We asked ADDitude’s innovative readers what tricks they have up their sleeve to avoid the powerful pull of the couch and embrace exercise. Here’s what they said:

“I purchased a treadmill and put it in front of the TV. If I want to watch TV, I have to walk on the treadmill for at least 15 minutes.”

“I signed up for a workout class with a friend.”

“Finding someone local to go on a walk with can be a game changer, especially if you explain that you need support getting out of the house). Having the other person to help me “task initiate” is brilliant.”

[Read:Take It Outside! How to Treat ADHD with Exercise]

“When I put a load of laundry in, I do a yoga or walking video until the washing machine buzzer goes off. I get in exercise and feel productive.”

“I just got a VR (virtual reality) headset and am super into one of the fitness games in it. I don’t even realize I’m working out.”

“I tricked myself into liking the gym by getting a “black card” which gets me access to a hydro massage chair! I work out, I get a massage.” 

“My creative solution: accountability and competition. I don’t want to exercise, but I do want to keep my promise to play tennis with my friend (and I also want to destroy him).”

[Watch: “How to Leverage Sports Psychology to Benefit ADHD Brains”]

“Committing to just the warm-up portion of a video exercise helps. I usually feel like doing the rest once I’ve warmed up.”

“I have finally, after years of wanting to, got into doing yoga regularly —every single weekday morning. I’ve identified the barriers, and tried to address them. Number one is:  I have to work out straight away, as if I do anything else, my meds kick in and I’ll get focused on it too much.”

“Sign up for an intramural sports team. That way, you have people counting on you to show up to practice and for games.”

Workout Motivation with ADHD: Next Steps

• Read: 6 ADD-Friendly Tips for Starting and Maintaining an Exercise Program
• Download: Free Guide to Health & Fitness — Lifestyle Changes for Adults with ADHD
• Read: Exercise and the ADHD Brain -— The Neuroscience of Movement

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

The Clinicians’ Guide to Treating Complex ADHD is a clinical compendium from Medscape, MDEdge, and ADDitude designed to guide health care providers through the difficult, important decisions they face when treating pediatric and adult patients for ADHD and its comorbid conditions. This guided email course will cover the following topics:

• DECISION 1: What should I consider when developing a comprehensive treatment plan for ADHD?
• DECISION 2: What medications and other approaches should I turn to as first-line treatments for ADHD?
• DECISION 3: How can I decide which ADHD medication to prescribe first?
• DECISION 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
• DECISION 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
• DECISION 6: What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
• DECISION 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

NOTE: This resource is for personal use only.

FOLLOW-UP: How should a clinician follow up with a patient being treated for ADHD?

A: Like diabetes or hypertension, ADHD is not an illness for which one can hand the patient a prescription for pills and assume recovery is automatic… | Keep reading on Medscape »

COLLABORATIVE CARE: How can collaborative care models improve care for patients with ADHD?

A: This model – wherein primary care providers, case managers, and psychiatrists work as a team to care for and monitor patients – effectively resolves many common barriers to quality… | Keep reading on ADDitude »

DIVERSION: How can clinicians educate patients about the danger of drug diversion?

A: Doctors can provide printed or video material explaining the legal and health risks associated with sharing or selling stimulants… | Keep reading on ADDitude »

TREATMENT RELUCTANCE: Why might a child resist ADHD treatment, and how can clinicians address medication aversion?

A: When someone refuses to even consider change, your best strategy is to show him empathy and normalize the situation. Instead of driving him into an even more defensive posture… | Keep reading on ADDitude »

POSITIVE PSYCHIATRY: How does positive psychiatry benefit ADHD patients in the long run?

A: Incorporating positive psychiatry is best viewed as the creation of a supplementary toolbox that allows clinicians an expanded set of focus areas to help patients achieve a more robust and sustained response to treatment… | Keep reading on MDedge »

RELATED RESOURCES

How to Get, Afford, and Refill Your Prescriptions With Minimum Hassle

Expert Webinar with Laurie Dupar, PMHNP, RN, PCC | Listen now on ADDitude »

CBT and DBT for ADHD: How Talk Therapies Reduce Symptoms and Boost Confidence

Expert Webinar with John Mitchell, Ph.D. | Listen now on ADDitude »

7-Week Guide to Treating ADHD, from Medscape x MDedge x ADDitude:

DECISION 1: What should I consider to develop a comprehensive ADHD treatment plan?
DECISION 2: What medications and other approaches should I turn to as first-line treatments for ADHD?
DECISION 3: How can I decide which ADHD medication to prescribe first?
DECISION 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
DECISION 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
DECISION 6: What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
> DECISION 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

BEYOND MEDICATION: Which nonpharmacologic treatments are proven to benefit pediatric patients with ADHD?

A: Effective behavioral treatments for ADHD do not change ADHD symptoms, but they do help children learn how to manage them… | Keep reading on MDedge »

LIFESTYLE INTERVENTIONS: How can patients optimize nutrition, sleep, exercise, and other lifestyle factors to improve ADHD symptoms?

