ADHD Medication: Make Duration of Effectiveness - DOE - The Standard

*Duration of Effectiveness-DOEShould Become The New Standard
Language and precision: Maps & Changing Territories. Korzybski: M
*DOEis a marker for the metabolic patterns of each person and each stimulant medication. It will be announced to the practitioner and patient for precise and individualized treatment. It is dangerous to ignore the built-in marker of effective treatment by not measuring DOE at every medcheck.
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Details MatterThe Meds don’t work long enough: The Duration Of Effectiveness [DOE], is not sufficient: Every stimulant drug and every family of stimulant drugs have their own expected DOE. It is not an indicator of drug activity, but this information is well-known to anyone who monitors the drug’s duration and action throughout the day.

Stimulant medications are expected to last less than 24 hours. This is an important point, but it is often overlooked. How long should meds be kept for if they last less than 24 hours? To get the most out of each med, it is important to dial in the duration. [AMP=Amphetamine Family, MPH=Methylphenidate Family]

Vyvanse [AMP] and Daytrana [MPH patch] both win the DOE race with 12-14 hr expected as optimum.

Adderall XR [AMP] is next with 8 hr DOE — sometimes can get 10, but often more DOE is too much – out the top of the Therapeutic Window: w

Concerta [MPH] and Focalin [MPH] both run 8 hr if dialed in effectively – some studies show longer, my experience: more than 10 hr with either of these is too much — see other articles on the ‘Top of the Window. ‘

Both Metadate CR [MPH] as well Ritalin LA [MPH] work at 8 hours. Side effects can occur if you push the dose higher
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The tablets that have no extended time
are the Immediate Release Stimulants.Expected, only a small portion of the day with Adderall Ir [Immediate Release Tabs] takes about 5 hours, Ritalin Ir [MPH] lasts for 4 hours.

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Details about the expected DO for each stimulant
*Likethe video and share it to your friends. DOE really does make a difference.
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This is a story about a young girl who explores the cause underlying her nail biting habits. This video introduces Body Focused Repeatable Behaviours (BFRBs), as a cause of nail biting. This story outlines several examples and explains how they can be treated. This video is intended only for educational purposes and is based upon scientific research.

This video was made by McMaster students Jordan Chin and Saba Bhatti in collaboration with McMaster's Demystifying Medical Program .
Copyright McMaster University 2022

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/
provides support for BFRBs
Where can I find more information?

See Houghton and colleagues for prevalence rates (mild or pathological). (2018)

For clinical case prevalence see: Hyles et al. (2009)

See Mathew and colleagues for self-harm continuums and self-injurious behaviours. (2020)

For genetic evidence see: Redden et al. (2016)

See Redden et. al. for SUD/ADHD comorbidities. (2016)

See Flessner et. al. for daily functioning with BFRBs. (2015)

For OCD-related content see: Tolin et al. (2018)

For emotional correlates see: Redden et al (2016); Roberts et al. (2013); Roberts et al.

(2015)

For dermatology and BFRBs see: Sampaio & Grant (2018)

See Houghton et Al 2018
for the choice between psychologist and physician.
For psychological treatments see: Reddy et al. (2020); Woods & Houghton (2016); Nakel (2015)

#DemystifyingMedicine
References:

Alexander, J. R., Houghton, D. C., Bauer, C. C., Lench, H. C., & Woods, D. W. (2018). Emotion regulation deficits in people with body-focused repetitive behaviour disorders. Journal of Affective Disorders, 227, 463-470. Chamberlain, S. R., & Odlaug, B. L. (2014). Personality features and body-focused repetitive behaviors (BFRBs). Current Behavioral Neuroscience Reports, 1(1), 27-32.

Flessner, C. A., Francazio, S., Murphy, Y. E., & Brennan, E. (2015). A study of executive functioning in young adults who display body-focused repetitive behavior. The Journal of nervous and mental disease, 203(7), 555-558.

Hayes, S. L., Storch, E. A., & Berlanga, L. (2009). A study of skin picking behavior: The prevalence and severity of this disorder in a community sample. Journal of Anxiety Disorders, 23(3), 314-319.

Houghton, D. C., Alexander, J. R., Bauer, C. C., & Woods, D. W. (2018). Repetitive body-focused behaviors: Are they more common than we thought? Psychiatry research, 270, 389-393.

Mathew, A. S., Davine, T., Snorrason, I., Houghton, D. C., Woods, D. W., & Lee, H. J. (2020). Comparison of body-focused repetitive behavior and non-suicidal suicide-injury: A comparison between clinical characteristics and symptoms. Journal of psychiatric Research.

Nakell, S. (2015). A healing herd: The benefits of a psychodynamic approach to treating repetitive body-focused behaviors. International Journal of Group Psychotherapy, 65(2), 295-306.

Redden, S. A., Leppink, E. W., & Grant, J. E. (2016). Repetitive behavior disorders based on body-focused behaviors: The importance of family history. Comprehensive Psychiatry, 66, 187-192.

Reddy, Y. J., Sudhir, P. M., Manjula, M., Arumugham, S. S., & Narayanaswamy, J. C. (2020). Guidelines for Clinical Practice in Cognitive-Behavioral Therapies for Anxiety Disorders, Obsessive-Compulsive Disorders and Related Disorders. Indian Journal of Psychiatry, 62(Suppl 2), S230.

Roberts, S., O'Connor, K., & Belanger, C. (2013). Emotion regulation and psychological models for body-focused repetitive behavior. Clinical Psychology Review, 33(6), 745-762.

Roberts, S., O'Connor, K., Aardema, F., & Belanger, C. (2015). The impact of emotions on body-Focused repetitive behaviors: Evidence from a non-treatment-seeking sample. Journal of Behavior Therapy and Experimental Psychiatry, 46, 189-197.

Sampaio, D. G., & Grant, J. E. (2018). The dermatology patient and body-focused repetitive behavior. Clinics in dermatology, 36(6), 723-727

Selles, R. R., Ariza, V. L. B., McBride, N. M., Dammann, J., Whiteside, S., & Storch, E. A. (2018). Initial psychometrics, results, and correlates for the Repetitive Body Focused Behaviour Scale: Examination in a sample youth with anxiety or obsessive compulsive disorder. Comprehensive Psychiatry, 81, 10-17. Tolin, D. F., Gilliam, C., Wootton, B. M., Bowe, W., Bragdon, L. B., Davis, E., ... & Hallion, L. S. (2018). Psychometric properties of a structured diagnostic interview to diagnose DSM-5 anxiety, mood, obsessive-compulsive disorder and related disorders. Assessment, 25(1), 3-13.

Woods, D. W., & Houghton, D. C. (2016). Psychosocial treatment for children with repetitive, body-focused behavior disorders. Evidence-based psychosocial treatments. Journal of Clinical Child & Adolescent Psychology, 45(3), 227-240.