Finding the best medication for ADHD management includes finding one that is affordable. Is a generic version the answer?
If you’ve had problems finding a medication for ADHD that you can afford, you’re not alone. In years past generic medications were equivalent to the name brand and were always a lot cheaper.
In recent years many new versions of methylphenidate (ritalin) and amphetamines (adderall) have come on the market and generic versions of many of the older medicines have become available.
The FDA has rules that generic medications must have the same amount of active ingredient and be available in the same forms (pill vs liquid) as the original medication. They can often be sold at a much lower cost because the company does not need to spend money researching and developing the medicine. They also offer competition to the original company, which can bring costs down.
Types of Medications for ADHD
A very useful resource that has ADHD medications grouped by type, dosages offered, if they have generic versions available, if they can be put into food or drink, and more is available from the Cohen Children’s Medical Center. This fantastic list of medications can help you and your doctor look at your insurance medication list to pick a medication that is affordable.
Most often the short acting medications are less expensive than the long acting medications. The short acting medications typically last 3-4 hours, whereas the long acting medications last 6-12 hours. Because it is difficult to take medications mid-day for many people, the long acting medications are typically favored.
In general there are stimulants (amphetamines and methylphenidates) and non stimulants (atomoxetine, guanfacine, and clonidine) that are approved to treat ADHD.
Stimulants are controlled substances because they have the potential to be abused and misused. When they are used appropriately for ADHD they have been shown to help prevent drug and alcohol abuse but they require close monitoring by the prescriber.
Which treatment should be first?
This article is about medical treatments, but that does not mean that behavioral therapy isn’t helpful. For preschool aged children, parent training in behavior management is the first treatment preferred. Parent training in behavior management is recommended for at least a part of the treatment regimen for children of all ages with ADHD.
The American Academy of Pediatrics ADHD Guidelines recommend stimulants as first line medical treatment in most instances. One is not preferred over the other. Individuals may respond better to one type of medication over another, but until the medications are tried, it can be difficult to know which will work best.
Family history can help. If a parent or sibling does best on one type of medication, it makes sense to try that medication first.
Pharmacogenetic testing is specifically not recommended in the most recent guidelines. Most insurance companies will not pay for this expensive testing because it has not been shown to be beneficial.
It is important to have close follow up with your prescriber with new medications and routine follow up as long as medications are used. These visits should assess how well they’re working as well as any side effects noted. It can take several medication trials before the right one is found.
I’m a pediatrician who treats many with ADHD, but when my own child was starting treatment it took a few tries before we found the right one. I talk about this and more in A Conversation About ADHD.
Side effects are similar with both types of stimulants, but some people tolerate one medication better than another.
Common side effects include appetite suppression, sleep problems, headaches, stomach aches, and mood changes.
Most of the time either a dose adjustment or change in medication can help alleviate the side effects.
Encouraging eating at times the medication is not active can help with the daytime appetite decrease.
Common long acting amphetamines include Adderall XR, Vyvanse, and Dexedrine spansules. There are others, such as Adzenys XR and Dyanavel, that do not have generic versions available.
Adderall XR is a long acting medication composed of dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and amphetamine sulfate. This is often referred to as mixed amphetamine salts. It lasts about 8-10 hours.
Vyvanse is a prodrug that lasts 10-12 hours. Prodrug means that it is chemically inert until it interacts with an acid in the gastrointestinal tract. It does not have any mood altering effects if it is crushed, injected or snorted, so it does not have the resale value of other stimulants. This is a potential reason that some insurance companies prefer this over more expensive medications.
Dexedrine spansules are made up of dextroamphetamine sulfate. They are less commonly used compared to Adderall XR, but they are available as a generic and name brand. The long acting form lasts about 8 hours.
There are several long acting methylphenidate medicines that have generic versions. These include Concerta, Metadate ER, Focalin XR, Ritalin LA and Metadate CD. (There are others that do not yet have generic versions.)
Metadate CD releases methylphenidate from beads (30% immediate release and 70% extended release) to mimic the effect of 2 doses of immediate-release methylphenidate.
Ritalin LA is also a once-daily agent designed to mimic the effect of the 2 doses of immediate-release methylphenidate. The capsule releases methylphenidate from beads: 50% immediate release and 50% delayed release. It tends to last about 6-8 hours, so it isn’t sufficient for a full school day plus homework for most kids.
The active ingredient in Focalin XR is similar to ritalin, but half of the ritalin molecule is removed, which often helps minimize the side effects. Focalin XR is a 50% immediate-release and 50% delayed-release agent that is similar to using the immediate release Focalin twice a day.
Concerta uses a unique mechanism to release the medication over time. There is an outer covering that immediately starts working, followed by a chamber that slowly and consistently releases medicine over the next several hours. It tends to work for a total of 10-12 hours and avoids the mid-day drop in effectiveness that is common to other forms of long acting medicines.
Generic for Concerta
Unfortunately the laws regarding generic substitutions were written before some of the new technology of medication was invented. The FDA is once again allowing substitutions that use a different delivery system than the original Concerta. I discuss this separately on my other blog if you want more information.
Side effects of atomoxetine include stomach aches, sleepiness, slowed growth (during the first 2 years of treatment), and rarely hepatitis.
Blood Pressure Medicines
Guanfacine and clonidine affect the blood pressure and heart rate. Both are available in short and long acting forms and have generics available.
They can lead to tiredness, dry mouth, dizziness, irritability, headache, and abdominal pain. Most of these side effects are minimized by slowly increasing the dose. Neither should be stopped abruptly due to side effects.
Of course cost is not the only thing to consider when choosing a medication, but if you cannot afford it, you will not be able to continue it. It must be affordable to be a reasonable choice.
There are two things you must check to estimate how much a medication will cost.
One resource to find the cash price is GoodRx. This site allows you to search for any medication and lists how much various pharmacies charge. It also allows you to print out coupons, which may or may not be able to be used with your insurance. They often have a link to less expensive alternatives, which is a very helpful function to estimate if you will be able to afford a medication.
The second thing to always check before starting a long term medication is your insurance formulary and preferred pharmacy.
The insurance formulary is a list of how much different medications will cost if you use your insurance plan. Some will allow you to use coupons with insurance, some won’t.
