When Should Teens Make Decisions About Their Medications?

For teens with ADHD, medications are often an important part of treatment. But getting some teens to take their medication on a regular basis can be a real challenge for their parents. That can make it hard to determine when teens should have more control over their treatment plans and when they get to make the decisions.

Teens and ADHD medication

The first step is considering your teen’s relationship to the medication, especially when there is resistance to it, says psychologist Margaret Sibley, PhD, a clinical psychologist and researcher at the University of Washington and Seattle Children’s Hospital. Dr. Sibley is also a member of the CHADD’s professional advisory board.

For some teens, the diagnosis and medication are new, and they’re not happy about either. For others, the medication has been part of their daily routine for years, and they’re tired of it. Some say they don’t like the way having a diagnosis of ADHD and taking medication daily makes them feel different from their peers. But for most, it’s the medication side effects they have trouble with. Some teens experience body tics or have trouble getting to sleep, while many who participate on sports teams say they can’t get enough calories to meet their needs because the medication affects their appetite. And for almost all teens, it’s just one more thing they have to focus on.

The adolescent years are part of your child’s growth from relying on you to do everything for their care, a time to become accountable for what they are asked to do—and your keeping tabs on it all. Eventually, as your teen moves into adulthood, they will be able to take charge of their medications. But for now, Dr. Sibley says, that’s not realistic for someone with ADHD.

“Asking [a teen] to do things independently doesn’t mean that I don’t have to watch and see that she’s doing it. It means that she’s going to be the one initiating it, but I’m going to check to see if you did it,” she says. “Some kids may not necessarily feel like they don’t want to take [their medication], but if you’re expected to take it on your own and you’re a teenager with ADHD and you struggle to do things consistently and to remember things—that’s a challenge.”

For such teens, Dr. Sibley recommends a basic routine, such as a parent placing the medication on the teen’s plate at breakfast.

Helping your teen work through resistance

For teens who just don’t want to bother or resist the medication for some vague reason (“ADHD is no big deal” or “I just don’t feel like taking it”), Dr. Sibley suggests that allowing them to see the science behind it can help. That might mean enlisting the help of your teen’s doctor to do what’s called a “titration” of the dose, which means trying different amounts or taking it at a different time of day. The doctor may even be able to help oversee a medication holiday, so that your teen can see what effect such a pause has on them.

After that, an honest family discussion comparing any negative side effects to the benefits the medications provide can help both of you decide whether it’s time to take a break. Dr. Sibley emphasizes for parents the importance of listening to their teen and the reasons why he or she is resisting taking the medication, followed by an effort to find alternatives whenever possible. For example, if it makes the teen feel less social, then not taking it on the weekends might be a compromise that works for everyone.

When there’s no such compromise yet parents are convinced that the medication is essential to their child’s well-being—and there are no major physical or mental side effects—it may be time to try a behavioral contract, says Dr. Sibley. In that way parents acknowledge their teen is unhappy about having to take the medication but explain why it’s important and offer to reward him or her for taking it regularly and without any arguments. A reward could be getting the okay to play a video game during the week or being allowed to get her driver’s license, for example. But Dr. Sibley warns against using this approach too often, saving it for what she calls big-ticket issues.

“There is this question that if your child doesn’t want to take the medication, but you think it helps them, what should you do,” she says. “And I don’t think there’s a right or wrong answer to that question. I think there are a few things that go into it that people might want to think about. Do you have good evidence that the medication helps your child in a way that’s meaningful, and do you honestly feel that the help that it’s giving your child outweighs any negative effects?”

Medication is a parent-teen partnership

In households where everyone struggles with organization, a system to be sure that both parents and teens follow through with medication can help—the parent giving it and the teen taking it. That might mean a written reminder somewhere easily seen, an alarm on everyone’s phone, or keeping the medication near the drinking glasses so it will be one of the first things everyone sees in the morning. There’s no one best system, so families can try different ways to figure out what works best and switch their routine if it stops working.

Prescriptions are only for the person for whom they are written

Giving your prescription medication to someone else is called “diversion.” Having a friend ask someone to share their ADHD medication is a common problem for teens. Their friends know the medication is often a stimulant and think it will help them get more homework done quickly. Or their friends may hope to experience some kind of rush or euphoria. But sharing medication without a prescription is a federal crime. Keep the lines of communication with your teen open when it comes to medication use and the risks of sharing medications, including both the health and legal risks. It’s a conversation to have regularly.

Read more on teens and ADHD management:

How have you helped your teen become more independent when it comes to medication as part of treatment for ADHD?