A: Regardless of whether a child’s treatment includes medication, maximizing exercise, sleep, and nutrition can effectively transform them into natural remedies for ADHD, and arguably establish the foundation… | Keep reading on ADDitude »

EXERCISE: How much and what type of physical activity will benefit a patient with ADHD, according to research?

A: With regular physical activity, we can raise the baseline levels of dopamine and norepinephrine by spurring the growth of new receptors in certain brain areas… | Keep reading on ADDitude »

SUPPLEMENTS: What supplements and/or vitamins can aid with ADHD symptom control?

A: Usually given in the form of fish oil, omega-3s are probably the best-researched supplement for ADHD. Numerous studies… | Keep reading on ADDitude »

PARENT TRAINING: How can Collaborative & Proactive Solutions parent training benefit an ADHD treatment plan, according to research?

A: CPS has been shown in randomized trials with both parent groups and in home counseling to be as effective as Parent Training in reducing oppositional behavior and reducing… | Keep reading on MDedge »

NEUROFEEDBACK: Is neurofeedback an effective ADHD treatment, according to research?

A: A body of research suggests that neurofeedback is a promising therapy for ADHD, but it should be considered a complement to medication and/or behavior therapy rather than… | Keep reading on ADDitude »

ENVIRONMENTAL CHANGES: Which accommodations and environmental changes have the greatest positive effect on children with ADHD?

A: Encourage parents and teachers to use clear and concise instructions with supplementary visual tools. When providing instructions in classrooms, teachers should look directly at the student… | Keep reading on MDedge »

RELATED RESOURCES

The Exercise Rx for ADHD: How Movement Improves Attention, Working Memory, and Executive Functions

Expert Webinar with John Ratey, M.D. | Listen now on ADDitude »

The Whole-Person Treatment Approach to ADHD

Expert Webinar with Lidia Zylowska, M.D. | Listen now on ADDitude »

How CBT and ADHD Coaching Help Adults Manage Their Symptoms Naturally

Expert Webinar with J. Russell Ramsay, Ph.D., and David Giwerc | Listen now on ADDitude »

New Supplement Strategies: Using Trace Minerals and Plant Extracts to Treat ADHD in Children and Adults

Expert Webinar with James M. Greenblatt, M.D. | Listen now on ADDitude »

7-Week Guide to Treating ADHD, from Medscape x MDedge x ADDitude:

DECISION 1: What should I consider to develop a comprehensive ADHD treatment plan?
DECISION 2: What medications and other approaches should I turn to as first-line treatments for ADHD?
DECISION 3: How can I decide which ADHD medication to prescribe first?
DECISION 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
DECISION 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
>DECISION 6:What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
DECISION 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

COMPLEX TREATMENT: How should clinicians approach treatment for patients with ADHD and comorbid conditions?

A: As clinicians, we must expect that adults with ADHD will come to us with complex presentations… | Keep reading on ADDitude »

PEDIATRIC COMORBIDITIES: How should clinicians adjust pharmacological treatment for children with ADHD and comorbidities?

A: Though stimulant medication, paired with behavioral therapy, is the first-line treatment for ADHD in children, contraindications and side effects may limit their use. For example, depression and anxiety can worsen… | Keep reading on ADDitude »

ADHD + DEPRESSION: What is the recommended approach for treating ADHD with depression?

A: Options for patients include an array of psychological and psychopharmacological treatments, along with newer, cutting-edge approaches… | Keep reading on ADDitude »

ADHD + EATING DISORDERS: How should clinicians adjust treatment approaches for patients with ADHD and comorbid eating disorders?

A: Treat both ADHD and the eating disorder together and don’t discount the relevance of ADHD symptoms in driving the eating disorder. ADHD has to be treated in order to unlock effective ED treatment… | Keep reading on ADDitude »

ADHD + EFD: How is executive dysfunction related to ADHD, and how should it be treated?

A: The FDA does not allow prescriptions for stimulants to be phoned into a pharmacy or refills to be added to prescriptions — and this adds to the burden of treating patients who take them… | Keep reading on Medscape »

RELATED RESOURCES

Substance Use Disorder and ADHD: Safe, Effective Treatment Options

Expert Webinar with Timothy Wilens, M.D. | Listen now on ADDitude »

Current Guidelines for Treatment and Behavioral Interventions for Tourette Syndrome and Tic Disorders

Expert Webinar with John Piacentini, Ph.D., ABPP | Listen now on ADDitude »

7-Week Guide to Treating ADHD, from Medscape x MDedge x ADDitude:

DECISION 1: What should I consider to develop a comprehensive ADHD treatment plan?
DECISION 2: What medications and other approaches should I turn to as first-line treatments for ADHD?
DECISION 3: How can I decide which ADHD medication to prescribe first?
DECISION 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
> DECISION 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
DECISION 6: What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
DECISION 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

STIMULANT + NON-STIMULANT: How can combination therapy improve symptoms with fewer side effects?

A: The term refers to using a stimulant and a non-stimulant to reduce ADHD symptoms. There were no lectures in medical school on this therapy and no studies of it when… | Keep reading on ADDitude »

SLEEP: Stimulant use is associated with an elevated risk for sleep problems. How can clinicians address this side effect?