You will also need to know if you can get your medications cheaper as a 90 day prescription. Many insurance companies will not allow a 90 day supply of controlled substances (methylphenidates and amphetamines) but will allow the non-controlled substances (guanfacine, clonidine, and atomoxetine).
Your prescriber will not know which medication is cheapest for you because each individual insurance plan varies – in other words, one Blue Cross Blue Shield plan differs from another Blue Cross Blue Shield plan. One Aetna plan varies from another Aetna plan. The same with United Healthcare and all the other insurance plans. They have many plans that all sound similar.
You can often access this list online by logging into your insurance plan’s website. If you cannot find this list, you will need to speak with someone at your insurance company. When you make this call, be sure to have a list of medications to check easily available. I recommend asking about each of the medicines listed on the Cohen Children’s Medical CenterADHD Medication Guide.
When looking at medications, be sure to look for subtle differences, such as an “ER” or “XR” after the name. These indicate a long acting form of a medication and often cost more than the short acting version of the same active ingredient.
Also check the amount in each pill. For example, methylphenidate ER 30mg is probably a generic for Metadate CD, but methylphenidate ER 36mg is a generic for Concerta (though it doesn’t specify which generic). If you’re not sure what all the medications are, bring the full list with you to your ADHD (or any chronic condition) appointments.
Before you start a new medication, if you have new insurance, or if it is the start of a new year, log into your insurance portal to look up medications before your appointment with your prescriber.
This can help prevent the need for multiple prescriptions for medications that are not affordable. You can work with your prescriber to help find the most cost effective medication that will work for you.
What can you do when worry sets in? How can you stop the panic? Check out these ways to calm the chaos in your mind when you start to worry and panic.
People with ADHD are often overly sensitive or have true anxiety and panic attacks. What can we do to stop the panic?
We all can get stuck in a rut. Catastrophizing is common. When we catastrophize, it’s as if the sky is falling and we lose the ability to cope.
Learning to cope when life throws problems and stressors in our way builds our resilience. Being resilient helps us to be successful.
Let’s look at ways to stop the negative thinking of panic.
1. Lean on a friend or family member.
Most of us recognize how good we feel when we help someone else out, yet we hesitate to ask for help. Why is that? When we’re in need, there are many people who can help.
It’s preferable if you can talk to someone who is at least in their mid-20s. Their maturity can offer many benefits. If you’re not sure who you can talk to, think of the many adults in your life who would be happy to listen. Parents, aunts, uncles, grandparents, coaches, teachers, neighbors… there are many people who care about you.
If you choose to talk to a peer, choose wisely. Some people can’t take the pressure of hearing negativity. Others will shut you out. And of course many kids overshare other people’s business, so don’t talk about things that are private with peers.
Don’t roll your eyes and presume mindfulness won’t help.
Mindfulness trains your brain to be aware of your body and environment without judgement.
Yes, it takes time to learn how to be mindful, but a lot of research shows that mindfulness can help with anxiety, chronic pain, stress, focus, and more.
Mindfulness is often referred to as a practice for a reason. You should practice it often, but there are no right or wrong ways to do it.
If you can’t sit still, don’t. It’s okay to get up and walk while being mindful.
When your brain keeps thinking of things, don’t get upset. Just redirect.
Start simple with breathing. You breathe every day, so you can do this step. Take deep belly breaths. Nice and slow. Focus on the breathing.
And this is something that can be done nearly anywhere.
5. Sing or listen to your favorite tune
What better way to get into a good mood? Listen to a favorite song. Sing along!
Research has shown that listening to music can reduce anxiety, blood pressure and pain. It can also help sleep quality, mood, mental alertness, and memory.
Pick your favorite feel good songs and make a playlist that you can pull up when needed.
We’ve all heard that exercise helps our bodies, but many people minimize the value it has for our mental health.
Regular exercise helps our mindset in general, but if you have the opportunity to work out when you’re upset, it can help lift your mood.
Combine numbers 5 and 6 and workout to some great tunes!
7. Change the scene
If you’re getting worked up, it can help to get up and walk around.
Especially if you are worried you will say or do something you’ll regret, leave the situation if you can.
If you can go outside, even better. Fresh air can be mood-lifting.
8. Think about what has gone right.
We tend to ruminate about what’s wrong. Negative thoughts are all we can think about. We need to learn to stop this rumination.
When you recognize that you’re ruminating, accept that you’re having whatever thoughts you’re having. Recognize that the thoughts might not be accurate and allow the thoughts to pass rather than trying to block them out. Trying to block out negative thoughts will just cause increased intensity of the thoughts you’re trying not to have. You can replace negative thoughts with positive thoughts: what is going right? What is the best possible outcome? How can you turn the situation around?
If this is hard, start to make it a practice to write down at least one thing at the end of each day that went well. Your hard studying paid off. You met a new friend. You had a good hair day. Whatever it is, keeping a list gives you something to reflect upon when you’re really down. Doing this daily also helps your brain practice finding the good in things. Like anything, practice makes things easier. It is really hard to find good things to think about when you’re in a bad place, but it gets easier when you’ve practiced when you’re not in a foul mood.
9. Be silly
You have to use this one sparingly.
Obviously in the middle of class you can’t start being silly, but if you’re able to get to a place that you can do a silly dance or anything silly to unwind: do it. Acting the part can help relax you and set the mood.
Be careful to not offend anyone or be hurtful in your humor and silliness.
10. Find perspective
Run through questions that help put your worries into perspective.
What are you really worried about?
How likely is it that your worry will come true? Use evidence to support your answer.
If your worry comes true, what is the worst thing that will happen?
If your worry does come true, what’s the most likely thing that will happen?
If your worry does come true, what are the chances that things will be okay
Sensory items can help calm our minds. Think of sounds, smells, textures, and visually relaxing things.
Squishy play doh or silly putty
White noise machines
Chewable jewelry – if you don’t know what this is, just search “chewelry”
Noise reducing headphones
Rock or sway
Run your fingers through a bin of sand, dry rice, or dry beans
Aromatherapy – Use candles, diffusers, or scented objects. Jasmine, vanilla and other scents might relax you.
