ADD-ADHD Treatment: 7 Essential Tips for Finding the Challenging Bottom of the Therapeutic Window

First, learn the basics of how medications work

Stimulant medications for ADD have certain easy-to-recognize characteristics of how they are working. If you understand these characteristics, you can adjust the medications correctly; If you don’t, you just won’t do them right, and the whole treatment process becomes significantly troublesome. Too often, medications are widely scattered over a diagnosis of * ADD / ADHD * rather than specifically treating the * person * with the ADD / ADHD challenge.

I liken this casual process of adjusting medication to going back and tossing a bucket of paint at a barn door in need of paint, rather than taking a fine brush and covering the edges, the details specifically. With ADD medications, * custom work * is required at the beginning and at each subsequent medication review. This article looks at the 7 essential tips on how to recognize and correct the lower part of the therapeutic window.

Consider the therapeutic window first

The * Therapeutic Window * is just what it says; the window, is the space, the place in time and the correction of symptoms in which the stimulant medication works best clinically, – the exact dose, the expected effectiveness of that specific product with that specific person. All products have characteristic features, they are metabolized, burned, at different rates in different people. The way we evaluate that window is by recognizing the top, bottom, and sides. We work to ensure that all bases are covered correctly and that the drug is performing at its expected maximum level of performance.

A key observation point with the lower part of the therapeutic window: the drug is underdosed. The top is too much, the bottom is not enough.

7 tips for finding the bottom of the therapy window: So what does the bottom look like?

  1. Obvious bottom: medications [Meds] They have no effect: “Below the bottom” means that the drugs are simply not working: No effect, no improvement in focus or attention, no delay in impulsivity, or hyperactivity is going crazy, the mind is constantly preoccupied, the avoidance and postponement of projects. remains clearly intact. Inappropriateness can be measured both at the end and at the beginning of the day. Is there a start in the morning, how long does it last in the afternoon? If you cannot answer any of these questions, the dose is, in most cases, insufficient.
  2. Unclear background: drugs don’t work enough: duration of effectiveness [DOE] not suitable: All stimulant medications have an expected duration of less than 24 hours. Marking the specific duration is essential to get the most out of each medication. Vyvanse and Daytrana win the DOE race with 12-14 hours, Adderall XR follows with 10 hours DOE, Concerta and Focalin run 8-10 hours if effectively marked, Metadate CR and Ritalin LA are both at 8 hours, the Rest for only part of the day with Adderall IR [Immediate Release Tabs] with an approximate duration of 5-6 h. Ritalin IR has a maximum duration of 4 hours. None of the short-acting doses of IR lasts beyond noon without significant side effects such as: excessive concentration in the afternoon and a sharp drop around 1 to 2 pm. It is important to be completely precise in the DOE’s expectations for each specific drug.
  3. Inaccurate Bottom – The apparent “bottom” is actually the top – the drugs appear to be “not working” but are actually too high a dose. The inability to concentrate, hyperactivity, and impulsivity are caused by too many medications, not insufficient medications. How to tell the difference? This will be another article, but for now think: emotional dysregulation – angry, sad, irritable, disrespectful, or high.
  4. Insufficient fund: the goal for the day must be set correctly: medications are not marked for the whole day, but simply to “finish work or school.” This problem has been with us since long before the 1960s, it’s paleolithic, and it just doesn’t address the ‘fascinating hours’ of 4-8pm. New drugs can cover all day, school, and work on their own anymore. they are not the only objectives. Family life, the night, and general cognitive management throughout the day have become important treatment goals with new medication alternatives.
  5. The bottom cycle with infrared: the bottom infrared: if released immediately [IR – Short Acting ] Medications are the first choice – If IR medications become the first choice for any reason, as managed care often does not consider the ‘compliance goal’ important to support [in spite of multiple references in the literature], the Fund is often overlooked with the focus on economics. If IR medications become an absolutely necessary option, responsible regular use throughout the day to prevent the inevitable cycles of ups and downs becomes an essential goal, even if you have ADD.
  6. Missing a fixable fund – Neglecting the goal of the PM fund: Target specifically the fascinating times at the beginning of treatment: PM time is not set properly, and if the extended-release drug has a DOE of 8 hours, then a short action clipping IR is essential at night and essential to accurately dial in the expected IR DOE at night. Just because it is night does not mean that the day is over.
  7. Fog of the uneducated client: the client cannot see the bottom or is not actively involved in the lower search process: if the ADD client is not involved in the process, if the conversation is only with the parents, if the discussions are not They clarify objectives related to the Upper, Lower and Side Therapeutic Window from the beginning, medical checks become a mixture of misinformation and guesswork. With stimulant medications, precision is possible, it’s fun, and it needs to be organized from the start. Predictable results can become the rule.

The window concept provides a different and more specific way of adjusting stimulant medications that makes the whole process more “enlightening”.

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