Why Adults with ADHD Abandon Medication (with William W. Dodson, M.D.)
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- Опубліковано 27 лис 2022
- In this hour-long ADDitude webinar, Dr. William W. Dodson explains why many adults with ADHD struggle to take prescribed medication consistently, and offers strategies for overcoming these obstacles to ensure more effective and consistent symptom management.
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Related Resources
1. Download: What to Ask Before Starting ADHD Medication
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2. Read: How to Improve ADHD Medication Adherence
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3. Read: ADHD Medications Rarely Work Perfectly on the First Try
www.additudemag.com/adhd-medi...
4. eBook: ADHD Medication and Treatment
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Been taking Vyvanse 20mg, and it's been 80% side effects, 10% motivation, and 10% focus. So going to give it a couple more weeks but damn the side effects make ADHD a better option
Something extremly smart and extremly underrated mr W. Dodson said in my opinion as a 4 times diagnosed adhd 29y over my lifetime (maybe 1 diagnosis every ~7 years) is that
"they gain access to there talents/abilitys when.... XYZ"
Thats a extremly profund and underrated thing about adhd!
I think most people think you are just a normal person with symthoms (but those are just to diagnose they are trivial)
To me, the main issue with ADHD meds is that they are very tedious to obtain. It's ridiculous to assume that someone with ADHD will be on top of it and remember to get a new prescription and order it on time every single month. I miss a lot of days just because I forget to order more before I run out.
That's where I set 2 phone alarms ahead of time that are titled as refill meds :)
Dr. Dobson- thank you for presenting this information. As a mental health professional and a person with ADHD I found this quite informative. I hope the FDA reconsiders their current approach to restrictions on stimulants. Please keep speaking on this topic. You are the voice of good tidings, sir. Thank you !
I wish the FDA would back off and realize they are only causing problems for those of us who have ADHD. It makes life miserable
Maybe put a timestamp in where the actual content begins, so that those who don't want to listen to several minutes of entirely unrelated content can skip ahead?
I am 78, still taking concerta 36
Finding a doctor to prescribe them is half the problem. My family doctor will not even after a consult from a therapist. Then finding a psychiatrist who can prescribe and is also versed in adult adhd is a unicorn. I wish I could try medication
Does anyone else feel like an impostor..?......no I "can't really have adhd" ....(eventhough I have been diagnosed)....."it is just me needing a label to explain me being a loser" 😑....it is a struggle.
yes but do you remember the feeling you felt when your life made sense finally? Stick with that :)
I feel like a original. Maybe you are just mild. Thats fine. Not a impostor. If you are misdiagnosed maybe probably rediagnose if it was a test. If a long rating scale with other pple maybe filling it out as well then probaly good one
or maybe lots of "we are not ready yet/willing to help people that much (eventho thats a win/win that is just only obvious to smarter people). Its like "we should help old people getting robbed? Get out of here we are not the slaves of people we dont know. (But it was also obvious to smart peopl that police altho altruistic would even from a egoistic perspektive be a win/win increasing productivity.
🎯 Key Takeaways for quick navigation:
00:02 🚀 *Introduction and Overview*
- ADHD medications, particularly stimulants, are effective but face inconsistent adherence.
- Many adults struggle to maintain consistent medication use due to various reasons like forgetfulness, myths, or safety concerns.
- Webinar aims to discuss strategies overcoming obstacles for effective symptom management.
04:29 🕵️ *Non-Adherence Issue Overview*
- Non-adherence, stopping treatment despite effectiveness, is a significant problem in ADHD medication use.
- A study by Nathan Capone reveals a steep decline in prescription refills over nine months, with only 13% continuing treatment.
- Effect sizes of ADHD medications are substantial, but the majority stop taking them within months.
09:50 🤷 *Reasons for Non-Adherence*
- Patients often don't know why they're taking the medication, leading to doubts about the diagnosis and its necessity.
- External pressure or an "exit interview" often initiates medication use without personal understanding or acceptance.
- Psychoeducation is crucial to help individuals understand ADHD as a lifelong neurologic condition and the meaning of medication.
14:32 🎓 *Delayed Diagnosis and High IQ*
- High IQ individuals often find compensations, delaying ADHD diagnosis until later in life.
- Cleverness can mask ADHD, leading to an average diagnosis age of 31 in the United States.
