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My 14-year-old daughter hasn't had success with stimulants. Should she try Abilify?

Trying a new medication requires careful monitoring 

Alan Ravitz, MD, MS

Senior Pediatric Psychopharmacologist, formerly with the Anxiety and Mood Disorders Center
Child Mind Institute

Q: My 14-year-old daughter has not had much success with stimulants. She tried Concerta for five days, Adderall for five days, at different doses, and she is currently in her second week of Strattera. We are waiting to see if that works. Our pediatrician said the next thing she would try is Abilify, and if that doesn't work, she would send my daughter to a psychiatrist to see what he would suggest. Have you used Abilify to treat ADHD symptoms? What percentage of people have no success at all with medication? What happens if meds don't work?

A: Abilify is not the drug of first or even second choice for ADHD although it is sometimes used to treat ADHD plus oppositional defiant disorder when you can't bring the behavior under control with ADHD medication alone. Abilify has greater risks associated with it than stimulants, including weight gain, diabetes risk, and a movement disorder called tardive dyskinesia.

Your daughter should see a child psychiatrist before starting Abilify. Trying several medications for five days at different doses, as she has been, doesn't give you enough time to find out if they are working. Strattera is going to take a good month before you know whether it works or not.

Very few people have no success with ADHD medications. It's possible that your daughter will not respond to them but it is unlikely. And you should certainly see someone who has expertise in psychopharmacology before you conclude that medication won't help her. A child psychiatrist would have managed your daughter's medication very differently, spending more time to monitor and adjust dosage.

If she hasn't received one already, I'd also recommend that your daughter get a careful diagnostic assessment by a board certified child psychiatrist to make sure that she does have ADHD and not something else. That means a doctor who pays careful attention to current symptoms, to the evolution of symptoms over the years, to the biological family history, and to her social and academic performance. The psychiatrist should spend at least a couple hours doing diagnostic interviews with you and your daughter. I would never start Abilify without doing this kind of comprehensive diagnostic assessment.

Published: March 12, 2013

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jstout · Mar 12 2013 Report

This is not an unusual scenario for me as a mental health advocate. I am director of a nonprofit, and in our county, most parents take their children to the family pediatrician or practitioner, usually due to financial need. Even with sliding fee scales, some of these people have to rely on their family doctor, who lets them run a charge account or underbills them, rather than on psychiatrists, psychologists, or nurse-practitioners available at area mental health centers. Also, in a small community, stigma is rampant, and parents are ashamed and embarrassed to take their kids to the centers.Our organization, and others, work hard to help decrease this stigma with education and referrals, but we have an uphill battle. I am praying that the new Healthcare Act will broaden families' choices for care of their children with mental illnesses, but I fear the progress will be slow. Jill H. Stout, Executive Director Mental Health America of Wabash County (IN)

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