Dear Dr. Sharon: my teen with ADHD won’t take his medication!

Dear Dr. Sharon –  

My 15 year old son was diagnosed with ADHD 2 years ago, and has been prescribed a stimulant medication since then to help with his symptoms.  He had no problems taking the medication until the last 6 months, and now often refuses to – he says he “doesn’t like how it makes him feel”, and that he doesn’t feel as creative when he takes it (he’s a talented sketch artist!).   His teachers, our family, and even him, all notice a difference when he does adhere to the medication schedule though – but the fights and back and forth arguments are exhausting, for all of us.  What can I do?
Collette

Dear Collette – 

 Thank you for reaching out! Many parents of adolescents with ADHD wrestle with similar challenges. As teens try to figure out who they are, what they value and where they fit in, they often struggle to balance their desire for independence with their continued reliance on their parents. This dance occurs within the context of raging hormones, social media ideals, academic pressures and shifting peer dynamics. When you add ADHD to the mix, it’s really a bubbling witch’s brew (sorry–I couldn’t resist the seasonal pun!).  Let’s unpack some of the “why” in your question, then tackle the “how” together.

-Dr. Sharon

 

Adolescence and ADHD

A teenager’s opposition is a force to be reckoned with! 

The parent-child push and pull during adolescence can be both frustrating and confusing. I applaud you for your thoughtful and patient approach to what is a tumultuous period of development for any child. From his perspective, there is a valid and real reason that he has been refusing to take a medication that has historically been helpful to him. 

Many teens who refuse or skip taking medication for their ADHD symptoms are testing limits, exploring their independence, or want to see what they are able to accomplish on their own. While teen resistance and refusal is nothing new, managing the symptoms and treating ADHD consistently and correctly during the teen years builds an important foundation for their upcoming transition to adulthood. 

Research has long indicated that the best treatment for ADHD in children and teens is a combination of cognitive behavioral interventions to improve executive functioning skills, parent training and medication. Let’s address your questions by first uncovering how medications for ADHD work. 

 

Medications for ADHD and How They Work

Since you are asking about medication and how to manage your son’s refusal to take it, let’s zoom out and take a brief look at medication for ADHD in general.

ADHD medications have evolved significantly since the introduction of Ritalin in the 1960s (the first of its kind to gain FDA approval for use with children). Today, parents are able to choose from a spectrum of pharmaceutical options to address the symptoms of ADHD in their child. 

Medications used in the treatment of ADHD symptoms work by increasing the availability of two primary neurotransmitters in the brain: dopamine (involved in motivation, pleasure and satisfaction) and norepinephrine (involved in focus, the stress response and alertness). These medications fall into two main categories: stimulants (Ritalin, Metadate, Focalin, Adderall,Vyvanse, Journay, etc.) and non-stimulants (Strattera, Intuniv, Clonodine, Qelbree, Wellbutrin, etc.). 

As the levels of these neurotransmitters change, some of the symptoms of ADHD improve. We see longer attention spans, reduced hyperactivity and impulsivity and better self-regulation. But, as I like to say, pills don’t teach skills. They frequently act as a catalyst to help people retain tools and techniques to manage executive functioning challenges. My strong recommendation is that therapy or coaching play a significant role in any treatment plan.

 

Managing Side Effects

While it is true that side effects may be observed or reported in children, teens and adults who take these medications, the benefits often outweigh them. But, negative side effects are the most common reason given by children for not wanting to follow their prescribed regimen – things like loss of appetite, headaches, dry mouth, being more easily angered, and trouble sleeping can bedisconcerting. Many side effects, though, can be resolved with adjustments to dosage, timing of medication, or the body’s adaptation to the effects of the prescription.

For your son, it sounds like the decision to pursue medication as a part of his treatment plan was one that you carefully considered and that has been largely beneficial.  It also seems like everybody sees the positive results of the medication. The problem is that he doesn’t “feel like himself.” His mind doesn’t wander into creative jaunts the way he likes which works well in math class but not as much in art. Plus, no parent wants their child to feel “less than” anything, least of all like themselves!  

 

Medications shouldn’t affect personality-while medications for ADHD help manage behaviors, they are not created to affect personality. 