Glitter jar – make your own!
Cognitive Behavioral Therapy (CBT) is very effective for anxiety management. Ask your physician to help find a good therapist for you.
If you’re not willing or able to work with a therapist, there are some interesting options to try online. These are not meant to replace professional help, but they help to remove the most common roadblocks to working with a therapist: cost, time, and not wanting to talk to a real person. Learning online might help you see what can be done with therapy and open your mind to finding a therapist.
Woebot is a free app that uses artificial intelligence to teach CBT. It can help you think through situations and learn about yourself with intelligent mood tracking.
MindShift™ CBT uses scientifically proven strategies based on Cognitive Behavioral Therapy (CBT) to help you learn to relax and be mindful, develop more effective ways of thinking, and use active steps to take charge of your anxiety.
What’s Up? is a free app currently only available for iOS users using some of the best CBT (Cognitive Behavioral Therapy) and ACT (Acceptance Commitment Therapy) methods to help you cope with Depression, Anxiety, Anger, Stress and more!
NEW! Common Sense Media is a well known resource to assess if a movie, game, or other media is appropriate for kids. They now have a list of mental health apps with suggested ages and rankings. Check it out on Common Sense Media Apps to Help Mental Health!
There are many traits common to people with ADHD that can make them seem self centered or conceited. Learning about them can help loved ones understand behaviors and people with unintended behaviors work on having expected behaviors.
Most people with ADHD are very empathetic and kind, but can come off as self centered and uncaring. Why is there this discrepancy? What can you do to help others realize that you really do care about them and not just yourself?
Many of the traits of ADHD can make a person seem self absorbed. Let’s go over a few of them. Once you understand why you do what you do and how those actions are perceived by others, can you think of ways that you can help others to recognize that your actions do not mean what they seem to mean?
1. Time management and awareness
Many people with ADHD have significant problems with time awareness. This makes it easy to run late. All. The. Time.
When you’re often late to meet ups with friends (or forget about them all together), they can see you as not caring.
What to do about it…
Working on improving time management and organization might be a long process, but it’s worth it.
Use post it notes as reminders – put them where you’ll see them when you need them (a note on your backpack to remember your project or in the bathroom to remind you to brush your teeth)
Set your alarm to remind you to leave on time (have it go off when you should start putting on shoes and doing other getting ready to leave stuff, not just when you need to leave)
Look at your schedule each morning and on Sunday evenings
Don’t overschedule – anticipate more time than you’ll need for things so you’re not rushed
Ask for help – friends would be happy to help you stay on top of things if you ask
It might not be obvious to others how much mental preparation is needed to shift gears. If you’ve been planning to do something and plans change, it is disappointing. When your mind is finally in the zone and someone interrupts, it’s frustrating.
It’s hard for people to understand why a sudden change in plans is met with resistance. This is especially true when we often seem impulsive. Resistance to change in plans seems contradictory to the impulsiveness that often comes out.
What to do about it…
If you tend to lash out at people when they alter plans, the first step to change the behavior is to recognize it. Learn to recognize triggers. Whenever you note a trigger, learn what you can do to help yourself have a positive reaction.
Have a talk with those close to you about why you don’t like to suddenly change plans. They won’t know how you feel if you don’t share it, and most people who care about you will help accommodate if you understand. You might need to remind them when you’re in the moment, but it’s best to have the first conversation at a time in advance.
3. In the zone
If you’re in the zone getting stuff done, it is really frustrating to be interrupted. You know that you’ll have to re-enter the zone, which can take a long time and a ton of energy.
Most of us know what it feels like to be deep in concentration only to have someone ask a question or make a noise that ruins it. The mental energy to get back into the zone is huge. How do you handle the situation?
Your reaction may not be appropriate – there’s that impulsivity at work. If you yell, blurt unkind words, or try to ignore the interruption, it will not be received well. You will seem self centered if you lash out.
What to do about it…
Learn to take a few big breaths before you react to a disruption.
Give your mind a chance to settle. You were able to get into the zone once, you can do it again.
A little break can help.
Exercise has been proven to help our focus, so if you can take a quick walk – even if just to the bathroom – it might help.
Mindfulness can really help here. It needs to be practiced, but it only takes a moment to help clarify your mind. For more mindfulness tips and several free apps to help guide your mindfulness, see my Pinterest Mindfulness board. If you use mindfulness regularly, you will notice less stress overall.
Healthy food can renew your energy. Just be careful to not overeat out of anger or boredom.
Working memory is like the RAM in a computer. It’s where information is temporarily held while constructing a sentence or forming an idea, solving an equation, remembering where we put something. If the information is “valuable” we then store it in long term memory, like saving to a disk, from which we can pull the information later. Information that doesn’t seem valuable, such as names or dates, isn’t stored.
Forgetting details is common among people with ADHD.
When it comes to forgetting birthdays, anniversaries, and other important dates, it can make you appear uncaring.
Many people with working memory problems fear that their thought will be gone if they don’t blurt it out right away. Unfortunately, interrupting others is socially inappropriate. If you do it often, you come off as self absorbed.
What do do about it…
If you struggle to recall your thoughts, jot stuff down quickly to trigger your memory.
If you find yourself interrupting others, practice looking for pauses in a conversation. Use that pause to speak your mind.
Use reminders. Put important dates and events in your calendar. Look at your calendar daily.
Play games that help you practice short term memory.
ADHD can lead to many problems with communication.
As mentioned above, working memory problems can lead to communication problems. If a thought pops into your head, you’re likely to share it right away. It doesn’t matter if someone else is talking. You don’t want to forget it, so you blurt it out.
It’s also common that if someone interrupts when you are talking, you get very upset because it breaks the line of concentration. That’s especially common among people with ADHD because it’s so hard to retain a line of thinking, but people might find it annoying that you interrupt them but won’t tolerate being interrupted.
Maintaining eye contact during a conversation might be really difficult. You might tend to look around the room or out the window when someone’s talking to you. This can be perceived as not paying attention.
A similar issue is found during class when you’re listening to the teacher, but doodling or playing with a button on your shirt. This can make it appear that you’re not paying attention, even when you are.
