individualised treatment: the pitfalls and possibilities

As Lana entered adolescence, her treatment needs continued to evolve.

Adapting treatment to match changing patient needs

  • At age 12, Lana had recently moved to a new school and was unsettled
  • Although Lana was receiving short-acting medication twice daily, her parents complained that this was not working
  • Through communication with Lana’s teacher and Lana herself, Dr Martins discovered that Lana had not been taking her second dose of medication at school, because she felt embarrassed and stigmatised
  • This discovery allowed Dr Martins to switch Lana to long-acting medication, allowing Lana to maintain her treatment while avoiding the need for a second dose of medication at school
  • Lana also received additional psychoeducation to help her better understand why adhering to her ADHD treatment is important

 

Medication holidays

  • When she was 14 years old, Lana had a medication holiday during her summer school holidays, at the request of her parents
  • Lana’s behaviour changed during this period and so her parents were reluctant for her to resume medication treatment after the holidays
  • After starting school again without medication, Lana’s impairments re-emerged
  • Lana, her parents and Dr Martins came to a joint decision to re-start her medication treatment

 

Recognising and managing comorbidities

  • Aged 15, Lana visited Dr Martins complaining of medication side effects
  • Reassessment revealed that Lana had comorbid anxiety disorder
  • In addition to her medication, Dr Martins prescribed Lana cognitive–behavioural therapy and psychoeducation to help her understand her anxiety disorder

 

Key learning

Build a therapeutic alliance with your patient, their family and other members of their support circle (eg teachers) and regularly monitor your patient’s progress, because life events can affect a patient’s ADHD treatment. Treatment and goals need to be adapted as your patient’s needs evolve.