Personality is a combination of traits that are unique to each individual. It’s what makes your son–“him.” If anybody taking ADHD medication experiences a blunted affect – seeming withdrawn, more quiet, less engaged – or becomes more hostile and emotionally volatile, then it is essential to contact your provider immediately. Something needs to be tweaked or even stopped which must be done under medical supervision.   

 

Adolescent Medication Refusal

A teen’s opposition is a force to be reckoned with. From his perspective, there is a valid and real reason that he has been refusing to take a medication that has historically been helpful to him. I applaud you for your thoughtful and patient approach to what is a tumultuous period of development for any family. 

Growing up with ADHD, many kids feel different, less than and struggle to find things they like about themselves and feel proud of. Whether it’s sports, art, music or theater, having an area where you feel competent and confident is essential to countering the negative messages you receive about being neurodivergent. These interests and hobbies also build essential self-esteem. The fact that your son enjoys his artistic creativity is a real asset for resilience and positivity.

“Why now?” Questions to Ask…

I am curious about what might have changed in the last 6 months for your son to report that he “doesn’t like how he feels” when he takes his medication. It’s always worth asking “Why now?” when somebody wants to make this shift. While it is worth reaching out to teachers who really know him, the best place to start is talking with him. 

I’m sure you’ve tried this but here are a few suggestions:  

  • Did someone make a comment that he took to heart?
  • Has he had less opportunity for creative pursuits recently? 
  • Did his schedule recently change?
  • What is missing when he takes his medication that he wants back? 
  • Could you come to a compromise agreement about taking the medications during the school week but not on the weekends as an experiment?

Any information you gather will help you be able to get a sense of the bigger picture, to identify what may have triggered these recent refusals, and address the underlying cause. 

Tips to Reduce Conflict about Medication

Here are four tips to reduce conflict over taking medication and maintain positive connections with your teenager:

#1 – EDUCATION IS KEY! This is a natural opportunity for education surrounding their ADHD. Make a time to discuss what their symptoms look like, how medication they are  prescribed works and what their experience is like when they take and when when they don’t. It can be very useful to contact your child’s prescribing physician and schedule an appointment to gather more information too. If your child is refusing the medication, then this appointment is critical. You want them to talk to their provider about what’s going on (with or without you in the room). 

#2 – TALK ABOUT EXECUTIVE FUNCTIONING SKILLS: While it may appear as outright medication refusal or a willful  non-adherence, underlying executive functioning skill deficits can contribute to a pattern of refusal. Troubles with self-regulation, working memory, organization, procrastination and time management affect productivity and following schedules. With their Now/Not Now brains and preference for immediate gratification, teens with ADHD may forget how their medication helps them as a student, as a tennis player or as a cellist. Work together to create doable routines and organizational systems for following medication regimes so your teem is an active participant in their treatment plan.

#3 – AVOID THE HELICOPTER: Parental scaffolding helps teens prepare for adulthood by helping them practice independence. Instead of telling older teens and young adults that they must take medication, discuss options with them. Explore ways to improve executive functioning skills with therapy, coaching or other activities. Point them towards resources instead of telling them what they have to do: use collaboration so they have skin in the game. As the parent of two emerging adults, I know how tough it can be to witness our children struggling and succeeding on their own terms. Although it’s much easier to say what we think and tell them why we are right, this type of communication doesn’t result in a trusting relationship. Scaffolding strategies will show more respect for their growing maturity.

#4 – REMEMBER BIOLOGY: The ADHD brain matures more slowly than neurotypical brains–as much as three years. When you normalize their ADHD-related struggles as part of their biology and their genetics, you help to reduce their discomfort about being ‘different’. There is no shame in needing assistance with learning certain skills, routines or behaviors if your brain lacks adequate dopamine or norepinephrine.  

 

 

 

 

Surviving Back To School: A Neurodivergent Parent’s Guide

As thoughts begin to turn from planning picnics and BBQ’s to planning school lunches, our parental priorities shift from “summer fun” to “get it done.”  The back-to-school transition helps set the stage for a successful school year. It is a great opportunity to help equip kids with the tools they’ll need for a smooth start. But for parents and caregivers of neurodivergent students, this time of year can feel especially overwhelming, as it is so much more than just pencils and pens that our students need.  In fact, parents of children who have learning and thinking differences are more likely than other parents to say they feel stressed (39% vs. 28%, respectively), unprepared (19% vs. 12%), scared (17% vs. 9%), and/or lonely (10% vs. 3%) when it comes to back-to-school season. This week, I’ll share practical tips for how you can survive and thrive during this back-to-school season.