It’s also really easy for you to become bored with a conversation. This means you might suddenly change the topic to something unrelated. This can make others in the conversation feel that you don’t appreciate what they’re saying. Maybe you don’t. But there are social norms that others can follow that help them wait patiently for others to finish before changing the subject.
It can even be hard for you to keep on track with your own thoughts. You can be talking about one topic, then something leads you astray, leaving others confused. Your brain might be ahead of your words, so your sentences lose their meaning to others.
What to do about it…
It sounds silly, but practice does help. Sometimes we get frustrated with ourselves and just stop trying, but then we never get better at communicating.
Watch others in group settings to see how they interact and how others perceive what they say and do. Replicate the things that are well perceived and avoid doing the things that are not appreciated.
Mantra: don’t interrupt.
It isn’t uncommon for people with ADHD to be overly sensitive. This happens after years of being told you’re doing things wrong, being too loud, forgetting stuff, and the million other ways you get negative feedback.
Rejection sensitivity can lead you to become upset at friends for no apparent reason from their point of view. They might feel like you push them away because they don’t understand that their response hurt your feelings.
People with ADHD often seem outgoing because of their unlimited energy and talkative nature, but they also can have trouble being around a lot of people. Too much input and stimulation can be distracting, especially to the ADHD brain.
When people perceive you as the “life of the party” type personality, it can make it difficult to explain why you don’t want to go to an outing or event that will have a lot of people. It might seem to others that you feel above everyone else so don’t want to participate.
What to do about it…
Have an escape plan to leave early if the crowd is too overwhelming.
If you turn down an invite, be sure to let your friend know why. For example, if the crowd is just too overwhelming, let them know you’d rather do something with a smaller group.
Impulsivity can get us in trouble in the humor department, making people with ADHD seem uncaring and downright mean.
Sometimes saying a “funny” thought that pops into our minds is not the right thing to do. It might feel good to make people laugh, but if that laughter is at the expense of others, you will not be perceived as a nice person.
What to do about it…
Watch for real reactions when people are laughing. Are some people uncomfortable or upset about the joke? Those are the types of jokes that you want to steer clear of.
One good rule of thumb: Don’t make fun of other people or groups of people. You might hurt someone’s feelings, and that is never funny. (Even if it makes some people laugh.)
If you are careful, you can make fun of something temporary or non-identifiable, such as bad drivers or people who fall. This is easier to do if you include yourself in the group, such as joking about a time you fell or walked into a wall.
9. Outside the box thinking: good for leaders, hard on kids
Society and school teach us to conform. We should act as expected. Clothing styles dictate what we should wear.
Many people with ADHD are non-conformists. This can be a great trait because it can lead to new ideas and change. Leaders and inventors are non-conformists. This trait can help you make a difference in the world.
But if the expectation is that you work a math problem showing your work in a specific way, you need to do it that way. If you’re supposed to dress for a formal dinner or a group function, you can come off as uncaring if you show up in attire that doesn’t fit expectations.
What to do about it…
Keep being you!
Think outside the box and create as much as possible, but when a certain behavior is expected, try to conform.
This means if your teacher wants a project done a certain way, do it that way.
If you’re going to a location with a dress code, follow it as much as you can. Don’t wear something that will bring attention to you unless you’re supposed to be the center of attention, such as at your birthday party.
Remember to always stay in your role.
If your role is a student, let the teacher teach. When you earn the role of teacher, you can teach.
When you are the athlete, let the coach coach. If you earn the role of coach, you can coach.
When you hang out in a group, let others help to decide what to do. Take turns. Even if it’s not your choice, try to stay focused on the activity. Don’t let your friends think you think they are boring, even if the activity is boring to you. Find something in it that interests you.
If you’re motivated and learn knowledge as well as people skills along the way, one day you’ll be the leader. Then you can lead. Until then, you will be seen as bossy in a negative way if you try to take charge prematurely or inappropriately.
Check out what Jessica McCabe has to say about ADHD and relationships
Inspiring stories from people who were seen as failures. Others have risen above predictions — and you can too. Rise and thrive!
Do you feel like a failure? Moving forward in life is hard, especially when others tell you you’re not good enough. I often tell struggling kids and their parents that schools make good workers… people who do what they’re told. Teachers want you to show the work in the way they do it. They want you to follow a rubric of instructions. There’s often no room for individuality or ingenuity. In short, school isn’t designed to teach future leaders, inventors, or creators. Continue reading for inspiration if you feel like a failure. Others have risen above predictions — and you can too!
Students who are smart and natural leaders tend to struggle in that box we call school, but can shine in life!
If you’ve heard these things before, there are two options: cave and prove them right or thrive and prove them wrong.
Inspiration from others
Tell me about a time someone told you that you could not do something and you went ahead and succeeded out of spite.— Amanda Deibert 🏳️🌈 (@amandadeibert) April 19, 2019
This was posted on Twitter and is a fascinating and inspiring thread. If you need inspiration, read some of the stories below. For even more, click the link above.
And when the original poster was asked if she had a story of her own…
Are you struggling to control side effects from your ADHD treatment? Learn some tips to help manage them effectively so you can thrive with ADHD!
With everything we do, we must weigh risks and benefits. Many people with ADHD need help managing their symptoms, and that often includes medications. Unfortunately this treatment can lead to side effects. If we can manage the ADHD medication side effects, the risk to benefit ratio tips toward the benefit side.
1. Appetite suppression
A decreased appetite is common when stimulants, such as methylphenidates or amphetamines, are used. I have seen kids who gain weight better on their medicine because they can actually sit long enough to finish lunch, but most will lose a few pounds when they first start their medication. After the initial drop, most can maintain a healthy weight with some simple adjustments.
Make the most of non-medicine times
I often say that kids on stimulants don’t have eating disorders, but they have disordered eating. They eat at unconventional times.
Before meds kick in
Start your day with a healthy breakfast that includes protein, whole grains and fats. The typical American diet of cereal for breakfast is mostly carbs, which gives quick – but non-sustaining – energy.
Protein, fiber and healthy fats can provide longer-lasting energy.
Don’t limit yourself to “breakfast” foods. If a sandwich or leftovers sound good to you, eat that for breakfast.
