Is Your Teen Ready to Make Medication Decisions?

 ADHD Weekly May 31, 2018

For teens affected by 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. While most teens are not developmentally ready to take full responsibility for that kind of self-care, they can be encouraged to move in that direction. 

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, an associate professor in psychiatry and behavioral health at Florida International University’s Herbert Wertheim College of Medicine and a member of the CHADD 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 or it’s no longer effective for them. Some teens have said they don’t like the way having a diagnosis of ADHD and needing to take a medication daily make them feel different from their peers. But for most kids, it’s the medication’s side effects they have trouble with. Some teens may 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 teen years are part of your child’s growth from relying on you to do everything for his care, a time for your teen to become accountable for what he or she is asked to do, and you keeping tabs on it all.  Eventually, as your teen moves into adulthood, she will be able to take charge of her 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 says 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. Your teen’s doctor may even be able to help oversee a medication holiday—taking some time off from it—to see what effect this has on him.

The last step is to share all this information with your teen so he can understand from an outside perspective how the medication affects his daily functioning, Dr. Sibley says.

After that, an honest family discussion comparing any negative side effects to the benefits the medications provide can help both you and your teen decide whether or not it’s really time to take a break. Dr. Sibley emphasizes for parents the importance of listening to your 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, Dr. Sibley says. That’s where 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 easy to be seen, an alarm on everyone’s phone, or the decision to keep 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 should try different tricks to figure out which works best for their family and may want to 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.” It’s a common problem with ADHD medications, because teens know they can use them as a stimulant, whether to help them get more homework done quickly or because they are hoping to experience some kind of rush or euphoria. But sharing medication without a prescription is a federal crime. Keep the lines of communication open when it comes to medication use and the risks of sharing medications, including both health and legal risks. It’s a conversation to have regularly with your teen.