A: Clinicians should titrate while evaluating a patient’s environmental and familial conditions, screen for primary sleep disorders, and… | Keep reading on ADDitude »

MED CHANGES: When should a patient switch to a different medication and/or dosage?

A: If a stimulant is causing excessive irritability, restlessness, or seriousness throughout the day, a dose reduction… | Keep reading on MDedge »

ADHERENCE IN CHILDREN: How can clinicians improve medication adherence in children with ADHD?

A: ADHD medication initiation and adherence are increased when patients have a strong working alliance with their clinician and trust the health care system… | Keep reading on ADDitude »

ADHERENCE IN ADULTS: How can clinicians improve medication adherence in adults and adolescents with ADHD?

A: As clinicians, we must acknowledge how difficult it is take medications every day. And we must be proactive in asking our patients, “How many times did you skip a dose, and what impact did that have… | Keep reading on ADDitude »

RELATED RESOURCES

How to Optimize ADHD Medication: Strategies for Achieving Better Symptom Management

Expert Webinar with William Dodson, M.D., LF-APA | Listen now on ADDitude »

Why Adults with ADHD Abandon Medication — and How to Improve Treatment Outcomes

Expert Webinar with William Dodson, M.D., LF-APA | Listen now on ADDitude »

How to Optimize Stimulant Treatment for Children and Adults: Better Symptom Management Without Side Effects

Expert Webinar with Thomas E. Brown, Ph.D. | Listen now on ADDitude »

7-Week Guide to Treating ADHD, from Medscape x MDedge x ADDitude:

DECISION 1: What should I consider to develop a comprehensive ADHD treatment plan?
DECISION 2: What medications and other approaches should I turn to as first-line treatments for ADHD?
DECISION 3: How can I decide which ADHD medication to prescribe first?
> DECISION 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
DECISION 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
DECISION 6: What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
DECISION 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

MEDICATION CHART: What are the similarities and differences between the most commonly prescribed ADHD medications?

A: This chart presents the most popular and most commonly prescribed medications used to treat ADHD in children and adults… | Keep reading on ADDitude »

METHYLPHENIDATE: How effective is methylphenidate in the treatment of ADHD?

Dosing and uses, interactions, adverse effects, warnings, administration, images, and more. | See medication information on Medscape »

AMPHETAMINE: How effective is amphetamine/dextroamphetamine in the treatment of ADHD?

Dosing and uses, interactions, adverse effects, warnings, administration, images, and more. | See medication information on Medscape »

DEXMETHYLPHENIDATE: How effective is dexmethylphenidate in the treatment of ADHD?

Dosing and uses, interactions, adverse effects, warnings, administration, images, and more. | See medication information on Medscape »

LISDEXAMFETAMINE: How effective is lisdexamfetamine in the treatment of ADHD?

Dosing and uses, interactions, adverse effects, warnings, administration, images, and more. | See medication information on Medscape »

ATOMOXETINE: How effective is atomoxetine in the treatment of ADHD?

Dosing and uses, interactions, adverse effects, warnings, administration, images, and more. | See medication information on Medscape »

RELATED RESOURCES

Pills and Beyond: A Guide to the Formulations and Delivery Options of ADHD Medication

Expert Webinar with Laurie Dupar, PMHNP, RN, PCC | Listen now on ADDitude »

Medication Management: How to Use and Adjust Stimulants Safely

Expert Webinar with William Dodson, M.D., LF-APA | Listen now on ADDitude »

7-Week Guide to Treating ADHD, from Medscape x MDedge x ADDitude:

DECISION 1: What should I consider to develop a comprehensive ADHD treatment plan?
DECISION 2: What medications and other approaches should I turn to as first-line treatments for ADHD?
> DECISION 3: How can I decide which ADHD medication to prescribe first?
DECISION 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
DECISION 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
DECISION 6: What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
DECISION 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

MEDICATION: What classes of medication have been shown to treat ADHD effectively?

A: Methylphenidate is the drug of choice approved by FDA for ADHD in children aged 6 years or older. It is the most commonly used drug… | Keep reading on Medscape »

BEST PRACTICES: How can a clinician determine a patient’s optimal dosage of the stimulant medications used to treat ADHD?

A: Many pediatricians are trained to give a certain number of milligrams per kilogram of a patient’s body mass, but there is no evidence that dose is affected by size, age, gender… | Keep reading on ADDitude »

THE MED DECISION: How should clinicians navigate parental concerns around treating children with ADHD medication?

A: While it’s important to educate parents on how medications work and why they might be used, it’s equally critical for clinicians to support… | Keep reading on ADDitude »

HEART HEALTH: Do cardiovascular risks exist for older adults taking ADHD medication?

A: A new meta-analysis concluded that “ADHD medication use was not statistically significantly associated with the risk of any CVD… | Keep reading on ADDitude »

ADHD & SUD: Does ADHD medication increase risk for future substance use problems?

