Expert: Dr Billy Levin - 12/7/2007

Question
Dr. Levin,

My 11 year old daughter is on Concerta and it is a marvelous thing.  I am just wishing it could last 14 hours rather than 12.  At this age, her school activities and homework make for a long day requiring focus to complete them all.  
Is there a 14 hour dosage for Concerta?  Her dosage lasts exactly 12 hours.  We know the moment it kicks in and the moment she goes "off line".  We definitely do not want her to have to take medicine at school as we are completely keeping her condition private.  No one saying "oh, she has issues".  Labeling is a reality as we learned in the past.  
Also, if I can ask another question.  Will our daughter outgrow or overcome this condition?  I can't imagine anyone waking up with this grizzly bear.  
Thank you for being there for so many of us frustrated and concerned parents.  

Sandy


Answer
May I assume as you would value my opinion, it gives my the right to be frank about you and your doctor. By keeping it a secret from the school makes no medical sense whatsoever and makes me very anxious about the treating doctor. There is no way that the doctor can give an optimal dose of any medication without feed back from the school. Only an optimal dose works best! So he is guessing the dose instead of monitoring to an optimal dose with feedback from parent AND teacher.
Next ,most important is the school cooperation in managing her situation at school sympathetically and constructively. It is absolutely essential for the school to be fully informed by the treating doctor so as to get their understanding and co-operation. There are specific school programs for children with ADHD/ADD. How can the school implement them if they are in the dark.
Lastly the fact that your are hiding the problem makes me especially anxious about the school insight and ability. Surely if the school has any insight and your daughters problem is real they will has already suspected a problem. If there is any positive responce  to  medication they will recognize it and feel her parents are deceitful and dishonest. More important are you not teaching your daughter also to be deceitful in trying to fool the school. The very people who should be undstanding and helping her.There is no discussion about the pointless word "labelling" If she has inherited a neurological condition that carries no embarresment what is there to hide beside ignorance! Sorry if I am being too frank. ADHD treatment is an essential team effort with all role players fully informed and involved. There are specific rating scales used to monitor progress and electiveness of medication. How will this be done on regular monthly basis with no school involvement? You have a lot to think about before we discuss increasing the duration of action of the medical treatment. There are distinct possibilities! Will she outgrow it? Only with effective team  management and medication of which none are present at the moment. The grizzly bear will have a good chance to succeed with a team that knows what to do to optimize treatment.