Adjust Expectations

As the parent or caregiver of a student with unique learning needs, you know that being flexible is essential. Why not give yourself that same space (and grace) to be able to NOT do it all, and remain flexible with what you’d like to accomplish? Setting too many goals at once – “I’ll arrange playdates every weekend,”  “We will eat breakfast as a family every day,” or “I’ll volunteer 5 hours in the classroom” – can feel overwhelming to both you AND your child.

Families living with ADHD can be especially sensitive to changes in routines. When new tasks are thrown into existing ones, confusion and frustration often come along for the ride. This year, consider viewing back-to-school tasks through the lens of what is truly important to your family’s needs. Instead of one long “to-do” list to slog through, focus on one or two things that are truly important for your family right now.  By limiting your goals and adjusting your expectations, you’ll minimize pressure on everybody and reduce family stress.  

Start Preparations Now with Low-Key Conversations

Now is a great time to begin easy conversations about returning to school – asking what your child is most excited about doing or seeing when they go back, what foods they look forward to in their lunchbox, who they’ll high-five first, etc. These are no-pressure conversations that signal change is afoot. Start with “Tell me what you know about….” this new grade or this new school. You’ll get a sense of their level of understanding and be better prepared to meet them where they are.

By pairing these conversations with visual cues at home such as a countdown calendar, displaying photos of familiar school staff and classmates, meeting their teacher or walking the hallways of a new school, you’ll help make going “back to school” seem less frightening and more familiar.  These conversations are just as important with college age students so set aside some time to start now

Set a Positive Course with Collaboration

Setting a positive course for this year depends on collaborating with your son or daughter to establish clear goals and useful strategies. Kids with ADHD spend a lot of time listening to what they could do differently from caring adults, friends,

coaches, etc. By including some of their opinions in whatever program you create, you increase their buy-in. When they feel like their ideas matter, these kids are far more likely to cooperate. So, start this school year with a calm, honest family conversation.This chat sets the tone for how you will work together to make it a success.

Take the Time to Reflect First

Before you sit down with your son or daughter, consider your responses to these questions: 

  • What do you hope for your child or teen this year?
  • What went well last year and why?
  • Can you identify any behaviors or decisions that made a positive difference? 
  • What were some of the challenges? What improved them?

When you’re ready for your conversation, ask them similar questions. Offer some of your reflections and see if you can agree on some goals for this fall. Write these down and, together, choose one to start with.  It can be fun to treat this as a “time capsule” too: make a copy and place it in an envelope to be opened at the end of the semester. Then you can review how things actually worked out–the successes and the challenges.- kept in an envelope until the end of the year (or month, semester, etc.), then reviewed together and discussed.  

Practice time management skills now

Many children who are neurodivergent struggle with time and get frustrated.This makes morning routines tricky and causes conflict.

It’s harder for them to feel time, plan for things accordingly and then actually do them. They tend to overestimate how long a task will take and how much effort it entails. Then they feel overwhelmed, procrastinate or avoid it altogether. Or, they underestimate how long a task will take and the effort involved. Then they leave things until the last minute, rush to complete them and feel very stressed in the process.

Use Backwards Design to Teach Time and Planning Skills

When planning school schedules, practice using backwards design with your child to help them plan – in reverse – for where they want to be (or want to have done) in the future.  This means working backwards  by starting with the end goal and allocating time accordingly.  Sit down in advance and review what needs to be accomplished and how long things actually take.

“You have to be at school by 7:30. It takes  twenty minutes to ride your bike, lock it up and get to homeroom so that puts you at 7:10. Before that, you want to eat breakfast (ten minutes), go to the bathroom, brush your teeth and get dressed (fifteen minutes) which puts you at 6:55 am. Then you have to wake up. Usually you hit the snooze button once or twice which lasts another fifteen minutes. So that means you have to set my alarm for 6:40 if everything goes perfectly. Maybe we should set it earlier for this week, just in case.”

Backwards design benefits kids by teaching them how to estimate time, develop the ability to sequence events and improve planning and prioritizing. 

