make these observations without knowing which period is off and which is on. Your son can also keep a careful diary of his own observations. The observations can be reviewed after the trial for any significant differences in homework completion, grades, etc, on and off medication, and then make a better informed decision about whether to continue medication as a part of his treatment plan.
Conducting such a trial will also respect your child’s need to participate in decision-making about treatment. This type of activity can be particularly effective for skeptical teenagers who prefer to “see” before they “believe.” Medical professionals can also provide your teenager with books and videotapes about ADHD treatment, and put him in touch with ADHD support groups that can help him understand how others have learned to manage their ADHD. Remaining on medication is not an easy choice for teenagers.
Abuse of Stimulant Medication
For a minority of teenagers with ADHD, resistance to taking stimulant medication may be less of a problem than overuse. Stimulants are classified as Schedule II drugs by the US Drug Enforcement Administration and, sooner or later, teenagers who take stimulant medication usually become aware of its “street value.”
Your child may be tempted at some point to give or sell his medication to others, or to take more than the prescribed dose himself. While it is a fact of life that most teenagers experiment with some form of high-risk behavior, such as a single episode of alcohol or drug experimentation, the presence of ADHD makes it especially important for you (and, ideally, your child’s pediatrician) to discuss the dangers of drug abuse with him and to monitor his medication use.
Teenagers who are doing well on a treatment plan that may include taking stimulant medications are generally less likely to abuse stimulants than those who do not have a treatment plan in place and are not taking medication, and because of this are experiencing low self-esteem, are more impulsive, and are more inclined to take risks. If your child has a coexisting behavioral disorder, or has abused or sold medication in the past, develop a system for dispensing medication that prevents these possibilities to the greatest extent possible.