Expert: Dr Billy Levin - 7/23/2010

Question
Hi, my 8 year old child (49 inches tall/49 lbs) was diagnosed with ADHD a few years back and we have tested out different combinations of medications for a while now.  For school, she takes a 27Mg pill of concerta long acting and 1 methalyn 5mg pill in the morning and then 2 5mg methalyn pills in the afternoon.  On weekends/holidays we give her 18mg concerta long acting and 1 5mg pill in the morning and sometimes 2 5mg methalyns in the afternoon.  She recently got an acting roll on TV show.  On medicine, she is focused, but a bit flat (lacks excitability).  Of of medicine she is full of life but not focused.  My question is, is there one or a combination of her medications that can help her with focus but still give her the "happy go lucky" attitude that the directors want her to have on set?  The first two days we tried the holiday med plan but she was flat.  We were thinking about trying the "no medicine" plan, but have fear she wont be able to focus enough to remember her lines.  Does one of her medications help better with focus while the other controls her hyperactivity?  Any advice you can give would be a huge help!

Thanks, Dad

Answer
I am afraid the dosage program makes no sense whatsoever. Why not just monitor her requirements using rating scales and establish her optimal dose of Concerta without the need of the other medication. Her height and weight plays NO part in establishing the optimal dose. As Concerta works for 12 hours why the other medication in the afternoon? If she is "on stage" in the evening the medication will have worn off anyway. An alternative might be Strattera.  Establishing an optimal dose is essential. Neither too much or too little will work well!