A: No. What’s more, treatment with ADHD stimulant medication prior to age 9 may actually decrease a child’s likelihood of abusing drugs and alcohol later in life, according to research… | Keep reading on ADDitude »

RELATED RESOURCES

ADHD Medication Options and Benefits for Children

Expert Webinar with Walt Karniski, M.D. | Listen now on ADDitude »

Medicating Your Child with ADHD: How to Manage the Feelings of Guilt and Judgment, and Make Peace with Your Decision

Expert Webinar with Roberto Olivardia, Ph.D. | Listen now on ADDitude»

7-Week Guide to Treating ADHD, from Medscape x MDedge x ADDitude:

DECISION 1: What should I consider to develop a comprehensive ADHD treatment plan?
> DECISION 2: What medications and other approaches should I turn to as first-line treatments for ADHD?
DECISION 3: How can I decide which ADHD medication to prescribe first?
DECISION 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
DECISION 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
DECISION 6: What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
DECISION 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

ADHD TREATMENT: What are the recommended first-line treatments?

A: The therapeutic approach to ADHD has been shifting. In some cases, environmental restructuring and behavioral therapy alone has been effective. The medications of choice are stimulants, and… | Keep reading on Medscape »

PEDIATRIC GUIDELINES: What are the AAP guidelines for treating ADHD in children?

A: In 2019, the American Academy of Pediatrics (AAP) released updated guidelines on attention deficit-hyperactivity disorder (ADHD) that… | Keep reading on Medscape »

ADULT GUIDELINES: Do U.S. practice guidelines for adult ADHD exist?

A: APSARD is currently establishing guidelines for ADHD in adults — the first of its kind in the country — set for release in 2023… | Keep reading on ADDitude »

MEDICATION: What are ADHD’s first-line pharmacological treatments?

A: Although stimulants for adult ADHD are associated with the highest treatment response rates, other medications are options… | Keep reading on MDedge »

NON-PHARMACOLOGICAL: What research-validated complementary therapies exist for the treatment of ADHD?

A: Families can positively impact ADHD symptoms by modifying their environments in three simple ways: through sleep, exercise, and food changes. Here’s how… | Keep reading on ADDitude »

RELATED RESOURCES

Integrated Care for Children with ADHD: How to Form a Cross-Functional Care Team

Expert Webinar with Leslie F. Graham, MSW, Douglas Russell, M.D., and Sheryl Morelli, M.D. | Listen now on ADDitude »

Lifestyle Changes with the Biggest Impact on Kids with ADHD

Expert Webinar with Sandy Newmark, M.D. | Listen now on ADDitude »

7-Week Guide to Treating ADHD, from Medscape x MDedge x ADDitude:

> DECISION 1: What should I consider to develop a comprehensive ADHD treatment plan?
DECISION 2: What medications and other approaches should I turn to as first-line treatments for ADHD?
DECISION 3: How can I decide which ADHD medication to prescribe first?
DECISION 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
DECISION 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
DECISION 6: What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
DECISION 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

May 1, 2023

A new stimulant medication, Xelstrym (dextroamphetamine), will soon be available for the treatment of attention deficit hyperactivity disorder (ADHD) in children ages 6-17 and adults 18 and older. Xelstrym is the only transdermal amphetamine patch to be approved by the Food and Drug Administration (FDA). It was presented at the annual conference of the American Professional Society of ADHD and Related Disorders (APSARD) by drug manufacturer Noven Pharmaceuticals, Inc., in January.

Xelstrym is a once-daily patch that should be administered two hours before an effect is needed and removed after nine hours. It has a printed backing on one side and a release liner on the other. Medication is absorbed through the skin via application to the hip, upper arm, chest, upper back, or flank areas.

According to a Noven press release distributed on January 10, Xelstrym would be available by the end of March. It is now expected to launch later this year.

Xelstrym is available in the following strengths: 4.5mg, 9mg, 13.5mg, and 18mg. Patients with a known sensitivity to amphetamine products should avoid taking Xelstrym. ^{1, 2}

The FDA approved Xelstrym in March 2022, one year after approving the stimulant Azstarys for the treatment of ADHD in people ages 6 and older.

Dextroamphetamine is approved for the treatment of narcolepsy and ADHD. U.S. brand names for dextroamphetamine, besides Xelstrym, include:

• Dexedrine
• Dexedrine Spansules
• Procentra
• Zenzedi
• Dextrostat
• Liquadd

Adderall Shortage: Could Xelstrym Help Patients?

Xelstrym may help lessen the impact of the lingering Adderall shortage — which began last November and has affected the supplies of other well-known stimulants — however it is also a Schedule II medication subject to regulations by the U.S. Drug Enforcement Administration (DEA). After a $21 billion nationwide opioid settlement, new limits were imposed on controlled drug supplies by the DEA. ADHD stimulant medications are classified as federally controlled substances (CII).

In a recent ADDitude reader panel, patients described the hardships they’ve faced since the shortage began. Ann from Illinois, like many women with ADHD, went undiagnosed for much of her life. She was diagnosed in October 2021 but has struggled to fill her prescription since then.

“All my life, I beat myself up mentally because I thought I was lazy and worthless, but knowing I had ADHD and needed support from medication made me see myself in a new light,” she said.

