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63: When Your Teen Doesn't Think They Need Their ADHD Meds

SHOW SUMMARY:

ADHD Changes as Kids Grow Older: Medication Dosing and Teen Buy-In This episode explores how ADHD evolves from childhood into the teen years—and why treatment may need to evolve, too. Dr. Ujjwal Ramtekkar explains how to think through medication changes, respond when a teen says they do not need medication, and consider safety, driving, and everyday functioning alongside school performance. Dr. Ramtekkar, a Harvard-trained, double board-certified psychiatrist and nationally recognized expert in ADHD, pediatric sleep, and child mental health, joins Dr. Jennifer Dilts and Dr. Nerissa Bauer for a practical conversation grounded in real-world care. Key topics ADHD can change shape with age. Hyperactivity may become less obvious, while inattention, impulsivity, procrastination, and executive-function challenges stand out more. Growing demands can make ADHD seem worse. Middle school, high school, and beyond bring more responsibilities, sometimes faster than executive-function skills develop. Medication dosing isn’t based on weight alone. Clinicians consider benefit, side effects, duration, and timing; a child doesn’t automatically need a higher dose as they grow. Coverage matters beyond school hours. Homework, sports, driving, and evening routines may influence medication timing or formulation. Get specific when medication “isn’t working.” First identify the concern—such as homework delays, missed instructions, or driving safety—before deciding what needs to change. Teen resistance may be about autonomy. Identity, privacy, and feeling controlled can play a role. Asking what the teen wants to make easier can open a more productive conversation. Try a shared, measurable experiment. A two-week “detective experiment” with clear goals can help families assess medication’s impact without turning treatment into a power struggle. Distinguish forgetting from refusing. Unused medication may point to an adherence challenge, not necessarily a deliberate decision to stop. Keep safety and monitoring in view. The discussion covers untreated ADHD risks as well as monitoring growth, appetite, blood pressure, and cardiac symptoms. Focus on functioning. Dr. Ramtekkar’s guiding principle: “More skills and less pills.” 

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