How to Optimize ADHD Medication to Achieve Better Symptom Management (w/ William Dodson, M.D.)

ADHD stimulant medications are effective, well tolerated, and safe. But there are two problems that prevent those with ADHD — children and adults — from experiencing all the life-changing benefits that they can produce.

1. Many clinicians do not receive adequate training in how to use ADHD medication to get the very best result for each individual.
2. It is often difficult for patients and doctors to objectively determine when they have derived the maximum benefits from taking medication.

These less-than-optimal outcomes have tragic consequences. Studies have shown that 80 percent of people who try medications for ADHD are no longer taking them after a year. In other words, the vast majority of people diagnosed with ADHD are not getting the treatment they need and deserve when life-changing benefits are easily achievable.

The good news is that there are ways to assess how well ADHD medications are working and to optimize each medication to achieve symptom control. Research-validated, paper-and-pencil assessments, such as the Clinical Global Impressions Scale (CGIS), can accurately measure progress in treatment. Simple practice methods can likewise help to quickly find the best medication and dose for each individual person while minimizing side effects. This webinar will help you and your doctor get the best outcome possible from ADHD treatment.

Download the slides associated with this webinar here:

4:03 4 Assessment Methods
7:00 10 Areas of Impairments of CGIS
15:34 Optimized Medication Management
15:55 MTA Study Results
17:20 What Are Reasonable Expectations?
18:21 Effect Sizes of ADHD Medications
20:07 First-Line Treatment of Choice
20:40 Is One Molecule Better Than the Other?
23:43 Stimulant Dosing
25:07 Choose Target Symptoms
29:25 Speed of ADHD Medications
30:30 What About Those Who Do Not Benefit from Stimulant Medications?
34:26 How to Find a Clinician




Related Resources
1. ADHD Medication Options: Stimulants, Nonstimulants & More

3. Download: ADHD Medication Tracking Log

4. eBook: "ADHD Medication and Treatment"

[heidiburton]

I’m diagnosed ADHD and also a 45 year old. My kids are recognized as “needs to be ruled out” including autism, which I’ve also been diagnosed as. Also bipolar, ocd, etc. I was taking adderall for about 8 years but suddenly the new doctor who took over the practice stopped it, saying that I had no need for it. I have three kids, am a single mother, we struggle a lot and I think your posts are informative as well as compassionate. Thank you for helping people!

[jonathanberry]

🎯 Key Takeaways for quick navigation:

03:19 🧪 *Effectiveness of ADHD Medications*
- ADHD medications are highly effective in treating symptoms.
- Various assessment methods help determine medication efficacy.
- Medication effectiveness is not always easily discernible without proper assessment.
05:09 📋 *Assessment Tools for ADHD*
- The Connor Global Index Scale is commonly used for assessing children's ADHD symptoms.
- Computerized continuous performance tests (CPTs) like the TOVA measure vigilance and attention.
- Clinicians also resort to less scientific methods, including the SWAG (Scientific Wild Ass Guess) approach.
08:12 📊 *Monitoring Medication Response*
- Baseline assessments before medication provide a starting point for comparison.
- Optimizing medication involves finding the right dosage that provides maximum benefit.
- Overdosing can lead to side effects, which can be categorized as "Starbucks syndrome" or "zombie syndrome."
15:00 💡 *Optimizing ADHD Medication*
- A scoring system helps clinicians and patients gauge the effectiveness of current medication.
- Starting with the right medication and dosage is crucial for optimal symptom management.
- Regular evaluations and adjustments are essential for sustained symptom relief.
17:29 🧠 *ADHD Medications: The First Line of Treatment*
- Stimulant medications are recognized as the most effective and safest treatment for ADHD.
- Comparisons between stimulant molecules reveal that individual responses vary.
- Extended-release formulations offer more consistent benefits for individuals with ADHD.
23:59 🎯 *Dose Determination for ADHD Medication*
- There's no one-size-fits-all approach for determining the appropriate dose of ADHD medication.
- The target symptom approach focuses on addressing specific ADHD symptoms.
- Regular dose adjustments are necessary, especially during growth phases or changes in symptoms.
26:22 💊 *Dosage and Improvement Metrics in ADHD Medication*
- Understanding optimal dosage adjustments in ADHD medication,
- Importance of observing improvement with dosage increase,
- Impact of ADHD medication on sleep patterns.
27:31 📜 *Maximum Dosage and Regulatory Guidelines*
- Discussing the concept of "maximum dosage" in ADHD medications,
- Differentiating between FDA-set maximums and off-label maximums,
- The role of regulatory concerns in determining dosage limits.
28:39 🩺 *Monitoring Symptoms and Physiological Measures*
- Using blood pressure and pulse rate as indicators of optimal medication dosage,
- Importance of continuous symptom monitoring during medication adjustments,
- Autonomic nervous system hyper arousal as a measure of overdose.
29:35 🚀 *Speed of Onset and Delivery Systems*
- Addressing the immediate effectiveness of stimulant medications,
- Differences in onset speed between various ADHD medication delivery systems,
- Benefits and considerations of bank-loaded delivery systems like Concerta.
30:43 🔄 *Treatment Failures and Alternative Approaches*
- Exploring the 15% of individuals not responding to stimulant medications,
- Diagnostic reevaluation and ensuring the right ADHD diagnosis,
- Exploring alternative medications and strategies for treatment-resistant cases.
32:52 🕵️‍♂️ *Identifying Candidates for Alpha Agonists*
- Characteristics and behaviors indicative of potential success with alpha agonists,
- Importance of patient feedback and understanding personal experiences,
- Identifying specific symptoms like restlessness, impulsivity, and emotional vulnerability.
34:29 🌐 *Finding Knowledgeable ADHD Clinicians*
- Challenges in finding clinicians with expertise in ADHD diagnosis and treatment,
- Recommendations for seeking specialized ADHD professionals,
- Utilizing resources like professional lists, conferences, and personal referrals.
52:15 🌙 *Understanding Sleep Problems in ADHD*
- Sleep disturbances are prevalent among individuals with ADHD.
- The primary sleep issue related to ADHD is the inability to shut off the brain and body to sleep.
- Two distinct groups: those with intrinsic ADHD-related sleep problems and those who develop sleep issues due to medication.
53:37 🛌 *Medication's Role in Sleep Improvement for ADHD*
- Stimulant medications can actually help some individuals with ADHD-related sleep disturbances.
- The "no risk trial nap" is suggested to demonstrate how medication can aid in sleep.
- The belief or perception about medication's effect on sleep can influence its actual impact.
54:02 🚫 *Addressing Medication-Induced Sleep Disturbances*
- Some individuals may experience sleep disturbances only after starting ADHD medication.
- Consideration of adjusting the medication dosage is crucial for those experiencing insomnia.
- For those on amphetamine medications, vitamin C can act as a countermeasure by aiding its excretion, helping with sleep issues.

