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ADHD: Attention Deficit Hyperactivity Disorder
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Medication Timing, Dosage, Monitoring, and Duration of Treatment

Margaret V. Austin, Ph.D., edited by C. E. Zupanick, Psy.D.

In addition to the drug itself, there are many other factors that determine if someone will have a positive treatment result. The timing, duration, and dosing are all important factors to consider. As with children, adults show variability in their response to medications. Unfortunately, only trial and error will reveal which drug, dose, and schedule will be most effective for any one individual.

blurry clockChildren and adults with ADHD may require different dosages and schedules. For example, adults may need medications to wind-down in the evening so they can fall asleep. Children may need medications in the morning to increase focus during the school day. Adults tend to do better with longer-acting medications than do children.

Once medication has been initiated, monitoring its effects is critical to determining its value. This takes the form of self-monitoring, and monitoring by other observers.

Self-monitoring the effect of medications takes considerable time, effort, and organization. Nonetheless, it is a vital step. Unfortunately, the symptoms of ADHD, such as inattention and disorganization, are also characteristics that make accurate self-monitoring difficult. A patient must notice and record, both the impact of the medication, and any side-effects that occur. This is not a task that folks with ADHD tend to relish. The methods used to self-monitor can be tailored to each person to capitalize upon their strengths. There are now some apps that provide medication reminders and self-monitoring prompts, via smart phone notifications. These apps can make the self-monitoring process simpler and more enjoyable.

Whenever possible, other people residing with the patient should be included in the treatment monitoring. It is often surprising how different people interpret the same results. If anyone questions whether treatment monitoring is really worth all the effort, they should consider this: The doctor's diagnosis and treatment is only as good as the information patients provide!

How long should treatment last?

As we have discussed throughout, ADHD is a life-long condition. However, the quality and severity of symptoms can change over time. For example, a child's hyperactivity may be experienced as excessive energy, and the need to be in constant motion. When that child becomes an adult, his symptoms may gradually evolve into an internal mental restlessness. Symptoms may become easier to manage over time as they become more internal and less behaviorally driven. Nevertheless, the condition remains.

So, how long should treatment last? This varies from one individual to the next. Some people remain on medication and continue practicing the skills they've learned. As time goes on, and personal changes occur, these people adapt their treatment efforts to compensate. Another person might tire of the ongoing nature of medication use and monitoring. So, they may stop taking it. For people like this, they will to do their best by working towards individual improvement and personal goals throughout their lifetime. Still other people ebb and flow between actively trying to do their best on medication; and then later, finding it easier not to. At some point, they become discouraged and stop their recovery efforts altogether. Then, later they again become more motivated and take up the plan again. These are all reasonable and common approaches to coping with a chronic condition such as ADHD. Regulating one's behavior and sustaining therapeutic efforts is an ongoing process, and may certainly become a frustrating one. However, we all can benefit by monitoring our progress throughout our lives, and readjust our efforts accordingly. This normalization helps to make it be less about ADHD and more about choosing actions that are beneficial across time: This is something that is wise for everyone to do.