Collaboration in medication management

A reminder that psychologists need to develop basic knowledge about pharmacotherapy

By Edward R. Christophersen, PhD, ABPP, and Carla Allan, PhD

An eight-year-old male named Charlie, recently diagnosed with ADHD (Combined Type) presented for his first follow-up session with his psychologist, after initiating a stimulant medication under the care of his primary care physician. The boy was diagnosed three months ago by his psychologist and the family had attempted to treat his ADHD symptoms using behavioral therapy as the sole intervention. However, his academic impairment persisted and, as recommended by the psychologist, the family decided that it would be best to use a combined treatment approach (medication plus behavioral therapy).

Generally, Charlie presented as a boisterous, young male. He thrived on social attention and praise. He was always willing to practice pro-social behaviors in session.

However, when he presented to the clinic after the initiation of his stimulant medication, he was a very different boy. He was nervous and had been licking the skin around his mouth to the point that it was raw. His eyes darted around the room and he refused to participate in practicing his bedtime routine with a visual checklist, which was something he had done before without issue. He hid behind his mother and cried when he was encouraged to participate.

The psychologist began to ask questions about Charlie’s stimulant medication, which was 10 mgs of Adderall XR, a dose that seemed appropriate. Unable to swallow pills, Charlie had been instructed to sprinkle the capsules on food. Upon further questioning, it was discovered that Charlie’s parents had been sprinkling the capsules on peanut butter crackers.

At this point, the psychologist had figured out the problem: Charlie was accidentally getting the entire amount of his extended release stimulant all at once. Although the capsules can be sprinkled on food, it is not supposed to be sprinkled on foods that are chewy, as chewing breaks all of the capsules open at once and defeats the extended release design of the pill.

The psychologist recommended that Charlie’s parents sprinkle the capsules on some yogurt in the morning instead.

A few days later, Charlie’s mother called to provide an update: he was much less agitated and his lip licking behavior had decreased dramatically. Charlie was back to himself (with improved attention and impulse control as a result of his stimulant medication) in no time at all.

It is important that psychologists develop basic knowledge about pharmacotherapy. Primary care physicians often treat mental health problems. Psychologists are in a prime position to provide collaborative care.