- Diagnosis often occurs through disruptive behavior in boys or as an ancillary feature in educational testing for girls.
17:10 📉 *Dosing Challenges*
- Suboptimal dosing is common, either too low to control symptoms or too high, causing intolerable side effects.
- Dosing must be finely tuned to individual response, and finding the right molecule and dose is crucial.
- Common blame on ADHD medications for side effects caused by additional stimulating medications (caffeine, nicotine, etc.).
20:30 🏛️ *Institutional Barriers*
- Institutional barriers, as outlined by the American Academy of Pediatrics, include a lack of physician preparedness, unnecessary drug restrictions, and difficulty obtaining refills.
- The "antibiotic fantasy" contributes to non-adherence, expecting a short-term solution for a lifelong neurologic condition.
- Clinician attitudes, including limited support for medication, can significantly impact adherence.
25:07 🧐 *Beliefs Impacting Adherence*
- Misconceptions about ADHD being outgrown with age or the idea of "drug holidays" contribute to non-adherence.
- Clinicians promoting these misconceptions may negatively influence patient commitment to lifelong treatment.
- Education and dispelling myths are critical to establishing realistic expectations for ADHD medication use.
28:43 📉 *ADHD and Life Expectancy*
- Untreated ADHD reduces life expectancy by 13 years.
- Increased risk of accidents and substance abuse.
- Impact on education, coexisting disorders, and overall life.
29:54 🎓 *ADHD and College Transition*
- Many adolescents with ADHD stop medication in college.
- High risk of academic struggles and flunking out.
- Advises intentionally stopping medication before college to understand the impact.
31:29 💊 *Medication Management Strategies*
- Recommends starting medication management skills by age 15.
- Emphasizes the importance of parents' involvement even when the child reaches 15.
- Highlights the need for clinicians and parents to be vigilant about medication compliance.
32:53 🔍 *Ensuring Medication Compliance*
- Stress on choosing the best medication and dose for each individual.
- Emphasizes that assuming patient compliance is a mistake.
- Practical strategies like writing everything down, pill counts, and reminders are crucial.
34:49 ⚖️ *Coping with Non-Compliance*
- Acknowledges that non-compliance is common in ADHD.
- Urges proactive management and support for ADHD individuals.
- Stresses the necessity of lifelong treatment for successful outcomes.
35:58 🌐 *Successful ADHD Treatment*
- Evaluates medication success on a scale of 1 to 10.
- Defines successful ADHD treatment as finding the right molecule and dose.
- Highlights the importance of understanding the unique ADHD nervous system.
39:57 🔄 *Long-Term Effects of ADHD Medication*
- Addresses concerns about long-term physical and emotional side effects.
- Asserts that ADHD medications, when appropriately used, should have no long-term issues.
- Leverages historical data spanning over 70 years of ADHD medication usage.
42:17 🚫 *ADHD Medication and Substance Abuse*
- Dispels the myth of stimulant medications increasing the risk of drug abuse.
- Cites studies indicating a clear protective effect against substance use disorder with ADHD medication.
- Challenges common misconceptions about ADHD medication and addiction.
45:29 🔥 *Challenges with ADHD Medication Regulation*
- Criticizes unnecessary regulations and controls on ADHD medications.
- Highlights the historical context of ADHD medication regulations.
- Advocates for changes in the system to ease access to medications for those with ADHD.
49:23 🚩 *Finding the Right ADHD Practitioner*
- Encourages seeking practitioners who specialize in ADHD.
- Advises attending support group meetings and utilizing online resources.
- Recommends exploring local ADHD organizations and talking to school counselors.
53:11 🔄 *ADHD Comorbidities and Treatment*
- Acknowledges the high prevalence of comorbid conditions with ADHD.
- Emphasizes the importance of understanding and addressing comorbidities.
- Discusses the distinction between hyperarousal and anxiety in ADHD individuals.
57:16 ⚠️ *Age and ADHD Medication Safety*
- Rejects age-based restrictions on ADHD medication.
- Clarifies that ADHD and its treatment remain consistent across ages.
- Challenges misconceptions and recommends seeking a cardiologist's opinion if necessary.