Notice the Positive to Raise Self-esteem

Parents of neurodivergent children are 2.4 x’s more likely to experience challenges related to their mental health than their parent peers, making self care strategies an essential component of your back-to-school parenting toolkit.  Equally important, however, is to extend these practices to neurodivergent learners with ADHD. They benefit from explicit support and instruction in identifying and incorporating positive events in their day that nurture self-esteem.

Spend a few minutes at the end of the day and check in with your child, asking “What are two things that went well today? What were your favorite times of the day?” Many kids with ADHD tend towards negative mindsets marked by internal self-criticism and judgment. Shifting their thinking not only nurtures growth mindsets but also self-care. By noticing what is working, they start to feel more confident and courageous. Set aside a time to review two highs and one low of the day. Often dinner is a good place to do this. One of my clients calls this talking about “the happy and the crappy;” for another it’s “the rose and the thorn.” 

Your Self-Care Makes Family Life Stronger

Noticing the positive applies to you too. Self-care goals or guidelines for this year bc when parents are stressed kids pick it up and act out.  As adults, we tend to think acts of self care look like bubble baths, a piece of chocolate, reading a book, etc. But setting boundaries, keeping organized, and lowering the pressure of unrealistic expectations also provide much needed relief.  Before tending to your child, start this school year off on the right foot by reflecting on your capacity, your limits and treating yourself with compassion. Then you can show up and guide your child towards thriving once classes begin.

  Ready, Set…LET’S GO!

Back to school will be a breeze for you and your child with neurodivergence when it includes collaborative conversations, time for community support, opportunities to practice time management, setting realistic expectations, and room for personal growth and positive reinforcement.  Help your child or teen navigate this shift back to school by easing them into the changes ahead with the tips above, and you’ll feel ready to tackle this time of year together! 

 

“I wish more people understood how it felt to be neurodivergent”: What to Know About Neurodiversity

Time for a societal change? Awareness of neurodiversity is one step, acceptance and valuing these differences are the goals. This would mean a shift from ‘corrective’ behaviour therapy offered by Early Intervention centres. Here’s what to know about the Neurodiversity movement.

‘There is nothing wrong with being neurodiverse. It is simply a different way of thinking. Some of the greatest minds in history are suspected of being neurodiverse and their discoveries have changed the world. If as a society, we could find a way to embrace neurodiversity and support individuals rather than treating it as a problem to be solved, we might be a lot further in finding solutions for some of the major problems we are currently facing’ says Donna who is neurodivergent herself and has two neurodivergent children. As Autism Acceptance Week (previously referred to as Autism Awareness Week) nears, two mamas and Speech and Language Therapists Fátima Ionescu and Melanie Muttit advocate for a societal change to move from awareness of autistic individuals and neurodiversity to acceptance, support and inclusivity instead. The autistic community would like us to move away from Autism Awareness and instead to Autism Acceptance due to the ableist views and perceptions created by Autism Awareness Day. This would also mean not aiming to “fix” or “correct” neurodivergent attributes and characteristics as some Early Intervention centres aim to do and instead looking for neurodiverse-affirming approaches

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How do I avoid the perfectionism trap?

Dear Dr. Saline, I recently started my first full-time job after graduating from college and feel like I’m struggling with the adjustment. I’ve had the usual ups and downs in school which come with ADHD. But now that I’m working, my tendency toward perfectionism has become overwhelming. Worst of all, I don’t think my work is any better as a result of all the extra effort I put into it. Do you have any advice on how I can get unstuck from the perfectionism trap? Thank you, Kathy

From Dr. Saline:

Dear Kathy, First of all, congratulations on your first full-time job! It’s an important milestone, and it’s natural to take time to figure out new routines and skills as you make this transition. Wanting things to go well reflects your desire to do well. But when this desire morphs into a need for everything to be just right, anyone can tip over into complicated perfectionism. Perfectionism is a common issue for kids and adults with ADHD who simply want to avoid making another mistake (again). While banishing perfectionism forever may be your goal, it’s not that realistic. Instead, you can learn to turn down its noise and create more effective coping strategies for motivation and quality.