As meds wear off
Before hanger sets in, grab a healthy snack at the time you start to feel hungry in the afternoon or evening.
If your parents try to make you wait for dinner, talk to them about how your hunger affects your mood and behavior.
Eating a healthy snack (or call it an appetizer) can help keep those under control. You should still be able to eat dinner, but if it affects your appetite, warm up last night’s dinner as your appetizer each day. You’ll still eat what the family eats, but it will be timed differently. Still sit with your family for the conversation if your hunger doesn’t coincide with the family dinner. Family meals are important!
After school if you’re hungry, grab a mini-meal. Heat up leftovers, make a sandwich, or grab a plant and protein pair.
apple slices, grapes, or berries with cheese
bell peppers with cream cheese
berries and yogurt
cucumbers, carrots, bell peppers or snap peas with hummus
apple, banana or celery with peanut butter
smoothie made with fruits, vegetables, and yogurt
broccoli, carrots, cauliflower, snap peas or celery with a yogurt dip
If you’re hungry after dinner, again grab a mini-meal type snack, not junk food.
Don’t waste empty calories
If you’re able to eat, pick the healthiest part of the meal first. Don’t start with the side dish or roll. Eat plants and proteins. Plants are fruits and vegetables, and most of us fail to get the recommended amount of these daily.
People with ADHD tend to be very sensitive and emotional in general, but medications can increase moodiness at times. Look for patterns about when the moodiness is the worst to help identify why it happens.
Some people get more irritable when their medicine is working, others as it wears off. This can be due to a medicine that’s not the best fit or at the wrong dose. Be sure to talk to your prescriber about how your medicine is affecting your mood.
Many people experience a rebound of symptoms as the dose wears off. If this happens, some people can use non-medication changes, others require a medication adjustment.
If you can be alone during this time frame, that may be all you need.
Listen to music. Exercise. Read. Whatever helps you adjust.
If this isn’t sufficient, discuss adjusting the dose or adding a short acting dose in the afternoon with your prescriber.
When these medication adjustments aren’t sufficient, adding a non-stimulant medicine can help buffer the rebound. Again, talk to your prescriber.
Sometimes stimulants can can trigger an underlying anxiety.
Anxiety can look like anger or increase irritability.
It can lead to headaches, stomach aches and other physical symptoms.
Anxiety is a common cause of insomnia. Lack of sleep makes anxiety worse. It’s a hard cycle to break sometimes. Talk to your prescriber if you’re experiencing this.
When anxiety distracts, it can look like poor focus, which can be misintrepreted as too little stimulant. Increasing the stimulant makes it worse.
Anxiety often leads to avoidance, negativity, over planning and trouble with patience.
Help for anxiety
Therapy is the first line treatment for anxiety, but if it is caused by medication, adjusting the medication can help.
Sometimes adding another medication to help with the anxiety may be needed.
It is very important that you talk to your prescriber about any anxiety you have, whether it’s medication related or not. No one should suffer in silence.
Other causes of moodiness
Moodiness can be related to chronic sleep deprivation or hunger – see the related sections of this post to help manage those issues.
If you think your medicine keeps you up, talk to your prescriber about changes that could help.
4. Stomachaches and headaches
If stomachaches or headaches seem to happen due to the medication, taking the medicine with food can help.
These symptoms sometimes only happen at the start of a new medication, when the dose is increased, or when resuming after being off of it for awhile. If this is the case, you should notice these side effects go away after consistent use.
When the stomachaches or headaches are persistent and not tolerable, talk to your prescriber to discuss changing medicine or changing the dose.
Repeated movements or sounds are known as tics.
Tic disorders are common in kids with ADHD:
About 20% of kids with ADHD have chronic tics.
Around half of all children with chronic tics have ADHD.
Tics can come and go. They often change over time, so an eye blink can go away and be replaced by a nose twitch or shoulder shrug.
Because of this natural cycle it can be difficult to decide if they’re on their normal cycle or worse due to medication.
Some people will even notice that their tics are less common when they’re on medication for ADHD, especially with guanfacine or clonidine.
If you note that tics increase with the start of a new medicine or an increase in dose, evaluate how these tics affect you. If they are minor, such as an eye blink, it is okay to ride it out. The tic will most likely continue to come and go and it’s not causing distress. If it causes you distress, talk to your presciber about behavioral therapy or a medication change.
Recent headlines have put psychosis and stimulants in the news.
In short, if you’re doing well on a stimulant, either amphetamines or methylphenidates, there’s no need to worry.
The study being reported is about new starts on these medications.
As is often the case, headlines are overestimating the risk. They are designed to make you want to read the article.
I am writing a whole post on this, so tune in next time… if you don’t want to miss it, sign up in the pop up or the right sidebar so you’ll get each new post in your in box. I promise to never use your email for any other purpose!
This presentation will be of interest for all ages living with ADHD. It will include experiential activities, and guidelines for using ADHD strengths in order to follow your passion from childhood to the workplace!
This will be a combined group of the parents and students. We appreciate your RSVP so we can plan seating, but if you decide to come at the last minute, you’re welcome to show up! All meetings are free and open to the public. RSVP here
Does rumination and negative thinking keep you from finding appropriate solutions and moving forward? Learn how to overcome negative thinking with ABCs.
We all have negative thoughts, but when we get stuck in a rut about them, it’s called rumination. When we ruminate, we can’t stop thinking the negative thought, which keeps us from finding appropriate solutions and moving forward. Cognitive Behavioral Therapy (CBT) teaches how to break this cycle of rumination. One way to use CBT is to think of your ABCs. Use the handout linked below to stop thinking negative thoughts.
A is for Adversity
When there’s a problem, we need to identify the trigger, or what is causing the adverse situation.
Check out the following examples to see how the process works.
Situation 1: Your BFF hasn’t answered your important text.
A: Your friend is usually quick to reply and you’re worried that there’s something wrong that’s kept her from replying.
B: You don’t know if she’s mad at you or dead on the side of the road after an accident.
C: You are worried that you did something to anger your friend or that something catastrophic is keeping her from answering.