Made with HARPA AI
Thank you for the summary with timestamps. Huge help 🙂
The reason why I finally stopped was my heart started racing when I took the meds (Adderall). I probably should have consulted with my doctor before doing so, but I didn't. I recently started taking buproprion and atomoxetine and they're helping enormously.
BTW: I keep my meds on my end table. I take them as soon as I get up and haven't missed a dose in over two months.
Thank you so much. I’m 60F diagnosed last month, no prescriptions yet, onepartial intake with a psychiatrist that talked over me, said I’d managed this long without meds so probably didn’t need them and I didn’t even get a chance to ask questions. I have a follow up in a week but I will look for someone else. I have EDS and chronic pain and fatigue so I want to be educated about any benefits or side effects.
Maybe the reason for not filling prescriptions is because the hassle is too much to deal with. It took me over a month to find a prescription that I could afford and that I could fill. Pharmacists turned rude toward me the second they read the medication. I felt so stigmatized that I just gave up. I’m not even sure I’m going to continue because of it.
My nurse practitioner said that peeps w ADHD are more prone to have migraines. The ADHD meds I tried caused migraines for me, so she said I probably can’t take them. Would be interested to hear a webinar on this topic if there isn’t already one!
The other problem w the ADHD meds I tried was after it wore off for the day, I became sort of impulsively irritable, like I would react negatively to what someone says to me even before I knew what was going to come out of my mouth. No bueno.
What are you taking? Have you tried Vyvanse? It has the least noticeable onset and offset.
I’m currently on bupropion and I would definitely not recommend it, as it makes my vestibular migraines significantly worse. I believe it’s due to the increased risk of seizures, seizures and migraines are very linked.
@@johnmoore1495 oh thank you for the input! Not taking anything except 60 mg propranolol for migraines and essential tremor. Doesn’t work too well I don’t think, might go cold turkey and see what happens for now but will keep the vivan se in mind for the next time I feel the urge to try again!
@@laurelb4193 have you tried guanfacine or clonidine, they’re alpha agonists, they’re not stimulants and they lower blood pressure mildly so they should be migraine safe, I plan on trying guanfacine.
@@johnmoore1495 I haven’t! Thank you for the tip, I will definitely look into them!
I just tried Ritalin and one other Med that I can’t remember the name of rn bc migraine lol
I was top of my class all my schooling years, had insomnia since I was self aware (sleep 3-4 hours a day for 4 days and then the 5th day sleep 7 hrs), used to study with the TV on without volume and the radio on while I was reading since I was very young, always running 15-30 min late despite not wanting to be late, forcing myself to do things because I have no motivation most of the time, never physically restless because my mother was very strict and you had to behave...at 46 years of age I been recently diagnosed with ADHD, I just thought I was bad at life, I was given Trazadone to help with my sleep and slight chronic depression, just sleeping better is great, still not been long enough for the antidepressant effect.
I'd love the chance to voluntarily quit adhd meds, but my mental health services are so sadly American that half my health care team feels that adhd isn't real and meds are just for drug seekers. They've abruptly stopped my meds after prescribing them for a few months. They hold my mental health in their hands as well as an alcoholic holds their 18th beer, and I'm still utterly shocked and broken over the neglect and emotional abuse I've experienced. I thought I saw a glimpse of hope with the diagnosis, but I was mistaken. Much like the American dream, every attempt I made to hold onto my sanity and grit my teeth throughout verbal assaults and all the b.s-ing, my efforts were in vain. My mental health declined and I'm stuck now. I can't continue subjecting myself to panic inducing situations if the professionals cannot be professional, and who knows who they answer to because accountability is a blurry subject. It's as if I'm expected to just shut my mouth and tolerate whatever they feel like saying or doing to me, and having a say in my mental health plan is unacceptable.
Oh no I’m sorry, this sounds awful. I believe you and hope you can get a new treatment team somewhere else. Maybe you can show them the Additude site at least?
@@laurelb4193 thank you for your kind response, and I will try to remember to show the next provider.
I really recommend Dr. Russel Ramsey's book "The Adult ADHD Toolkit"
Or suggest some videos/podcasts with him speaking. He provides a lot of coping tips for ADHD that are based on cognitive behavioral therapy. So they're very practical and doable. It might provide some relief until you can receive proper help. I really sympathize with what you're going through... it's disgusting how big a roadblock some professionals make for us when we try to get our ADHD treated. It's a battle, but coping tips can help ease the burden somewhat. Dr. Ramsey's book was a lifesaver for me.
