Wednesday, November 14, 2012

Are Your ADHD Meds Working?

Last week I went to an excellent conference by the Holiner Psychiatric Group here in Dallas, where I learned a ton of cool new information about psychopharmacology (medication for psychiatric illness).  The wise doctors of the Holiner group talked about treatment resistant depression (fascinating!), medications during pregnancy (pregnancy is always a favorite topic for me), marijuana (quite timely, given my previous post), and medicating adult ADHD (um . . . . boring).

Let me be honest and say that usually when the topic of adult ADHD comes up, I get sleepy.  Truthfully, even the topic of childhood ADHD bores me to tears.  I try to pay attention, but when I start to realize that nothing really has changed in our understanding of ADHD, I get the overwhelming urge to catch up on Facebook. 

Part of my resistance to the subject of ADHD is due to frustration.  So many times, parents and teachers seem to immediately want a magical medication to fix a hyperactive or inattentive child's difficult behaviors.  Then, if the medicine doesn't immediately turn their little rascal into a zombie-like angel, they act as if all hope is lost.  I'm really more of a proponent of managing ADHD through behavioral modification paired with medication. So, if the medication doesn't turn out to be an immediate cure and multiple medication trials are necessary, parents and teachers can still manage ADHD symptoms through modification of environmental variables.  And, it's really rare to get the medication perfect in the first trial.  Parents really do need to be patient and communicate well with their child's doctor.  Unfortunately, I hear more complaints that "the medicine ain't workin'!" then efforts to try different strategies.

So, I wasn't very excited to hear more about ADHD medications.  But, as I was flipping through the Powerpoint handouts the wise psychiatrist shared, something caught my eye.

Does your child drink orange juice, eat a Poptart or down a bowl full of cereal before or after taking his/her meds?  Have you noticed your child's medications not working as well or have believed they have never really worked?  It could be that the most important meal of the day is actually preventing your child's medications from doing their job!  Citric acid, which is found in orange juice, gatorade, kool-aid, fortified cereals, some granola bars, and Poptarts can actually prevent the absorption of ADHD medications. If the medication is not absorbed into the blood stream, you will not get the expected effect of the drug.  It essentially just passes through the body and exits, unnoticed by the brain. 

Citric acid may be in more foods then you realize.  If your child's breakfast is "vitamin fortified" or has extra Vitamin C, choose something else (eggs, toast, waffles, etc.).  These Vitamin C rich foods should be avoided an hour before and after your child takes his/her ADHD meds.  This goes for most types of ADHD meds, older and newer varieties.

Remind your child's school nurse, counselor, teacher, and cafeteria workers.  Many of them, in my experience, are not aware of citric acid's mighty absorption-prevention power!  You may find that the medication you thought was another disappointing failure is actually the magic elixir you were looking for all along!  This really could prevent the need for more medication trials, and help a parent move on from a hyper-focus on getting the right med, to helping their child learn some behavioral strategies to compliment the medications effects.

Or, at least we can hope :)


  1. Very interesting! Lately I've been really fascinated by the possible gluten-hyperactivity link. It seems there isn't much research yet on it one way or the other (I want to dig a bit deeper), but there does seem to be some evidence of a higher-than-expected overlap between ADHD symptoms and gluten intolerance, and at least one study that found a gluten-free diet reduced symptoms (I think it was for kids who had the ADHD/gluten intolerance overlap). I've always been really skeptical of the idea that diet contributes to ADHD symptoms, but now I am starting to think the jury is still least, possibly for a subset of kids.

    1. Now, that sounds interesting, Ellie. I'm sure diet plays a more important role in our children's behavior than we know. A diet of Now and Laters and hot Cheetos surely isn't recommended :) Let me know if you learn any more about this!


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