D: There was no indication that she was upset with you last time you spoke. She is a safe driver and the road conditions are fine. It is possible that she could have forgotten to charge her phone (again). She could have the ringer off. Sometimes texts don’t go through. She might be busy doing something and unable to check messages.
E: Do you feel less anxious realizing there are other reasons that your text has gone unanswered? What about these new thoughts can help you problem solve? Is there another way to reach your friend, such as through her parent or another friend? Should you call instead of text?
Situation 2: Too much to do!
A: Last week you missed a couple days of school so you got behind and can’t quite get back on track. You have a paper due, a huge test this week, and practice every night after school.
B: There’s so much to do, you’re overwhelmed and can’t even start on any of the schoolwork. After practice you want to just relax and watch YouTube videos. You need time to relax to feel better, but then you realize hours later that no work has been done, so you’re going to be up all night working. This leaves you too tired to focus at school so you get confused on even simple concepts and questions.
C: Anxiety is keeping you from initiating what needs to be done. While relaxing is important, you are not using your time efficiently, which is adding to the problem. You’re sleep deprived, which increases anxiety.
D: Take a look at how much time you’re spending on everything. What can be pushed off until later? Where are the priorities? How can you moderate your down time so you can be productive but still have time to relax?
Mindset: This is a situation I have the capacity to deal with. I’ve developed a pattern of avoidant coping but I can get better at non-avoidant coping through the right kind of practice. This is an opportunity for that.
E: Does realizing how much down time you waste help you regroup and use time more efficiently? Are you motivated to set timers to help limit your free time? Can you grab a friend to study together to keep you on track? Are there things you need to change in your schedule so you can devote appropriate time to tasks? Are any of your teachers willing to extend the deadline since you were sick? What can you learn from this to do it better next time?
Most of us want to be happy, but true happiness remains elusive. What’s the big secret? I don’t think there’s a single secret. There are many things that can add to our happiness. I don’t mean making millions of dollars, having the latest model cell phone or having the cutest prom date. Those can bring temporary happiness, but they miss on true happiness. Sometimes they actually can make us unhappy.
Have you heard the title quote before?
Live is a marathon, not a sprint. ~Unknown
I think it holds some of the best ideas about true happiness. Life is a marathon, not a sprint. Let’s break down what that means. I’ll start with a bit about what goes into running a marathon. Then I’ll give several examples of how we’re sprinting along and how this can lead to burnout. I’ll end with tips on how to turn this into a marathon. Pace yourself. You’ve got a long life ahead!
Running a marathon isn’t easy.
People must train for long periods of time. It takes dedication and consistency.
There is a big time commitment – and it’s not all running. It’s coming up with the time to run regularly. And eating enough healthy calories to sustain your body.
Not to mention preparing yourself mentally.
Only after months of hard training can you actually run the marathon.
Sometimes injuries delay things unexpectedly.
Excitement builds as the date approaches.
During the marathon, you might feel on top of things as you run past others, but then there will be some who pass you. There are moments a runner may feel like there’s no way to go on because you have nothing left to give. It takes grit and resilience to keep going.
After finishing, you might even spend time wondering what you could have done differently to shave off time.
And you need to take time to rest so your body can recover.
Then maybe you start the cycle all over again.
Society of here and now.
We’ve become a society that has access to everything right here. Right now. While it seems like this is a good thing on the surface, this can lead to impatience, anxiety, and entitlement. All of these lead directly to unhappiness.
It’s not uncommon to hear how busy people are. They complain, yet they often seem to be bragging of all the things they have to do. Being busy isn’t something to brag about.
It is seen as a negative thing when we take time to relax. We’ve become a society that doesn’t value balance, despite everyone talking about finding work-life balance.
Being constantly busy and expecting everything when we want it has become our general expectation. We don’t learn resilience when we’re able to get what we want when we want it. Resilience is when someone is able to pick up and move on when something doesn’t go their way. If we never learn resilience, we’ll be unhappy in life.
The good news is you can learn resilience at any age!
Instant access to friends and family
When I was growing up, we had no cell phones. (I’m a dinosaur, I know.)
I didn’t even get voice mail or caller ID until my mid to late teens. If a friend called and no one was home, we didn’t even know they called. Sometimes that caused frustrations because we had to keep calling to find someone to answer if it was important, but it also was a lot more freeing in many ways than being constantly attached to a cell phone.
We looked forward to talking at school and activities. There were fewer distractions when we were with people because it was rare that someone had to take a call. It took planning to arrange to meet friends, but that itself helped us learn an important skill!
In today’s world if want to tell a friend something, I text them. This is impersonal and doesn’t build communication.
Sadly, we often impatiently wait for an answer. Some people even start to worry when the text remains unanswered for a few minutes.
~ Did I do something to make them upset?
~ Are they having fun with someone else and ignoring me?
The facts can be very different.
Maybe the text is delayed. Their ringer could be off. If they’re driving they shouldn’t answer. Maybe they’re practicing self regulation and it’s not a time they are using their phone – they’re doing something else. The phone can be in another room – or taken away by parents.
So many things can interfere with a quick response, yet we often get upset when the reply isn’t instantaneous.
Isolation of online
There are so many things to do online. Some of these are required for school or work. Sometimes we simply want to relax and check up on things or watch a video.
That keeps you away from actually living life and self care.
Set limits for yourself. You will find that you have more time to do other things that bring more joy. Less time online also means less time to get upset with what others post.
If we are in need of things, we can order online and Amazon will deliver it tomorrow. There are even food delivery services that will deliver from any restaurant in the area, so we can order online and never leave the house.
While this seems convenient, there’s something to the action of going shopping or out to eat. Planning a day and time to be able to shop (or eat out). Actually looking through the store and possibly running into someone you know or having a simple conversation with the store clerk are becoming lost skills. We are isolating ourselves by taking the convenient road.
Fear of the great outdoors
In years past kids would play outside until it got dark outside. They’d walk to school and back unsupervised. A great memory is shared in The Summer of No TV.
Today parents are afraid that kids will get hurt or abducted, so they won’t allow them to roam alone.
Parents of today tend to schedule kids in sports, music lessons, dance classes, scouts, and more.
