How to Deal with Teens Who Refuse To Take Their Medication

I'm often asked by parents how to deal with their teenage son or daughter who may still need to receive medication but who refuses to take it. This can be a very frustrating and difficult problem for parents to deal with, and I thought I'd share with you an approach that I have often found to be helpful.

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In my experience, one reason why many adoles-cents start to protest taking medication to help with their ADHD symptoms, is that many children are never receive a good explanation about what it means to have ADHD and why they are taking medication in the first place. I have seen many children who have been taking medication regularly for years without really understanding why. In these instances, it is not surpri-sing that a child would start refusing to take medication in adolescence.

One way to try and prevent this problem is to make sure that when your child begins medication, he or she understands why. Ask your child's physician to explain this to your child and get their advice/suggestions about how you can talk with your child about this. There are also many good books that have been written for children that explains what ADHD is and how medicine can help.

Something that can almost always be help-ful to do is to try and interest your child in an "experiment" to see if he or she continues to need and benefit from the medication.A very good book for older children and adolescents is called "Distant Drums and Different Drummers - A Guide for Young People with ADHD" by Dr. Barbara Ingersoll. Another good choice is "I Would if I Could - A Teenagers Guide to ADHD/ Hyperactivity" by Dr. Michael Gordon For younger children, a very good book is "Otto Learns About his medicine. All these books are available at http://www.addwarehouse.com in the Kids section.

If a teenager refuses to take medication, here is the approach that I take. First, I would really listen to what concerns the teen has about the medication. Trying to engage your son or daughter in a dialogue about their concerns so that you can more fully understand them is the first step. Inevitably, acquiring this under-standing will be essential in helping decide how to best address this issue. If engaging your child in this dialogue is difficult, your child's physician may be able to help. If your child has been seeing a counselor, this person should also be able to help with this.

Something that can almost always be helpful to do is to try and interest your child in an "experiment" to see if he or she continues to need and benefit from the medication. There are two ways to do this. One way is to actually discontinue medication for a period of time - say several weeks or more. Before doing this, discuss with your child how you and he/she will judge the outcome of this "experiment". Be clear about what changes in your child's grades and behavior at school would indicate that the medication is still needed. If your child is able to maintain his or her performance at the expected level for this period without medication, then perhaps it is no longer required. If their grades and/or behavior decline, it would suggest that the medication needs to be resumed.

The problem with this approach is that an entire grading period can go down the drain as the results are being gathered. For this reason, I often try to arrange a shorter "trial" to see how helpful the medication continues to be. This trial covers a 3 week period during which I try to get the best feedback I can about the child's behavior and academic productivity at school. During the first week, the child is on medication as usual.

During the second week , the medication is discontinued, and during the final week the medication is resumed. At the end of each week, the child's teachers are asked to complete ratings of the child's behavior and school work for the week. Similar ratings can be completed by the teen him or herself. Once again, the ADHD Monitoring Forms are a good choice to use for this.

Make sure your child understands that the value of the trial is to see whether the medi-cine is still helpful.Make sure your child understands that the value of the trial is to see whether the medicine is still helpful. I would present it like this: "Why don't we do a careful experiment to see whether the medicine is still being helpful to you? At the end of the "experiment" we can go over the results with your doctor. This will help all of us to decide whether it still makes sense for you to take medication or whether you may no longer need it." The important thing is to secure your child's cooperation with the proposed study. If this is not possible, than having your child talk with his/her physician or counselor about this is probably necessary.

Two important points. First, for this to be helpful, the teachers need to understand the importance of what they are being asked to do. Try to pick a couple of teachers who know your child well and whose cooperation you can count on. Because middle school and high school students typically only spend 50 minutes per day with each teacher, you really need a teacher who will observe your child carefully and fill out the forms conscientiously.

It is also best to do this kind of trial in such a way that your child does not know when he or she is not getting medication. If they simply stop taking their meds for one week, they may act differently at school simply because they know they are not on meds - certainly, their self ratings for this weekcould be biased.

The way around this problem is to have your pharmacist prepare identical capsules to be used during the trial. They do this by grinding up the medication and placing it in an opaque gel cap. For the non-medication week, your child receives identical capsules that are filled with an inert substance such as lactose. This way, your child does not know when they are getting medication and when they are not. (Note: You may need your physicians help in arranging this with the pharmacy.)

I know this seems like a lot of trouble but at the end of the trial you should have is some pretty objective data about the impact of medication for your child. In cases where medication is still needed, what you see is that the child received much better ratings for behavior and/or work during the medication weeks than during the placebo week.

What if this is not the case and your child did as well during the placebo week as during the medication weeks? If so, then your child may be right - perhaps medication is not necessary.

The thing to do is to sit down and review the findings with your child. I'd suggest getting the physician involved here. If it looks like the medication was helpful, this may convince your child that they should continue to take it. Of course, this still may not happen, but then talking with your child about why they want to deny themselves something that really helps would need to be done, often with the assistance of a physician or psycho-logist. Trying to force medication on a teenager who simply does not want it is likely to create more problems than it solves. This is why the kind of experi-mentation described above in which your child is involved as a willing participant is preferred.

I hope the above discussion can be helpful to you. Remember, if you would like to receive sample issues of ADHD RESEARCH UPDATE to review just e-mail your request to: addhelp@mindspring.com and I'll send them out to you.

David Rabiner PhD, Licensed Psychologist as published in ADDed Attractions, July 15, 1998.