I'm sorry. I have experienced the same things you described. Having ADHD and needing to deal with this garbage is a living Hell. They treat us like drug addicts. They don't realize how much worse they make the experience.
29:30 statement begs the question of life expectancy comparisons between *treated* ADHD sibling vs normal sibling?
Thank you Doc!👍
Thanks!!!
I tried Vyvanse and it was great, except for a bit of insomnia but after a while my blood pressure was through the roof. I’m still waiting for an alternative.
Many compliments for many clever recognitions also i relly love that you Sir look at tiltrating and (data to figure out whats the most common conclusion froum research intoit) but most of all finding the connection between lazy tiltaration and discontinuation is the major thing. I think that all the other things are just signs of people that can barely think/have major brain problems and the general population seeing lack of motivation as not a problem to be fixed overall (just like earlyer generations saw working woman [insert minority in terms of power not foreners but any minority in any mutlitude of interesst groups] or at least not something that does even differ between people. Most adhdh people i saw seem mild (makes sense becaue towards the mean of a statistical distribution there are most people. Meaning there might be more mild than medium and more medium than severe people with adhd. Add to that that high iq/motivation people will seek out treatment sooner and you will have a scewed view of adhd based on your patients.
Also most adhd people i saw seem to be kinda like "therapy = good" "Sugar = bad" "bigh pharma = bad" "natural = good" (naturalfallacy), thc oil = good, adhd = creative superhero totally fucked in the brain and shit lifes but they seem to not know sicne how are you supposed to know you are not normal when noone will admit they had it easyer they just say "oh it was the worst i was such a undergod" to get extra browny points and not have to help anyone since they are also fuckd. "Im so poor i cant give you money wink wink".
Also many "professionals" seem to not relly get it. Even those that get it the most seem to not relly get it altho its night and day.
I dont think its egoistically good to ignore the adhd thing. It will come back to bite people will vote, decide to be moral or not, decide if they are faily treated and act accordingly, and so on. Society does best if its productive not when a select group rules by productivity destroying means of deception and strategic ignorance.
Have you never experienced some people ignoring a obvious problem as to not having to deal with it?
As a adhd person i would beg to make a small correction "They stop when it gets boring" for me personally is about as correct as "The depressed person starts to be sad when something bad happens." or "The person with a broken bone stops walking when they dont feel like it."
Its many things. More pain, less pleasure, less drive, brain not working (somethimes works amazing so its not broken it seems)
I'd love to go back on medication, but I can't justify the risk. The depressive episodes when medical providers decide to pull the rug out from underneath me are much more likely to cause harm than untreated ADHD.
America?
Yeah I was given half milligram Xanax for 10 years then I went through losing my house and my wife and I asked to be put on a higher dose they told me I was abusing them and cut me off so when you don't need the meds they hand them out like candy but when you need them the most they take them away
@@ralphtom3431 well you clearly didn’t need them, as you’re doing fine today without them.. your doc was right. 🇺🇸
@@JT0007 I’m sure dealing with withdrawals during all that life stuff was not fun by any means.
@@johnmoore1495 Man was it hard to stop. Do you take Rx? I’m 6 months clean now. 🇺🇸
It feels harmful that it is referred to as abandonment when so many are making the choice due to the symptoms developed from the medications out weighing what they are benefitting.
We really need to reconsider if we are simply expecting to much from eachother, in my opinion. If our work and stress loads are just being pushed past a functional level on the species level? Idk.
That was one hell of an intro
Man I wish this guy was my doctor.
If I didn’t take my medication, I’d be an everyday a**hole, and I’d be smoking weed before noon
"Just what I wanted, a new genetic code!" hahahaha 28:00
This made me laugh out loud. I clipped it too. I just got a diagnosis at 56, and it’s been a huge relief to know that there’s an explanation for so much of my life.
Short: Good job on the title and this focus. Correct in my experience most adhd people are anti medicaiton (instinct), pro therapy since one does not work well if not lots of effort/finetuning and the other feels good/plesant/seems healthy/helpful no matter if it does anything if it works or does not work. Also milder people/more motivation or misdiagnosed people would go more to therapy since it requires traveling/appointments/selecting and also most likely presuposes some level of trust in the programm.