“It was heartbreaking for me when the Adderall shortage hit my local area. It felt like this new healing journey was cut abruptly when I could no longer find my medication in stock anywhere. I became depressed as I fell back into old habits where I laid around screaming at myself in my mind to get up and do something, anything! Thankfully, my pharmacist worked with me to get on Vyvanse.”

One ADDitude reader said they called seven pharmacies in one day to get their Adderall prescription filled, but instead “went two weeks without medication because there was nothing I could do.”

Tiff, who lives in Kentucky, hasn’t gotten “any dose or type of ADHD medication since late August 2022.”

“Currently, I take Bupropion twice a day. It is not helping with my ADHD at all. We couldn’t get Vyvanse paid for, so that was a no-go. This is affecting every aspect of my life, including work.”

One mom from California relayed the hardship her family experiences due to 30-day refill maximums for her child’s Class II stimulant medication.

“It is a real hardship for my child in college,” she said. “We have to work together as a family to get him his medication during this critical time of his education. And there is little empathy from our health providers. They just expect us to ‘buck up and deal with it.’”

More on Xelstrym

To learn more about Xelstrym, including usage and side effects, visit www.noven.com/xelstrym/. To receive future updates on its release, visit www.xelstrym.com.

Sources

¹Noven Pharmaceuticals, Inc. (n.d.) Xelstrym. https://www.noven.com/xelstrym/

²Daily Med. (2023, March 28). Label: Xelstrym. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0862f02a-72a8-41cc-8845-57cf4974bb6f&audience=consumer

I have another therapist whom I see on my phone, too. But unlike Stephanie, this therapist starts a session by asking if I would like to “get help with a problem,” “work on my goal” (which has been decided for me), or “track and journal.” Also unlike Stephanie, this therapist is available 24/7 — but doesn’t remember my big parties, my book launches, my successes, or my failures.

This therapist is named Woebot, and it’s a therapeutic chatbot powered by artificial intelligence (AI).

A free app available for both Apple and Android devices, Woebot serves “tens of thousands” of users daily, said its founder and president, psychologist Allison Darcy, in The New York Times in 2021. Based on principles of cognitive behavioral therapy (CBT) and “natural language processing,” Woebot engages users in text-based conversations, and is designed to help people cope with stress, anxiety, and depression in a growing field of mental health tools.

Woebot tells me during our chats that it can also help with my anger, procrastination, and guilt — common issues for people living with attention deficit hyperactivity disorder (ADHD). It sounds useful: America is plagued by a therapist shortage and long wait times for care. The high cost of therapy can also be a barrier. If you can’t find a therapist and you need one fast, a free chatbot built on sound CBT-based science sounds tempting.

My advice: Resist.

[Read: The Top 6 Mental Health Apps, According to ADDitude Readers]

WoeBot Woes

Woebot assumes neurotypicality. It expects that all brains can be retrained to cope with negative emotions using the same therapeutic model. But ADHD brains process information and emotions differently.

For example, Woebot doesn’t understand that people with ADHD have big, all-consuming emotions. When I told it I was mad, Woebot told me to “imagine my emotions had a voice.” Wait, what? I was in total rage mode when it asked me to write down three of my angry thoughts. So I did, albeit poorly. It then asked me to identify my “cognitive distortions” — i.e., thought patterns that aren’t based on facts.

But when I’m mad, I am too flooded with hot emotion to stop and look for cognitive distortions. Something is wrong; I need to calm down, but the opposite is now happening.

Woebot also claimed it could help with procrastination. But it offered such a complicated mathematical equation about the merits of doing something now or later that I couldn’t (and still can’t) understand. Maybe it could assist in a pinch — if I remembered it existed. But Woebot did not intervene when I began tumbling through TikTok rather than washing dishes.

[Read: The Emotional Resilience Playbook for People with Big Emotions]

Woebot was no match for my negative self-talk, either. When I told it I felt sad because I don’t have any friends — social issues are a common problem in women with ADHD — it launched an ineffective CBT round-and-round that had me fill in blanks and flag “unhelpful” thoughts. Eventually, I avoided my negative thoughts by watching TV instead. (Avoidance is not an acceptable tactic for coping with negative thoughts, of which I had several regarding Woebot.)

We Need More Than AI Chatbot Therapy

At least Woebot comes with safeguards: Certain words trigger suggestions for immediate clinical intervention. During one conversation, Woebot told me, “I can’t comment on the content of your thoughts, just the process. If you’re looking for guidance around content, this might best be done with a human.” I still don’t know what triggered that response, so how would someone in serious trouble understand it, and how could it help those people using Woebot in place of that therapist with availability in October?

No matter how poor my efforts or how ineffective our sessions, Woebot always told me that making an effort was the important part. Unfortunately, mental illness doesn’t get bonus points for effort. We need effective help to improve our lives. And that means a human therapist, not a bot.

