| Remember the 'Top of the Window' is ranging too high | | | | 4. The Patient argues that It Works Well and Can't |
| in dosage, the 'Bottom of the Window' is too little | | | | See the Side Effects. They are so happy to have a |
| dosage. The worst thing that can happen when you | | | | new focus they push to have the dose up because |
| are working to carefully correct stimulant meds: an | | | | they do, so desperately, wish to improve. |
| overdose upwards because that apparent 'bottom,' | | | | 5. The School Is Pleased - In A Structured Setting Side |
| the apparent under dose, was actually too much meds | | | | Effects Are Less Obvious. This report often throws |
| and the patient was actually coming out of the 'top.' | | | | off the Treatment Team, because the team is not |
| Here is how that looks clinically using these 7 pointers. | | | | trained to look themselves for these details, but relies |
| | | | to heavily on what the teachers say, ignoring their own |
| 1. When the Med Dose is too High: it can look like the | | | | personal concerns. |
| patient is no longer focused, they are hyper, confused, | | | | 6. Peer Relationships Suffer. People closest to the |
| and cognitively not as sharp. Every visit, every | | | | patient see odd changes and feel put off by the |
| medication review, every question in medication | | | | pressures and new, overbearing attitude that has |
| adjustment must consider the possibility that these | | | | slowly emerged. |
| symptoms mean the drug dosage is too high. | | | | 7. Malevolent Odd Actions, Never Before Experienced, |
| 2. OverFocus Looks Like UnderFocus: This single | | | | Occur. The patient becomes more destructive in odd |
| oversight is the absolutely biggest problem with | | | | ways. A manager who never gossips begins to |
| stimulant medications today: New medications work so | | | | gossip. A child decides to hit his favorite pet, and never |
| well the top actually appears to be insufficient dosing. | | | | did before. A child may start a fire in the back yard, or |
| Clinically it appears as if they need more medication. | | | | try to drive the family car... 'just for fun.' The symptoms |
| The big problem: More meds in this situation can make | | | | at first seem quite innocent but in the overall are |
| the patient much worse, perhaps dangerous, certainly | | | | maladaptive. |
| more unable to focus, due to that over-focusing. | | | | Do review these seven tips carefully. Dropping the |
| 3. Side Effects are in Evidence: This phenomenon, | | | | medication down, even a small amount, under these |
| actually going out the top - while looking like the bottom | | | | circumstances will often reveal the person who is |
| - always has side effects. Side Effects are often | | | | evenly focused, who is emotionally more on track, and |
| subtle, so inquiry must carefully review these: appetite | | | | performing better throughout the day. Dropping the |
| is down, weight loss occurs, agitation is higher, | | | | medication down will take them out of the 'Top' and |
| compliance appears worse. angered more easily, sleep | | | | put them back within the best therapeutic dosage, |
| is disturbed significantly when no sleep problems | | | | back in the targeted 'Therapeutic Window. |
| previously occurred. | | | | |