View Full Version : Treatment expectations for ADD-PI

05-27-16, 12:30 PM
I am new here, so bear with me. My 17 year old son has just started Concerta and has only been on it a couple of days, so I realize it is very early in his treatment.

He stays awake late at night, probably going to bed between 1 and 2 am and has a very difficult time waking in the morning. He says this doesn't change regardless of how many hours of sleep he has. I am exhausted with battling him in regards to him getting more hours of sleep. Are these normal sleep issues for ADD? Will getting him on the correct medication/dosage of medication help with these issues eventually? Can someone enlighten me?

05-27-16, 06:40 PM
What led you to decide to do battle in the first place?

Some battles have more to do with soothing a parent's feelings than with accomplishing valuable things. This might or might not be one of those.

Also, more generally, choosing your battles carefully is essential; otherwise, you'll burn yourself out as well as creating a hostile atmosphere.

05-27-16, 07:11 PM
I have those issues with sleeping too. Night is the only time when I can gather my thoughts. I don't get enough sleep, I know it's not healthy, I know this will make some of my problems worse an shorten my life. But going to bed at 22 would deprive me of some of my life quality and it wouldn't be worth it just for possibly living to 65 years of age instead of normal 55.

Inattention can be treated but many of us don't get relief for more than a small bit of the total amount of problem. Statistically Concerta may not be the optimal choice. Amphetamines are generally regarded better with inattention. For me, Concerta made some things better but most things became a lot worse. But it's individual.

05-27-16, 11:22 PM
Looking at this question from a different direction:

It does sometimes happen that sleep patterns improve with the right medication. However, it's not something that the parent of a 17-year-old ought to be particularly concerned about, because it's really not an issue unless that particular 17-year-old brings it forward himself. There are hundreds of other things that are more important.

05-28-16, 03:44 AM
To some degree, it's completely normal for teenagers to go to bed late, regardless of whether they have ADHD, due to an age-related shift in biological clock ( ep-in-adolescents). Normally, it'd be a good idea for him to adjust his daily schedule accordingly, but I'm guessing he's attending some kind of school with stupidly early start times and it's not an option.

ADHD can definitely make it worse. It's possible for treatment to make it better, either by treating the ADHD symptoms or because the withdrawal effects can cause sleepiness at the right time of day. It's also possible for treatment to make it worse because the medications (some more so than others) naturally promote wakefulness.

Here are some ways ADHD symptoms can interfere with sleep: (Some of these aren't official symptoms but are other problems I've noticed a lot of us having.)

All sorts of thoughts are happening in our heads, whether we like it or not. It's like trying to sleep with a TV on. (I've heard some people describe ADHD as being in the presence of numerous TVs, all on different channels, with the volume really loud--imagine trying to sleep through that! :()

Trouble with transitions, resistance to a change in activity, perseverating (sometimes called hyperfocusing) on a particular thing--people with this problem will have emotional or cognitive difficulties with moving from "not-bed" to "bed."

Trouble with the "initiation of actions" aspect of executive function. The best way I can describe this is that it's some weird urge to not do things. It can apply to a lot of different activities, but I'd say it's most noticeable for a little things that are slightly tedious but should be easy, like brushing your teeth. I think this is why so many people with ADHD are procrastinators.

If he is trying to go to bed, poor working memory or poor attention control can cause him to become distracted or confused during the process of getting ready for bed.

Having your attention absorbed in something (also sometimes called hyperfocusing) so you don't even notice it's bedtime.

Sensory issues can make it so lying in bed is uncomfortable. (For me, it just feels wrong if I try to sleep without a heavy blanket. But sometimes that's too hot, so I have to make the room cooler to compensate. But sometimes that causes an annoying windy sensation on my skin, or makes it too cold, or makes my hair move, or causes too much noise, or causes discomfort to others living with me. And that's just the problems from that one blanket thing, not all the other bed-related discomforts. :mad:)

ADHD-related restlessness can make it hard to physically hold still long enough to sleep. (And I noticed the withdrawal of my ADHD medication makes this worse for me.)

ADHD symptoms in his daily life could cause him to be stressed out in general, and stress can make it hard to sleep.

Tragically, most of these problems get worse when we're tired!

(Also: counterwill. That's not an ADHD thing, it's an everyone thing. It's the instinctive resistance to any sense of coercion, i.e. if someone tries to make you do something, you will feel an urge to not do it.)

05-28-16, 05:29 AM
Let his body come to terms with the Concerta. When he's difficult to wake up it's because he's coming out of deep sleep. Your patience will be appreciated.

These drugs are very subtle but also powerful.

06-24-16, 12:24 PM
I am wondering about Concerta being the proper choice as well. Hmmmm