AI Chatbot Therapy and ADHD: Next Steps

• Find: Psychologists and Therapists Who Understand ADHD
• Free Download: Emotional Regulation & Anger Management Scripts
• Read: “How Therapy Helped Me”
• Read: How Cognitive Restructuring Reframes Failure and Erases ADHD Self-Doubt

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

April 24, 2023

One in four middle and high school students has reported abusing prescription stimulant medications used to treat ADHD, according to a cross-sectional study recently published in the journal JAMA Network Open. ¹ Non-medical use of prescription stimulants among teens remains more prevalent than misuse of other prescription drugs, including opioids and benzodiazepines, the research found.

According to researchers at the University of Michigan, students who used marijuana in the past 30 days were four times more likely to abuse ADHD medications than teens who did not use cannabis. In addition, stimulant drug abuse was 36% more likely to occur in schools with a large population of students with stimulant medication prescriptions to treat ADHD than it was in schools with fewer students using prescription stimulants like Adderall or Ritalin. (Studies have shown that one in every nine high school seniors reported taking prescribed stimulants for ADHD.) (², ³)

According to the research, other factors associated with increased rates of stimulant drug abuse included:

• Schools located in suburban, non-Northeastern regions of the U.S.
• Schools with a high proportion of parents with a college degree
• Schools with a higher proportion of white students
• Schools with a medium amount of binge drinking among students (10%-19% of the total student body)

Prolonged stimulant abuse, researchers said, can lead to several detrimental health effects, including cardiovascular conditions, depression, anxiety, seizures, overdoses, psychosis, and stimulant use disorder.

“The key takeaway here is not that we need to lessen prescribing stimulants for students who need them, but that we need better ways to store, monitor, and screen for stimulant access and use among youth to prevent misuse,” said study author Sean Esteban McCabe, Ph.D.

For the study, the University of Michigan research team analyzed data collected between 2005 and 2020 by Monitoring the Future, a National Institute of Drug Abuse (NIDA) multi-cohort survey that measures drug and alcohol use among adolescents nationwide. More than 230,000 teens in grades 8, 10, and 12 from 3,284 secondary schools participated in the survey.

Dangers of Stimulant Misuse

Counterfeit Medication

Demand for prescribed stimulants to treat ADHD symptoms increased substantially from 2020 to 2021, a recent U.S. Centers for Disease Control and Prevention (CDC) report found. According to the CDC report, prescription stimulant fills were highest among males and females aged 5–19 and 15–24 years, respectively. ⁴

Previous studies have reported that more than half of adolescents who misuse prescription stimulants get the medication for free from friends or relatives. ⁵ However, illicit medications are increasingly obtained via online drug markets and social media referrals, making it harder to differentiate real and counterfeit medications. ⁶

“The drug supply has rapidly changed,” said National Institute on Drug Abuse Director Nora Volkow in a press release about the study. “What looks like medications — bought online or shared among friends or family members — can contain fentanyl or other potent illicit substances that can result in overdoses. It’s important to raise awareness of these new risks for teens.”

Students who use counterfeit medications often believe they are obtaining the actual medication as dispensed by a pharmacist, explained Kevin Antshel, Ph.D., professor of psychology at Syracuse University. “However, students obtaining counterfeit medications may purchase a product that is laced with potentially lethal amounts of drugs, usually fentanyl or methamphetamine,” Antshel said. “Fentanyl is especially concerning. A lethal dose of fentanyl is roughly the size of a few grains of salt.”

In May 2022, two Ohio State students died from suspected use of counterfeit stimulant medication laced with a synthetic opioid.

Drug Diversion

The University of Michigan researchers recommended that caregivers educate teens about the consequences of drug diversion (selling or sharing prescribed medications). “Nearly a quarter of adolescents who are prescribed stimulant therapy will be approached to divert their stimulant medications by their peers before the completion of high school (and more than half [54%] during college),” they wrote. ⁷, ⁸

Theresa E. Laurie Maitland, Ph.D., coordinator of the Academic Success Program for Students with learning differences and ADHD at the University of North Carolina, Chapel Hill, learned first-hand how widespread medication diversion is on college campuses.

“I asked a graduating senior if he had any advice for me. He said, ‘There’s one topic I wish you’d talk about with all students taking ADHD medication: How to handle the demand they will face to give away or sell their pills!’

“I was shocked but hid my reaction and listened attentively,” she said. “The student had been open about stimulant use, and the news spread quickly among his peers and classmates. He was often approached to sell or hand over ‘just one pill.’”

The FDA classifies stimulants as Schedule II controlled substances. Most state laws follow federal laws, with criminal penalties for possession without a prescription.

“Even if no money is exchanged, sharing your medication is, technically, ‘dealing drugs,’ and anyone who expects you to do it isn’t a true friend,” said Susan Yellin, Esq., Director of Advocacy and Transition Services at The Yellin Center for Mind, Brain, and Education in New York.

How Parents Can Help Teens

“The diversion of stimulant medication has serious legal and health risks for undiagnosed students and major personal, legal, and financial consequences for teens diagnosed with ADHD,” Maitland said. “We must inform those with ADHD about this important issue.”

Maitland offered the following suggestions to caregivers and teens:

1. Talk to Family Physicians
“For middle and high school students, doctors can provide printed or video material explaining the legal and health risks associated with sharing or selling stimulants,” she said.