They structure a child’s time so much that kids of today don’t learn how to fill their time with fun things to do. They don’t learn to work through problems and differences with friends on their own. The fear of injury and abduction overshadows the real dangers of kids not learning how to become independent and resilient.
This over-structured lifestyle leads to teens who don’t know how to find things to do other than screen time or scheduled activities. Kids don’t learn to use boredom as a door to discovery. They don’t discover their own interests and talents. It can lead to feelings of inadequacy and sadness.
Our society is growing adults who have no idea how to organize their own time and succeed in life.
If you’re a teen reading this, talk to your parents about how you can gain independence and be accountable for yourself. If you’re a parent, think about ways you can let go and let your kids figure things out themselves.
Want to know the secret to happiness?
Make it a marathon
You can’t get away from many of the busy activities in life.
The key is to use balance. Balance can lead to the secret to happiness.
Spend time with others
Find ways to be with friends and family on a regular basis in real life.
Go beyond your regular practice and game time and schedule unstructured time. When we are in class or at practice, we have rules to follow and things to do. Unstructured time is when we’re able to be creative with our time, find new interests, and learn more about one another.
Make time for yourself.
Yes, I know I just said to be with other people, and that is still important. When we’re alone too much, we start to feel self doubts. Anxiety grows. Depression can set in.
What I mean by making time for yourself is that we all need to practice self cares.
Here’s another self care necessity. I know you hear this all the time, but it’s important.
It’s easy to spend most of the day sitting. Failure to get daily exercise can lead to lifelong problems.
Find something you enjoy doing, such as a sport or dance. If it’s nice outside, invite a friend to take a walk or bike ride. Walk a dog. Play frisbee. Have fun! This directly and indirectly can increase your lifetime happiness.
Expand your horizon
We tend to get stuck in our daily routines, which can get boring and doesn’t allow us to find our true passions.
Explore other cultures.
Learn about other people and cultures through books, movies, music and cultural events. Visit a museum or historical site.
Talk to people outside your social circle. I know that can be intimidating for some and difficult if you’re in a small town, but it can be very rewarding to learn about other people and their culture.
If you don’t have time to read, or just don’t like reading, try an audiobook. You can listen while exercising or doing chores around the house.
Take up a new hobby
When we’re young our parents sign us up for things to do or buy our toys and games.
As we get older, we need to explore other interests to help find ourselves. There are many things out there that you might not even know about. Think about what characters in books and movies have done. Does any of that interest you?
You can try new things at school by taking an elective that you know nothing about.
Take an art class or learn to rock climb. If you think you can’t dance, sign up for lessons. If competitive sports aren’t your thing, check out a non-competitive league or an individual sport.
Join a new club at school.
Give to others
Community service is becoming required for many teens, but it should be something we do with a giving heart.
Doing things for others is one of the biggest secrets to happiness.
Don’t simply sign up for a service project because you need the hours. Find something that suits your personality and interests.
If you love the great outdoors, find ways to help others outside.
Love animals? Check out the animal shelters.
If you’re good in a subject and see a friend struggling, offer to tutor. (Be careful how you propose this… you don’t want to offend them or come off as a know – it- all.)
Is your neighbor aging? Offer to help with yard work or house work without charging. Leave a pot of flowers on their porch just because.
Do you love kids? See if you can volunteer at a summer camp or respite care.
If you’re interested in healthcare, look at hospitals and other healthcare settings to see if they offer volunteer opportunities.
We often associate spirituality with religion, but they are not the same. We can learn about our own spirituality through meditation and prayer. Spirituality involves a deeper understanding of yourself and the world around you. It is about loving yourself, others, and our planet.
Spirituality also involves mindfulness, philosophy, and more. Learn from books and other people to develop a deeper understanding of love and life. Attend a conference or retreat. Continue this learning life long.
Certainly religion is important to many people, and exploring your faith can be very rewarding towards overall happiness. Teen years are a common time to question, so it’s a great time to reflect, read, and learn. Learn about your own religion and others. This isn’t to change your belief, but it often reinforces it. If you do find that another religion is appealing to you, find people from that faith to talk to so you can continue learning.
Enrich your spiritual life by taking time each day for reflection. Keep a gratitude journal. Help others.
Check out your senses
Sights, sounds, touch, and taste are all important senses, but smell is especially helpful in our emotions and memory.
Certain smells can bring me back to my grandmother’s kitchen. Smells have a way of solidifying memories and then bringing them back. Some, like my grandmother’s kitchen are very positive, happy memories. Others can bring negative emotion. We can use this powerful sense to help us bring happy feelings or a sense of calm and peace.
Certain smells tend to lead to happiness. Citrus smells, such as lemon and orange, and peppermint can serve to pick up your mood. This doesn’t make you find happiness for life, but it can be a pick me up when needed.
Learn to be aware of all 5 senses. This is part of mindfulness and helps us in our awareness. There are many ways to learn mindfulness. Take some time and try some out.
Neurotransmitters are the messengers that bring information from one neuron to another. An imbalance in their levels can cause many problems. Medicines can help bring levels back to normal.
There’s a commonly held belief that people with ADHD should just try harder, but this doesn’t usually work. The symptoms of ADHD are caused in part by imbalances of neurotransmitters in the brain. Low norepinephrine levels lead to symptoms of ADHD. More and more evidence is showing the differences in the brains of people with ADHD compared to neurotypical (“normal”) people.
ADHD is real. You can’t just will it away.
What if no meds are used for ADHD?
Not everyone with ADHD is treated with medication. There are many reasons.
Some have never been diagnosed. Others don’t like medicine for whatever reason.
Many teens want to come off their medications. Some don’t like side effects. Others don’t want to be different.
Some people simply forget to take it and then struggle with the consequences of being unmedicated.
Many families have a hard time affording the medicine or taking the time to do the required follow up with their physician.
I’m sure there are many more reasons people stop (or never start) medicine.
Before discussing how the medicines work, it’s important to learn about neurotransmitters.
Our brain is of course very complicated in structure and function. There are millions of neurons that make up our brains. Between each neuron is a synapse, or space. Different areas of the brain serve different functions, and they all interact with each other. They also interact with other parts of our body and the outside world.