Perfectionism and ADHD

For folks with ADHD, perfectionism can be a way to overcompensate for feeling not good enough or being “less than.” It’s also a way to hyperfocus on a task, project, or idea as you push yourself to get “just right.” The trouble with perfectionism is that it can be a double-edged sword. When used productively, it can be a driving force in helping you do your best work. But it can also create a great deal of troubling anxiety that actually hinders progress. It’s all too easy to get stuck on one detail, go down a rabbit hole, and then lose sight of the bigger picture.

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Proactive change is a fascinating thing. It’s the type of change you seek when you desire a shift in your life. You might have identified an area you want to improve, a behavior you want to stop, or a wish you want to manifest. You are ready for a transformation but may feel overwhelmed with where to begin or what to focus on. Change is possible through desire, small steps, and support.

This week, I attended the educationally stimulating ICD Virtual Conference, “Shining a Spotlight on ADHD.” There were three terrific speakers- Melanie Sobocinski, PhD, PCC, Sharon Saline, Psy.D, and Ari Tuckman, PsyD, MBA. They shared a wealth of information. I’m focusing on three ideas I learned about change that I thought would be especially helpful.

Read the article! Oh, So Organized

Midyear Reboot: Five Strategies for Building Effective Habits

Midyear Reboot: Five Strategies for Building Effective Habits

AS WE APPROACH THE MIDPOINT OF THE SCHOOL YEAR, many parents notice that their children are less motivated and less engaged than they were in September. Perhaps their grades were disappointing or they struggled socially. If they’re in middle or high school, they may have changed schedules and teachers and are dealing with new experiences daily despite a general sense of blah. Developing new habits in order to set themselves up for success both in and out of school is what’s called for. This is a great opportunity to pivot and create habits that promote positivity and success. Even though change can be tough, doing the same thing that isn’t working likely results in defeat.

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How To Get An Accurate Diagnosis For A Child Who May Have ADHD

How To Get An Accurate Diagnosis For A Child Who May Have ADHD

If you have a child or teen who seems to be struggling more with low motivation, keeping up with school work, and organizing things from clothes to projects to chores than at the beginning of the school year? The winter doldrums are no joke for many students, especially those who may have ADHD or live with neurodivergence. This is a good time of year to look under the hood and investigate what’s going on for them and why they are wrestling with productivity and performance. While this process can seem daunting, investigating what is happening will offer information about their cognitive and emotional functioning.

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Using a Dopamine Menu to Stimulate Your ADHD Brain

Using a Dopamine Menu to Stimulate Your ADHD Brain

Your brain is a Tesla. When its battery becomes depleted, it needs to stop and recharge. You know the feeling when your power is draining down, but you don’t always know how to replenish it. Many of us grab our phones for a ‘quick’ doom scroll or a game of Geometry Dash. Others eat a cookie. This behavior is understandable, but it’s not helpful. “Most of us don’t spend hours scrolling through social media because we think it’s a good use of our time; we do it because we are looking for the stimulation we need to function,” says Jessica McCabe, the creator and host of How to ADHD, a popular YouTube series, and author of the new book How to ADHD (#CommissionsEarned).

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How to Control Your Anger When ADHD Emotional Reactivity Kicks In

Yes, the ADHD brain is wired to overreact and to feel emotions intensely. But you are not your ADHD reactivity. Here, learn how to change your reactive, habitual anger responses with thoughtful, soothing responses.

It starts with a trigger. In an instant, a volcano of anger and negative emotion erupts. Before you can process what’s happening, you say or do things that you will surely regret later. But you can’t stop yourself. If we’re being honest, sometimes it feels good to let it all out. Living with attention deficit hyperactivity disorder (ADHD) means living with a stress-producing condition that begets emotional reactivity.

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Connect more, argue less: The 5C’s of ADHD parenting

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It’s 9 p.m. and your 13-year-old daughter with ADHD is rushing around the house frantically looking for her social studies book. She’s just realized that she has to read a chapter and answer five questions to prepare for the quiz tomorrow. You calmly offer to help her find the book and review the material but, instead of graciously accepting your assistance, she screams at you “Why can’t you leave me alone? I don’t need you!” You snap back, “Well actually you do or you’d know where your book is and you’d have finished your homework by now!” Then you both stomp off to your respective bedrooms, wondering why things devolved so quickly into a yelling match.

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