ADHD - how to know when meds are working. 17 year old says "I dunno"

[Juicecharger]

Hi. My DS was recently diagnosed with ADHD after torturous years in secondary school where his work is concerned (also general chaos at home too). He's 17 and in lower 6th. We were both quite relieved on him getting the diagnosis as it explained so much and feels like a fresh start. The psychiatrist started him on 10mg of Methylphenidate which has been titrated up to 40mg. When I ask him if he's noticed any effects he says no. The thing is he has absolutely no interest in ADHD, doesn't want to know anything about it, not interested in learning any skills to manage it. Therefore there's also no reflection or analysis i.e. he doesn't ask himself 'does this feel different to how it felt before I started the meds'. He takes the medication at the start of the school day so the effects have worn off by the time he gets home. However, a couple of weeks ago when he was revising for forthcoming exams, he took them when he was at home for the day. What I noticed was: he spontaneously started talking about how he was going to organise his revision, he said that if he failed the exams (which would mean having to take them in September meaning revision during the holidays) it wouldn't be such a bad thing as he'd have plenty of time to get on top of the work over the holidays (two months ago this potential scenario resulted in rage on his part about the idea of having to study over the summer), and he asked for my bank details so he could pay me back some money he owed me saying that if he didn't, he might end up spending it and not then being able to pay me back. I felt all of this was really different to how he usually presents but when I mentioned this to him, he put the changes down to him maturing. Only very recently has he said that the 40mg dose might be making a bit of difference. For those of you with DC on meds how did you know it was working? Is it a dramatic shift with your DC saying they feel very different or is it more subtle and does what I've described sound like the meds are working. Would you say we should up the dose further (I will of course talk to his psychiatrist about all this but I'd love to hear from people who have been in this situation). I've told him that he has to start showing some more reflection to help get the treatment right but I'm not sure that's going to happen in any major way. I'd really welcome your thoughts and advice about this.

Hello OP
My DD almost 17 was diagnosed thid year. She has inattentive adhd.
We are on 36mg xaggitin/concerta.
For me, I haven't seen a major improvement in motivation or executive function to be honest.
But she is so behind in school work I think no magic pill can help so maybe she has given up.
She does say it helps with not having racing thoughts.
One day I went to work and she forgot to take her meds before school and she noticed her mind was racing and she just couldn't focus at all.
She came home had the meds and was calm within half an hour.
She still struggles with emotional dysregulation which is her main issue.
Her impulsiveness isn't reduced much either..she Spends all her money on trash and then feels bad if she doesn't have any money to buy things she really wants.
I think we need to up the dose to 45 but we have had to add a mood stabiliser to her cocktail of drugs so I am wary of any medication changes
I hope you can continue to see positive changes slowly.

Xx

You’ve noticed a big change. My son says he doesn’t notice- just like he didn’t recognise his ADHD behaviours. But he knows he can focus and accepts that he will always need it to work, but not for fun.

i do understand your relief and would suggest you delight in the changes you see,be positive with him and don’t involve DS in too many chats about it. It’s worth remembering, this is what you son has always been like- he hasn’t changed. The meds have turned down all the noise and interference in his brain.

I have been on both the above prescriptions (adult but petite so teen sized)

The latter the xaggatin was very off / on feeling of the effect but really made me robotic 40mg, I was efficant but made me emotionally dead- I could zone out the world

I am now on Elvanse 40mg and it's smoother - I am so much more productive and it works for me

Initially around an hour after taking I get a bit of euphoria - feel happy and really positive. Then I get a clarity and my focus begins, I still retain my humour, love and creativity which went with the xaggatin

It may be the smooth effect of the methyldate for you son that he doesn't realise
The difference but it will be having an effect

My 17yo also doesn't really notice a difference, but we do. She's chattier / animated, more engaged in tasks and you can get decisions from her. She does say it's a bit like drinking a Monster (which makes her head "quiet") but not as good. Trouble is she's also PDA and not in education due to depression, so she doesn't take it often enough to allow further triation. Hoping turning 18 and better antidepressants will help with that, and allow us to work more on the AuDHD.

My DD says she doesn't feel very different but sees her behaviour is different

I'm on the same medication and find that it basically doesn't work at all on the days I do not get enough sleep. If there's inconsistent results or if they're not sure, are they getting adequate sleep?

Have you asked the college or 6th form staff if they are noticing a difference in his presentation, and concentration levels?

DS (12) has been on meds for inattentive ADHD for nearly 4 years and he always says he doesn't feel any different and in many ways that's good, because you don't want them to feel different on them. But we have seen he is much more able to get down to work, to start and stick with things when on the medication, and maybe doesn't babble quite as continously.

I don't know if it's a common thing with ADHD, but DS, although generally very articulate, finds it hard to describe things, especially abstract things - so something like 'the difference between how I feel on and off meds' probably falls into the tricky category in terms of ability to describe.