This title is promising. Instantly suggest Mr Dr Dodson might have a better than average or good understanding of adhd. Of course the field is big and its compelx also mild/medium/severe severitys. I look forward to watching this. I hope the hole field/world would take more interesst and seriousness in this topic. I think thats one of the big reasons why there is so much skeptisism of adhd / medications in the first place. Also because they feel very uncomfortable or casing much insecurity/nonreasuring when they are not tiltrated perfectly/very good. Just like eye glasses that help a bunch but at the same time make seeing worse or strange since they are not polished/sanded to perfectly support the persons eyes. Just imagine that. That would instantly be fixed and people would critisise the eye glasses seller everywhere and with great intensity and motivation building social groups and using lots of executive functions to get what they want in a group/social/hard working/delayed gratification/social emotional intelligence/strike/demanding/motivated/know what you want/influence present/diligent way. Something you wont relly see from adhd people until the pain is much greated and they are not so desperate and lonly and destructive to society and themselfs but by definition lacking in motivation/delaying gratification and therefore delaying/removing discomfort until later/using the PFC (social brain) and lots if friends/collegues (little adhd have friends and if they usually less than normal people), also things like politicial activism/work/school that require interesst/motivation/working brain are hard. Also social brilliance/intuition/instinct is needed.
Just explaining why you might not see as much pushback eventho the problem might be more severe than non perfcet eye glasses.
I also imagine depressed people would be less "interessed/happy/entusjastic/energetic/optimistic when doing political activism generally, but there id imagine many high functioning people. Difficult to say.
Mr Dodson seems to relly be on the money with many of his recent presentations. Of course all adhd people working hard or hopefully pationately since its so interesstig (well depends if you are lucky and not drawn to watching boring tv stuff).
Anyway:
Good Job Additude Magazine. You organice lectures and have them structured seriously enought and seem to value a few in my opinion very good scientists like Barkley Dodson and a bunch more. Dearly needed.
Of course everyone if valuable and has different perspektives. The effort and passion to find whats true/scientific and try to find and test ways to help or doing anyhting in that direction is valuable independantly. Thank you.
I think one of the reasons is because of the popularity misleading book ADHD 2.0 which is filled with remedies such as balance board that have no obvious evidence. I have met so many people telling me it can be treated with balance board, diet, and fish oil. lol
Stopped medication for my child due to side effects of impaired sleeping and eating. What makes ADHD symptoms worse? Lack of sleep and poor nutrition.
Very true brain very good but something fundamental/broad hard to define seems deactivated/very wrong. Cant use it. And feel terrible lazy and more pain and no pleasure from pleasurable activitys (or very variable so somethimes yes but most of the time heavily diminished. You are on many right tracs sir.
Study/research more in that direction
How to get perfect medical treatment maybe with computer assisted help and many more spesific 1-10 scales maybe (dont have to be super accurate each but together they might make something very accurate and reliable to assist clinitians in treatment and fix many problems at once)
I hate it when these webinars address both children and adults with ADHD. The way it plays out, the self-direction of adults, and the demands on adults usually get "touched upon" but they rarely go into details, and like in the case of this video, it mostly focuses on Children/Adolescence. This was a waste of my time. As an adult who FOUGHT hard to get diagnosed because of ageism and sexism in the DSM-V criteria for diagnosing, what I wanted was tips for keeping myself from stopping taking it. I hate the idea of being dependent on a drug, I worry about it damaging my body (I am 53). I just started taking Adderall, after an unsuccessful attempt at taking guanfacine. I took it today for the first time, and I can already see how this would be easy to poo-poo taking it and gradually quit taking it without intending to. Since there is no titration of it I wish ADDitude would only do, either Children's videos or mature adult, and, as it pertains to adults, it's obvious from the questions that older adults (50+) need help in specific ways. I thought this video would address the "WHY," then provide tips for managing the "why," which it was very little on solutions. Very disappointed as per usual.
ADHD medicine ruins everyone eventually. Took Adderall the last 15 of 25 years. They call it the devils dandruff for a reason.