There are many pathways or circuits that bring information from one part of our brain to another. Neurotransmitters are the messengers that bring information from one neuron to another. They are made from amino acids.
Neurotransmitters each have a unique function but can be broadly classified into two categories: excitatory and inhibitory. Some neurotransmitters can serve both functions.
Excitatory neurotransmitters regulate motor movement, thought processes, anxiety, and more.
They can help us stay alert, but when they aren’t moderated by an inhibitory system, things can get out of control.
Inhibitory neurotransmitters act like brakes.
We need brakes so we don’t feel restless, irritable, and out of focus. When our brakes work, we can excel! Without brakes, we’re out of control.
Lock and key
Neurotransmitters act as messengers between different neurons. They are released from one neuron into the space between neurons called the synapse. They enter a neuron that has the proper shaped structure for it to fit.
It works like a lock and key.
Each neurotransmitter is like a different key. They each fit certain locks, and often can fit more than one type of lock.
Neurotransmitter levels and ADHD
When neurotransmitter levels are too high or too low, we can develop anxiety, depression, and executive functioning disruptions.
It is important to understand that to some extent we can control our actions, but neurotransmitters are important in the aspects that are beyond our control. Sometimes we just feel anxious or sad. Focusing can be very difficult. Executive functions, such as time management, working memory, and more, can be hard to manage.
Norepinephrine is an excitatory neurotransmitter. It is primarily made and stored in neurons but is also found in the blood and a small amount is stored in the adrenal glands, which sit on top of our kidneys.
Norepinephrine is involved in focus, emotions, sleeping, dreaming, and learning. Too much norepinephrine can cause anxiety, but too little can lead to problems with focus and motivation.
It can raise our heart rate, increase blood flow to muscles, and increase our blood sugar level – all symptoms we experience in times of anxiety. These are helpful responses when stress is caused by physical danger and we need to run away, but not so much when we worry about a test or other common anxieties.
These symptoms can lead to distraction, self-consciousness, and poor focus and performance. This can look a lot like when norepinephrine levels are too low, which is one reason why anxiety and ADHD can mimic one another as well as exacerbate one another.
Dopamine makes us feel happy. Getting a bump in dopamine feels good.
I often joke that we get a dopamine hit every time we check social media or win a game. One of the reasons depressed people overeat comfort foods is that eating rises our dopamine levels, which makes us feel better. (At least until the heartburn sets in or we notice we’ve gained a few too many pounds to be healthy.)
Dopamine is one of the neurotransmitters that can be both excitatory and inhibitory.
Drugs like nicotine (yes, even from electronic cigarettes), opiates, and alcohol all increase dopamine levels. Eating foods can have the same dopamine increase, as can winning a game or doing anything else pleasurable.
We can all choose healthy options to get dopamine hits. Exercise. Playing games. Enjoying the company of friends and family. Helping others. All of these are healthy things that bring us happiness.
Negative things, such as drugs and alcohol or too much screen time, can lead to more problems than they’re worth. Even though they bring temporary feelings of happiness, they cause more problems in the end. Avoid these dopamine hits.
Dopamine can increase our alertness and help with memory and motor control in addition to giving us pleasure.
Dopamine can be converted into norepinephrine and epinephrine.
Low levels of dopamine are associated with problems focusing, depression, the inclination to abuse drugs and alcohol, excessively playing games online or gambling , and overeating.
If the levels are low in motor areas of the brain, it can lead to the tremors commonly seen in Parkinson’s disease.
Low levels in other parts of the brain can lead to learning and memory problems, lack of energy and motivation, and a loss of happiness and interest in things that used to bring pleasure.
Low levels in the prefrontal cortex are associated with ADHD.
High levels of dopamine can cause overexcitement and disrupted thoughts. They can even lead to anxiety and paranoia.
Serotonin is important in the regulation of anger and aggression, body temperature, mood, sleep, sexuality, appetite and metabolism. It can help us relax when serotonin is available in proper amounts. Stress can lower our serotonin levels as we use it up trying to relax.
Low levels of serotonin can result in depression, anxiety, anger, panic attacks, low energy, migraines, insomnia, obsessions, irritability, craving sweets or loss of appetite, focus and memory problems, aggressive behavior, slowed muscle movement and speech, and having a decreased interest in sex.
High levels of serotonin cause diarrhea, headache, confusion, sweatiness, twitching muscles or stiff muscles, fever, high heart rate and blood pressure, seizures, and even death.
How do ADHD medicines work?
Stimulant medicines are considered the first line medical treatment for ADHD. The two types of stimulants are methylphenidates and amphetamines.
The differences in how these two groups of stimulant types work may explain why some people with ADHD respond to one type better than another.
Methylphenidates include prescription medicines such as Ritalin, Metadate, Concerta, Focalin, Aptensio, Quillivant and others.
The methylphenidates block the reuptake of dopamine and norepinephrine. This leaves more of these neurotransmitters in the synapse. Methylphenidates also help release these neurotransmitters from the neuron, again allowing more to be in the synapse.
Amphetamines include Adderall and Vyvanse. They increase the release of dopamine and norepinephrine from their storage sites into the synapse. They also slow the reuptake of the neurotransmitters, but not to a large extent.
How do medicines affect neurotransmitters?
Medicines that affect neurotransmitters are used to treat ADHD, anxiety, depression, and low blood pressure.
Stimulant medicines (methylphenidates and amphetamines) increase norepinephrine and dopamine.
Atomoxetine (Strattera) affects only norepinephrine.
Serotonin norepinephrine reuptake inhibitors (SNRIs) are antidepressants that work by increasing serotonin and norepinephrine.
Tricyclic antidepressants also increase norepinephrine and serotonin, but are not often used anymore since there are many safer options available.
Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat anxiety and depression. They block the reabsorption of serotonin, which leaves more available in the synapse.
MAOIs prevent the breakdown of serotonin (and other neurotransmitters) but are rarely used due to significant adverse reactions.
In addition to the resources hyperlinked throughout this post, check out the following:
Did you know that while stimulants that are used to treat ADHD can help people with ADHD, they can cause imbalances to neurotransmitters to those without ADHD? Learn how stimulants can make focus, attention, mood and more worse in Stimulants decrease brain function. Say What?