Monthly Archives: July 2016

Shouldn’t an Adult Take as Low a Dose of a Stimulant as Possible?

Shouldn’t an Adult Take as Low a Dose of a Stimulant as Possible?

The short answer is no and this is why.  anshul1

Someone with AD/HD doesn’t make enough dopamine and what they do make their brain chews up quicker than “normal” brains.  Dopamine is a neurotransmitter and its function is to make someone interested in things.  That’s why AD/HD could also be known as interest-deficit disorder.  If someone is interested in something they can pay attention and they may have a hard time stopping what they’re doing.  A perfect example of this is video games that are actually designed to release dopamine.  But on the other side of the interest coin, if someone isn’t interested in the underwear in the floor, they’re going to walk past it a hundred times until maybe company is coming over.  Now the person is going to be embarrassed if company sees their underwear so now they’re interested and they pick up the underwear.

We treat AD/HD with stimulants because they increase dopamine in the brain.  I like to think of stimulants as dopamine replacement therapy.  The goal is to get someone’s dopamine level as normal as possible for as long as possible during the day.  It would be great if we could get that level as normal as possible all the time but we have the constraints of side effects of medication – people often have trouble sleeping if their stimulant is still working when it’s time to go to sleep.

When a person’s stimulant dose is optimized that means their dopamine level is much closer to normal.  This is an over-simplified explanation but let’s say a person’s dopamine level is at 20%.  If they take a very low dose of a stimulant it might increase their dopamine level to 25% but the person doesn’t even notice that small of an increase.  So maybe they take a little higher dose and get their dopamine level up to 50% so they notice a little bit of a difference.  Maybe their head feels a little clearer but they still have trouble finishing mundane chores and they still can’t remember what they read in a book.

If the person stops at that dose and says I felt something here and I want to take as low a dose of a stimulant as possible, they still have to deal with having a low dopamine level and they still have significant impairments.  What’t the point of taking a medication if all they get from it is maybe half of their brain fog cleared?  They still have brain fog and they still feel overwhelmed.

In my opinion this is why a lot of kids and adults stop taking stimulant medication for their AD/HD and then say stimulants don’t work for them.  Most of the people I see as new patients who are taking a stimulant now or have taken one in the past have been underdosed.

When someone’s stimulant dose is optimized they really shouldn’t feel like they’re taking a medicine.  They just feel like themselves, only now they are accomplishing the things they always knew they were capable of accomplishing.


Parents, Screens and Kids With ADHD



Schools are finding computers and I-pads to be valuable tools.  So these tools are in your child’s hands and in your home. Choosing what to watch is just as important as how long your child spends watching or playing. Monitoring content is overwhelming -too many choices for kids and too little parent time or energy.  COMMON SENSE MEDIA ( is a great resource for parents. Try to use devices in a way that not only educates your child, but also brings you together as a family.  Like by playing Heads Up or Scrabble together.


Screens keep kids up not only because they delay bedtime (just waiting until the show is over, waiting to finish this level in the game, finishing a text conversation) but also because the BLUE LIGHT emitted from screens actually wakes the brain up and makes it harder to fall asleep.

Try to get TVs and other screens out of bedrooms. Try to get screens shut off an hour before bedtime, and if you can’t get a teen to charge his device outside of his room, at least put it in Do Not Disturb mode.  Those alerts can go on all night long!


“GOOD” stuff such as reading books, playing games as a family, being outside in nature, exercise, and building or making things are all needed in ADHD and needed to keep kids and parents healthy and happy!


It can be easy to allow screens to get in between face-to-face communication.  Your screen doesn’t usually talk back-right? But you want your child to learn how to engage with others and they learn this from you and from your example. Show your ADHD child how conversation works.  This usually goes something like this: I talk, you listen THEN you talk, I listen.

Listening and Talking with each other are still essential skills especially in ADHD!!!


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