2. Value Your ADHD Diagnosis
It’s important that adolescents understand and accept their ADHD diagnosis, and that parents include them in healthcare decisions. “When students accept their diagnoses and value their medication, they have no desire to give or sell their pills to others,” Maitland said.

3. Use Discretion
Teens must store their ADHD medications in a lockbox or other secure device. They should also use discretion when sharing information about their stimulant use. “Many students have told me it is best not to discuss one’s stimulant use until they make friends (or maybe not at all),” Maitland said.

4. Foster Open Dialogue
Parents should talk with their children about the health and legal risks of misusing, sharing, or selling medication and potential scenarios they may encounter.

Teens can even role-play what to say if a family member, friend, or stranger asks them for pills. “Have teenagers rehearse several scripts to prepare them to say ‘no’ and to deal with pressure,” Maitland said.

Most importantly, Maitland continued, “Young people need to know they can turn to us in awkward situations and talk with us about something they regret having done.”

Sources

¹McCabe, S.E., Schulenberg, J.E., Wilens, T.E., Schepis, T.S., McCabe, V.V., and Veliz, P.T. (2023). Prescription Stimulant Medical and Nonmedical Use Among US Secondary School Students, 2005 to 2020. JAMA Netw Open. (4):e238707. doi:10.1001/jamanetworkopen.2023.8707

²Garfield, C.F., Dorsey, E.R., Zhu, S., et al. (2012) Trends in Attention Deficit Hyperactivity Disorder Ambulatory Diagnosis and Medical Treatment in the United States, 2000-2010. Acad Pediatr. 12(2):110-116. https://pubmed.ncbi.nlm.nih.gov/22326727/

³Xu, G., Strathearn, L., Liu, B., Yang, B., and Bao, W. (2018) Twenty-Year Trends in Diagnosed Attention-Deficit/Hyperactivity Disorder Among US Children and Adolescents, 1997-2016. JAMA Netw Open. 1(4):e181471. https://10.1001/jamanetworkopen.2018.1471

⁴Danielson, M.L., Bohm, M.K., Newsome, K., et al. (2023). Trends in Stimulant Prescription Fills Among Commercially Insured Children and Adults — United States, 2016–2021. MMWR Morb Mortal Wkly Rep 2023;72:327–332. https://doi.org/10.15585/mmwr.mm7213a1

⁵Compton, W.M., Han, B., Blanco, C., Johnson, K., Jones, C.M. (2018) Prevalence and Correlates of Prescription Stimulant Use, Misuse, Use Disorders, and Motivations for Misuse Among Adults in the United States. Am J Psychiatry. 175(8):741-755. https://doi.org/10.1176/appi.ajp.2018.17091048

⁶Moyle, L., Childs, A., Coomber, R., and Barratt, M.J. (2019). #Drugsforsale: An Exploration of the Use of Social Media and Encrypted Messaging Apps to Supply and Access Drugs. Int J Drug Policy. 63:101-110. https://doi.org/10.1016/j.drugpo.2018.08.005

⁷McCabe, S.E., Teter, C.J., and Boyd C.J. (2006). Medical Use, Illicit Use, and Diversion of Abusable Prescription Drugs. J Am Coll Health. 54(5):269-278. https://doi.org/10.3200/JACH.54.5.269-278

⁸McCabe, S.E., West, B.T., Teter, C.J., Ross-Durow, P., Young, A., and Boyd, C.J. (2011). Characteristics Associated with the Diversion of Controlled Medications Among Adolescents. Drug Alcohol Depend. 118(2-3):452-458. https://doi.org/10.1016/j.drugalcdep.2011.05.004

As The Washington Post recently reported, the Adderall shortage is causing disruptive and frustrating ripples in the academic and social lives of students with ADHD.

New limits on controlled drug supplies, paired with increased demand for that supply and lingering supply chain disruptions, have touched millions of patients prescribed ADHD stimulant medication. The medication shortage, now entering its eighth month, has had a jarring effect on families, especially the parents who are expected to manage their kids’ modified treatment plans and adapt to the pain points of tracking down and trying out new medication options.

Recently, ADDitude asked parents and teachers: Have you noticed the impact of the ongoing Adderall shortage on any of your students’ school and homework performance? Their classroom behavior?

Their answers point to a domino effect wherein the Adderall shortage has caused constrictions in other medications’ supplies. The cost of alternative, name-brand drugs can run significantly higher than Adderall, causing a financial burden that not every family can sustain.

Inadequate medication coverage is causing some children to experience behavioral problems in the classroom. Some students are not consequently showing up for school, or they’re being kept home, according to caregivers, roughly half of whom also have ADHD. Adults who relied on Adderall, including teachers, say they are struggling to attend to their own responsibilities — many of which directly impact their kids. That includes getting to school on time, reviewing homework, and sticking to a consistent routine.

[Download: Free Parenting Guide for Caregivers with ADHD]

The Adderall shortage may be temporary, but the repercussions could have a lasting emotional, social, and academic impact on developing kids. Hear what caregivers had to say about the Adderall shortage, below, and contribute your experience in the Comments section, above.