Adderall=Meth=speed Rx 🇺🇸
yes, i waste time watching these vids but they talk more about the under thirties. I am 70 and i cannot waste the limited time left on things that are not relevant to me
I have a diagnosis and they refuse to give me medication for it. I complain and they don't care. Previously I had taken adderall for years and it was great. They forced me off of adderall and my life has fallen apart. 4 miserable years now and I cant get any help
ive stopped lots becaue of cost and i just found out my psych wrote in my report not adhered as havent accessed scripts for over a year.. its because for over 5 years i have noticed its made my orthodontic periodontal issues worse dramatically.. i actually feel them moving with pain.. i new they wouldnt believe me so i didnt tell them.. [they really arent interested too much of anything]
also didnt like half lifes of mood drops agitation and picking habits
28:41 This is interesting. I was under the impression that a significant percentage of people with ADHD (1/3rd to 2/3rd) stop having symptoms at some point in young adulthood, at least to the extent that they don’t meet the criteria for a diagnosis any more. So, does this mean that these people are just better at compensating for their symptoms? Maybe also because their environment is more helpful? Or are there differences in brain development? What is the accurate evidence-based way to describe this?
Also, should we make sure that all children with ADHD (unless misdiagnosed) retain their ADHD diagnosis as younger and older adults, even when they do not sufficiently demonstrate symptoms any more? My understanding here is that Dr. Dodson says that ADHD does not go away with adulthood, and that it is much preferable to medicate - implying that this is true even for adults that cope well enough to drop out of a DSM diagnosis.
It seems that this area needs to be looked at more. I am guessing that there is a lot going on in this area within research, and between clinicians and other experts. Is it possible to have a more public discussion about the findings, experiences and views here?
Btw, I am not a health professional, waiting for my own assessments for ADHD and ASD as a middle-aged adult. I just want to understand this better, to understand myself and the situation as a whole better.
There can be flaws in the tracking of symptoms into adulthood, if the researchers or clinicians use diagnostic instruments which measure symptoms as if they were evaluating a toddler or small child once the patient is a teen or young adult. On top of that, the brain overall does mature, just that the executive function is stuck at a lower degree of maturity once reaching adulthood. It probably will clearly surpass the executive function deficits of childhood, but still be very deficient compared to what's typical of non-ADHD adults.
My health insurance doesn’t cover adult ADHD at all. That doesn’t help matters.
You can get help from the drug company. "Takeda Cares" for Vyvanse is one.
Yes, Takeda’s program is very helpful, especially given the high price of Vyvanse. I wish there was a patient assistance program that helped pay for the cost of seeing a provider, though. My insurance doesn’t cover doctor visits for adult ADHD, either.
Intuniv works much better for me than stimulants!!!! Better % of people it works on than other non stimulants too. Helps me get shit some 😂
Can you explain exactly how it helps you? I’ve been looking into starting it.
Is there an ADDitude video on the typical comorbid diagnosis and how to better manage the ADHD. Just an example, I'm ADHD, Asperger's, and schizophrenic, and stimulants seem to be the only medication that works on my ADHD, so me and my psychiatrist are walking on eggshells.
Oh, I've also noticed, at least with me but if I include caffeine with my methylphenidate, Risperdal; sleep and appetite are fun myths that other people enjoy
Your sarcasm towards the end is hilarious 😂😭
Because speed and blood pressure medicine like clonidine makes one feel like crap -- are we focused? Working in a way that helps us masquerade as neurotypical? Yes -- do we feel like crap? Yep.
1) "There should be no side effects."
Could be BUT sideffects go away somethimes after taking a - say stimulant - for a longer time. So there might ALWAYS be sideffects at first so people might just stop instantly with this advice taken the wrong way. But ja it could definitly be 0 side effects. Not sure tho.
Many things said brilliant but some altho still on the hole brilliant might be a minimal overstep in terms of confidence (when interpreted to be unmistakable laws) but i think thats ofc not the implication.
I’m not convinced saying that “ADHD isn’t a disorder” is all that helpful. If you need to take medication to effectuate behaviors neurotypicals perform, then there is absolutely a deficit. And if that deficit impairs their everyday life, then that is a disorder.
It’s expensive. That’s the answer.
Medication? Not really, with GoodRx most ADHD meds are less than $20/month with the exception of Vyvanse because it’s brand only.
They talk about adolescents, but are college aged individuals kids? I don't think so. What these over privledged young adults have done to all the vulnerable in our country is unacceptable. Greek life behind it all. Nobody does anything about it either. The rich really suck.