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[itsnotakuma]

I'm 40 and still undiagnosed. This was very informative. Thanks for helping me get over stigma in trying to get help.

[heidiburton]

Also, my house is a complete mess since they stopped my medication! They don’t care. They are worried about addicts and what not and don’t care about the people who actually have therapeutic benefits. Why do the idiot abusers take precedence over actual suffering people? I’m all about neuroplasicity but nothing will ever turn my brain into a neurotypical brain! They have no compassion nor adequate education in my area, it seems. Do you know of a decent doctor near Richmond, Virginia?

[shelsea]

I have taken stimulants for ADHD for nearly 30 years. I have found that your body builds up tolerance to the medication to where it becomes necessary to increase the dosage to manage your symptoms.

[egifhpf]

When I started taking concerta which was tge first medication i was perscribed my whole life changed. My anxiety disappeared, muscle tension disappeared, insomnia disappeared, focus was 100%, & I could remember everything. Had ADHD since birth, my troubles started with learning/focus in school, was not diagnosed til mid 40's. I'm now 53 and struggle with most symptoms again as though I'm becoming immune. I'm going to combine estrogen to see if it fixes the issue ....

[lucymb]

Can birth control (progestin IUD) cause stimulant medication to not be absorbed effectively? I have heard that high progesterone levels in a woman’s cycle can make the medication almost ineffective. Would the synthetic version of progesterone (progestin) make my meds less effective or ineffective?

[karrkraft]

Why is the audio quality of every Attitude video like nails on a chalk board? The length of the videos is like, “ADHD be damned!”

[RavenVapor]

I'd like to hear why so many of these medications are so expensive. It doesn't matter that there are choices if you can't afford to buy them. I'm using dextroamphetamine (generic Adderall) cuz it's the least expensive way to go as far as stimulants. I'm on Medicare and I'm stuck with my med - I had tried Wellbutrin before trying stimulants and nothing. I wasn't diagnosed until I was 68. I'm 69 and having a really hard time finding any professional that really understands ADHD (at least the inattentive type). They aren't worth the cost or energy. I live in New Mexico and it's not very progressive. It's just another roadblock. If I don't have the financial resources to get help I'm SOL. I'd love to have a coach but cost is a huge factor for me. I know I'm not alone. It's just doesn't seem right...

[Azzy_Mazzy]

Great presentation, thank you Dr. William Dodson and additude magazine

[sashawhispers]

I have Autism and ADHD without the H. Do you know if ADHD medication takes away the boredom that comes with having ADHD? As we know, boredom effects work, etc. If it does, which medicines are effective in I have Autism and ADHD without the H. Do you know if ADHD medication takes away the boredom that comes with having ADHD? As we know, boredom effects work, etc. If it does, csn you please tell me which medicines are effective in this?this?

[marthayoung]

Have ADHD specialists noticed that generic Ritalin and Concerta do not work in the same manner as the actual drug yet drug studies do not use the generics? This may be a reason for the drugs to “stop working”

[LindaEskin]

Well... That contained some devastating news. ADHD meds don't work for women after menopause? Seriously? Just kind of glossed over that, twice! I'm 60, and looking to get assessed and treated. This would be really bad news, if it's accurate. Anyone have experience to the contrary - post-menopausal and experiencing good results from medications?

[carloscontreras]

Who is the person talking that sounds like they can barely breath…

[milutii]

"University of Halifax"...😅 Might have been a temporary lapse of memory. 😋 Dr. Penny Corkum is with Dalhousie University (Nova Scotia, Canada), for anyone looking.

[MissGold]

Why medicate us? So we can be normal (read: boring AF) ? 😂 no thanks. You can keep your monochromatic lives, I’ll continue to live in TECHNICOLOUR. 🎉🌈🌟