On Wednesday, Laurie Dupar, PMHNP, RN, PCC, a certified ADHD coach and a nurse practitioner, answered questions from two readers. But I had some questions too.
So I took the opportunity to ask a real expert and satisfy my curiosity.
What great answers did Laurie have for me? Read on …
Kelly: In your opinion, should medication be the first post-diagnosis intervention? That is to say, before attempting behaviour modification, should an ADHDer settle the issues of medication so as to start subsequent therapies from the platform of being assisted by medication or should behaviour modification and other organizational and lifestyle modifying therapies be initiated simultaneously? or previously?
Laurie: Hi Kelly! Great question. The answer is a personal choice. Because medication does not cure ADHD, but rather helps people manage their symptoms better, it needs to be used in combination with education about ADHD and the development of skills that also will help minimize their challenges. I think, ideally, behavior modification and medication should be introduced simultaneously. Simply put, the medication has been shown to help immensely in people’s ability to focus, concentrate and reduce distractions which make learning new behaviors much more successful.
Kelly: Is there a preferred approach to trials for medication type and dosage?
Laurie: I don’t know if there is preferred approach…it is very individualized per client. A standard is to start with one type or category of medication, watch for positive and/or negative effects and based on that either switch to another medication or adjust the dose of the one the person is on. It is important, especially when trying non stimulants to be sure to give the medication time to build in your system…which could be several weeks, before a person tries to determine if it effective for them or not.
Kelly: Are there certain medications you feel should be tried first?
Laurie: Again, this is very personal and needs to be discussed with your prescriber. The choice of medications to try are determined by many variables, including family health history, whether or not someone in the family has had a positive response to a certain ADHD medication, the clients willingness or ability to follow a certain consistency in taking the medication.
Kelly: Are there combinations of stimulants and non-stimulants that you know work well consistently (for those who can tolerate meds)?
Laurie: In my personal opinion, if someone has ADHD along with depression or anxiety, a combination of a stimulant (either methylphenidate or amphetamine based) with a non stimulant such as Strattera or another antidepressant works well to activate all the transmitters that seem to be ineffective or insufficient to cause those symptoms.
Kelly: Is there a known percentage of people for whom medications do not work?
Laurie: Great question. Not that I know of. Studies show 80% of children receive benefit and reduction of the core ADHD symptoms such as hyperactivity, impulsivity and distractibility. So that would mean for 20% something isn’t working. I think the actual percentage of people for whom ADHD doesn’t work is actually much less. The problem seems more about dosage, timing and type of ADHD medication.
Kelly: Does medication work for trauma induced ADHD often? always? never?
Laurie: Trauma induced…meaning organic brain trauma such as surgery to the frontal lobe, injury to the frontal lobe? Again great question…I know that ADHD medications are being used for “chemo brain” to help people going through chemotherapy clear that mental fog they often experience.
Kelly: Can you speak to the statement made by some that stimulant medications are addictive?
Laurie: This is what I say about the addictive nature of ADHD medications: People who have ADHD can hardly remember to take their medication from dose to dose during the day! This is not the behavior of addiction.
Kelly: Is there any information that suggests that stimulants are addictive to non-ADHDers but not addictive to ADHDers?
Laurie: This is a good point. Stimulants are more likely to be misused by people without ADHD. This misuse leads to a higher likelihood of psychological if not physical addiction to the stimulant.
Laurie’s web page can be found at www.CoachingforADHD.com, her contact information is also there at the bottom of her page.