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WHAT IS A COMPREHENSIVE TREATMENT PROGRAM?

A thorough evaluation should provide a basis for developing an appropriate and comprehensive treatment program. Usually, medication alone is not enough. A comprehensive treatment plan needs to "wrap-around" the individual. Often teacher training, parent training, family therapy, or individual counseling are needed. It is imperative that the whole picture be "looked at" for treatment to be effective because ADD effects life at school, in the classroom, within the family, with peers and also within the person, who can have a loss of confidence and negative perceptions about himself based on past and repeated frustration, struggle or failure.

Although medication can be an important component of treating ADD, it is only one piece of a responsible treatment plan. Other equally important components of treating ADD include providing a supportive environment, teaching the person organizational skills, study skills, memory skills, time management skills, to learn how to be self-aware about how they learn best, and what kind of physical setting is the most productive for them to work in.

The learning of these skills can be a long, careful process that must be reinforced regularly until the desired skills become habituated into the person's life routine and can be done without thinking. The medication is very helpful in that it allows the person to be "available" to learn the skills that will be important for a more successful school career and toward having a happy, independent and productive adulthood.

Usually, students with ADD will require special accommodations to help them access the education a school offers, such as a place to study that suits their needs, extended time on testing, periodic one-on-one review, skill reinforcement, consistency, routine, external structure and frequent positive reinforcements from teachers, family members and other involved adults.

Because ADD symptoms are so individual, each person needs individualized accommodations. There are no "one size fits all" plans. One can think of it like eyeglasses for people who are near-sighted. Though all need glasses, each person needs a different prescription.

It is important for people to understand that ADD is a real disability that effects all aspects of a person's life, (though it does not need to be handicapping). It is important for people involved with individuals with ADD understand that they usually have to put forth enormous effort to produce close to the same results as people who do not have ADD. Additionally, there are now brain studies that show that when someone with ADD is told to "just try harder" and does, the result can be anxiety and a brain that actually starts to shut down it's primary executive functions. The ADD brain works even less efficiently under stress than the brain of a person without ADD. What that means of course is that for many people the ADD symptoms will get even worse during times of high stress. This is a good scientific example of why people with ADD can perform better in testing situations when the pressure of time limits is removed.

Certainly, no one would tell a person who has a physical disability to just use some self-discipline and try harder to get around on their own! Rather, they would be supported by providing a wheelchair and a ramp in order to give equal access to a workplace, school setting or other services. Nor can one make a paraplegic walk by applying discipline. Similarly, one can't make a person with a biologically-based lack of self-control do better by simply disciplining them.

Individuals with ADD must be accommodated. It's not equitable to expect a person with a disability to compete with non-disabled peers by simply applying self-control to be like people without disabilities. Telling a person with ADD if they just tried harder and had more self-control they could remember, pay attention, be more organized, etc. without providing a supportive infrastructure is the same as ordering a physically disabled person to get up and walk. In this case accommodation is not made with a wheelchair or a ramp, but rather by developing support systems and accommodations that allow the person to do what they are capable of doing and meet the demands of the school or work setting.

Therapists, educators, and physicians routinely teach children that ADHD is a challenge, not an excuse. Medication corrects their underlying chemical imbalance, giving them a fair chance to learn, develop compensatory strategies, and face the challenges of growing up to become productive citizens. Accommodations for the disabled, as mandated by federal and state laws, are not ways of excusing people from meeting society's responsibilities, but rather make it possible for them to compete on a leveled playing field.

HOW DOES STIMULANT MEDICATION WORK?
Stimulant medication acts as a sort of "gate-keeper" in the brain which helps the brain to better regulate the manufacture, storage and flow of it's own neurotransmitters when needed by the brain.

Ritalin (methylphenidate) is the most commonly prescribed of the psycho-stimulant medications used for ADD. Others that are commonly prescribed are Dexedrine, and now Adderall. About 95% of the people who have ADD and take a stimulant medication obtain benefit. There are a rare few that receive no benefit from any stimulant medications and who do have "real" ADD.

Stimulant medications were first given to children with ADD symptoms in 1937, and have been extensively researched and studied since then. In fact, the largest body of research that exists for any medication for pediatric use is for stimulant medications.

Rapid-acting Ritalin starts to work within 15-20 minutes. It lasts about 3-5 hours (depending on the metabolism of the person). Ritalin is water-soluble, which means that there are no traces of the medicine left in the system once it has stopped providing beneficial effect. Because of this fact, people who are prescribed Ritalin need to re-administer it every 3-4 hours to maintain a therapeutic level. Ritalin is not physically addicting because of the quick absorption and depletion, and because of the relatively small doses prescribed for Attention Deficit Disorder.

Generally, the beneficial effects of Ritalin will peak about 2 hours after taking it followed by a lessening of benefits until the medicine is out of one's system. To ameliorate this "falling off" many individuals do best when they slightly overlap their doses. After one gets to know their own response to their medication and can determine when the medicine is out of their system, a dose overlap is often recommended.

Dexedrine Spansules and Adderall are slower releasing medications that provide a longer "window of benefit" for many people. Though the length of time someone with ADD will receive benefit from one of these slower acting medications varies from individual to individual, one can expect an effective therapeutic level to last approximately 5-8 hours per dose. For a variety of reasons, teenagers often do better with one of these medications.

Because the degree of symptoms of ADD are as individual as each person, the proper medication, therapeutic dosage amounts and optimal medication schedules vary from individual to individual. Body weight has no bearing on the therapeutic dose, though body weight is often used as a guideline when a medication trial is started. Typical dosage amounts of regular Ritalin are 40-80mg a day, given in three to four doses, though each person's needs can vary widely. Dexedrine Spansules and Adderall dosage amounts are generally from about 10-30mg a day, given in one or two doses. Though dosage amounts are important, the timing of the daily medication schedule can be just as important to achieving positive results.

There are generally few side-effects from the commonly used stimulant medications. These are usually mild and short-term. The most common is a reduction of appetite, which can be regulated by taking the medication just after eating (not before).




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Date of Last Update: 07/27/12