Adderall Shortage: Impact on Students with ADHD

“Some children who had used Adderall in the past have been changed to a different medication. The interruptions, resets, and resumption of new medications is noticeable in the classroom. Management tools and strategies are very helpful at these times.” — Jo Ann, Missouri

“The Adderall shortage is creating huge anxiety in my daughter, which leads to migraines. She does not function as well on other medications.” — Lisa, New York

“We couldn’t get the medications we needed, and had to get Vyvanse. It’s working, but the first fill was $400 with insurance. Not everyone can bear that, which may stop people from taking their medications at all. Neither of our two kids can do homework well without ADHD medications.” — An ADDitude reader

[Read: Could You Be Saving Money On Your ADHD Medication? Find Out Here]

“I am a teacher who has ADHD. For myself, luckily, I haven’t experienced a shortage for the slow-release Adderall, yet. For my students, absolutely. I noticed a huge increase in the number of students who fail to turn in assignments on time or fail to come to school.” — Noelle, New York

“We were briefly affected by the Concerta shortage prior to Adderall and, yes, it was difficult. My son relies on his daily medication to function. If I cannot give it to him, I will keep him home from school because I cannot send him into battle without the proper weapons to be successful. During those few months, I had to be proactive in contacting different pharmacies within short periods of time. I was also prepared to pay for the name brand out of pocket if we could not access the generic, as insurance would not cover the name brand.” — Amanda, North Carolina

“I have not noticed this, but the high cost of Vyvanse has definitely affected some of the lower-income high school students that I teach. Many lower-income families simply cannot afford it and are forced to use a drug that is less effective.” — Donna, Texas

“As a person, I need my Adderall to function. As a mom, I need my Adderall to support my kids. The shortage has left me unable to drive for field trips, get my kids to school on time, or even get out of bed at times.” — Lacey, California

“I am not always made aware if/when my students are on medications and/or when they stop, start, or change. However, I have observed changes in certain students’ behaviors (e.g. increased inattention, increased physical impulsivity).” — Theresa, Georgia

“As a teacher, it is a difficult (and blurry) line when it comes to medications and students. I have to assume a lot of students are medicated, but because their parents have not shared this with the school, I may not know for certain. And even if the information has been shared with the school, that doesn’t mean I am privy to that information as a classroom teacher. So, at this moment, I really don’t know if there are students who are being impacted by the Adderall shortage. What I know is that personally I am, and it makes my days very difficult.” — Brianna, Iowa

“My 14-year-old son started a generic Concerta this year for the first time. A few weeks ago, I couldn’t find a pharmacy to fill the generic. Eventually, I figured out that my insurer’s online pharmacy could fill a brand name Concerta prescription. In the meantime, about three weeks went by when my son struggled more with homework and tests. I am told the Concerta shortage is a result of Adderall patients seeking alternatives.” — An ADDitude reader

“Our oldest son with ADHD is already out of college and working. I know the shortage has affected his ability to feel like he’s performing well at his new job. He’s developed other strategies that he’s implementing (through years of CBT), but I have noticed that things seem to be more of a struggle than they were a year ago for him.” — Jenny, South Carolina

“I am a preschool teacher; my students are largely unmedicated. However, the shortage has affected my co-workers and some of the parents of my students in a noticeable manner. One parent-teacher conference devolved into hysterical laughter because everyone forgot all the important paperwork. I’m lucky I found a non-stimulant option for myself.” — Holly, Washington

“I am no longer a teacher, but I can say that for me, personally, I am having a hard time completing any tasks, and I am surprised I am even completing this task right now. I suppose it’s because I have other, what I might consider more important things to do, and answering this question is a distraction.” — Marisa, Georgia

“I was worried for my son, but his psychiatrist worked out other medication options with him.” — Cathy, California

Adderall Shortage: Next Steps

• Download: ADHD Medication Tracking Log
• Read: What Do You Mean You’re All Out?
• Read: A Patient’s Guide to Overcoming ADHD Medication Disruptions

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Online therapy sites and apps enjoyed a surge in popularity during COVID shutdowns, but they’ve remained appealing as a convenient, affordable, and flexible option. For people with ADHD, who may need check-ins more frequently than once a week, unlimited messaging has been a game-changer. Explained one ADDitude reader who used Better Help for their teen: “My child could send their provider a message whenever something was bothering them. They didn’t have to wait until the next scheduled appointment.”

Another essential tool in any mental health toolbox is meditation. Various studies have demonstrated the positive impact of meditation on everything from reducing stress and anxiety to promoting healthy sleep to improving symptoms of ADHD — and, thanks to a host of apps, the guided meditation have never been easier to access. A 2021 study published in Journal of Attention Disorders¹ revealed that meditation apps like Headspace significantly reduced anxiety and sleep problems in children with ADHD, no matter how much they meditated. The verdict is clear: meditation works, whether in app form, or otherwise.

But with hundreds of meditation and therapy apps promising life-changing results, how do you choose the one that meets your particular set of preferences and needs?

To ease the selection process, we asked ADDitude readers to share their favorite mental health apps, and to tell us what they loved about them. Here’s your top six.

[Read: Sleep Solutions in Your Back Pocket – Apps We Love]