Discussing medications with adolescents can be challenging. In general, my approach during the initial evaluation is to have a first evaluation appointment with the parents alone to gather relevant history, and then bring the teen back for a separate and individual appointment. Oftentimes, however, and particularly with older teens, I will see the family together for the first visit, all members in one room, and then meet separately with the adolescent. I base my approach on what I learn by phone from the parents when they call for an appointment. Because there is so much variation in family structure and the problems that kids and families face, I find it’s important to maintain some flexibility in how I evaluate adolescents.
One thing I don’t want to do is leave adolescents in the waiting room while I’m talking to their parents. If the parents need to be seen alone without the child present, then I will do that at a separate time. The important thing is understanding where adolescents are coming from, and what they’re challenged by. Often, they’re struggling with some aspect of how they view themselves, and how they’re going to be independent from their parents. And so, helping them to see the medication as part of how they can manage on their own can be very empowering.
How do you decide when young people can handle their own medications? In my experience, this varies by age and diagnosis. With ADHD, for example, it’s difficult because these kids have terrible organizational skills, so getting them to even find their medicine or remember to take it is a big challenge. Therefore, I suggest that you initially work with parents on the following strategies:
• Have parents help their child store the medicine in a consistent place, where it can always be found. As any parent knows, kids can be prone to misplacing things that are important. So, parents might try placing the medication by the toothbrush (presuming the child always brushes each morning!) or putting it out with breakfast.
• Encourage parents to allow their child to take the medicine on their own—but also provide parents with ways to check that their child took the medicine. Some kids will fight parents on this, so I suggest that parents tie taking the medication to privileges that their kids want, such as using the car or keeping their smartphone. Also, kids must be aware of the importance of keeping up with their treatment. In the case of ADHD, for example, driving can be quite dangerous if kids are not taking their medication. So, these issues must be explained. Kids need to know how many more automobile and other accidents happen to people who do not take their ADHD treatment as prescribed.
• Have parents and children come in more frequently for therapy to address any concerns about taking medication. Work with parents to reinforce the value of taking the medication.
Drug diversion can also become a problem, especially with older kids prescribed stimulants. One potential solution is to prescribe a long-acting formulation, such as Adderall XR as opposed to Adderall IR—although some kids will still sell it to friends as a study drug (Martinez-Raga J et al, Ther Adv Drug Saf 2017;8(3):87–99). In conjunction, I will often say something like, “Listen, this is a medicine that some people like to borrow; they like to take it so they can stay up all night and study. So, you’ll get this medicine from me only once a month, and I don’t give early refills.” I tell this to the parents, too. If a family member tells me the medication accidentally got flushed down the toilet or something terrible happened, that’ll be addressed on a case-by-case basis, and I might give an early refill one time, but that’s it.
In terms of how teens should secure their meds while attending college, I generally will give some practical advice. Some colleagues recommend that students bring a lock box with a cable on it that they can secure under their bed, where they keep their wallet and their medicine.