A Junior Asked to Sell His Pills: Treating ADHD in a 16-Year-Old With an Extended-Release Stimulant, Diversion Safeguards and the Evidence That Treatment Does Not Raise Substance Risk
[Student Name]
University of Phoenix
PMH/505: Psychiatric Management Of Children And Adolescents
Week 2 Assignment
[Instructor Name]
[Date]
The patient is a composite written for a model paper.
Marcus, 16, was diagnosed with ADHD, combined presentation, at age 8 and took methylphenidate until age 12, when his family stopped it because he "seemed fine." Now a junior, he is failing chemistry and Spanish, loses assignments and was in a minor car accident after looking at his phone. Teacher and parent ratings confirm current symptoms in both settings. His parents worry that stimulants will lead to drug use. Marcus mentions that two classmates asked whether he would sell pills if he got a prescription. What follows sets out the evidence and the plan.
Confirming Current ADHD
Adolescent ADHD often looks different from childhood ADHD: hyperactivity lessens, while disorganization, procrastination and inattention to schoolwork and driving become more impairing. Marcus's symptoms are confirmed by teacher and parent ratings and by his own account, with impairment in school and safety. Screening for depression, anxiety and substance use is negative; he drinks alcohol rarely and denies cannabis use.
History of His Earlier Treatment
Marcus's earlier methylphenidate course helped his grades and caused only mild appetite loss. It was stopped at 12 not because of side effects but because the demands of sixth grade were lighter and his family hoped he had outgrown the condition. Many adolescents are taken off medication at this point, and symptoms often return when schoolwork becomes more complex and independent.
Choosing a Medication
Pooling 133 blinded randomized trials of ADHD drugs in children, adolescents and adults, Cortese et al. (2018) reported that, in young people, all included drugs were more effective than placebo on clinician ratings of core symptoms, with methylphenidate recommended as the first-choice medication for children and adolescents when efficacy and tolerability were considered together. Based on this and his previous response, Marcus restarts methylphenidate in an extended-release form.
Addressing His Parents' Worry
Chang et al. (2014) used Swedish national registers covering more than 38,000 people with ADHD and found that stimulant medication was not associated with increased substance abuse; the rate was 31% lower among those medicated, and longer medication duration was associated with lower rates. I share this with his parents, explaining that untreated ADHD itself raises substance risk through impulsivity and school failure, and that treatment appears, if anything, to be protective.
His parents feared the pills would lead to drugs; the larger danger was the ADHD they were meant to treat.
The Diversion Risk
Wilens et al. (2008) systematically reviewed 21 studies of stimulant misuse and diversion and found that 16% to 29% of students with stimulant prescriptions had been asked to give, sell or trade their medication, with higher misuse and diversion associated with immediate-release preparations. Marcus's classmates' requests fit this pattern.
Safeguards
An extended-release formulation reduces the appeal for misuse and reduces the need for a school-day dose (Wilens et al., 2008). Medication is kept in a locked box at home, and his parents give him each day's dose. Prescriptions are for 30 days at a time, with pill counts at visits. Marcus and I discuss what to say when asked to sell: he chooses "My parents count them," which he finds easier than refusing outright. I explain that selling or sharing his medication is a felony and could harm a friend with an undiagnosed heart condition.
Nonstimulant Options
If diversion concerns grew or if he developed intolerable side effects, atomoxetine, a nonstimulant with no misuse potential, would be an alternative, though Cortese et al. (2018) found it less effective than stimulants in young people. Guanfacine extended release is another nonstimulant option. For now, the benefits of methylphenidate with safeguards outweigh these alternatives.
Talking About Misuse Directly
Wilens et al. (2008) found that students misuse stimulants to concentrate, stay alert, get high or experiment. I talk with Marcus about how classmates might see his pills as a study aid and why taking someone else's stimulant can be dangerous, especially with alcohol or energy drinks. He is surprised to learn how common requests are and says it helps to know he is not the only one being asked.
Driving
Adolescents with ADHD have higher rates of crashes. Extended-release medication that covers late afternoon and evening driving hours may reduce risk. We agree on no phone use while driving, enforced by a phone app, and a family driving agreement.
School Supports
With Marcus's agreement, his parents request a Section 504 plan for extended time, a second set of textbooks at home and weekly check-ins with a school counselor about assignments.
Family Communication
ADHD in adolescence often strains family relationships through missed chores, forgotten plans and arguments about homework. A brief family session sets clear, limited expectations and a weekly planning meeting on Sunday evenings, which reduces daily arguments. His parents agree to praise completed tasks rather than focus only on what was missed.
Organizational Skills
Medication improves attention but does not teach planning. A school-based or clinic-based organizational skills program teaches Marcus to use a single planner, break assignments into steps and check his online grade portal twice a week. Skills training adds to the effect of medication and lasts beyond it.
Alcohol and Cannabis
Marcus drinks rarely, but adolescents with ADHD are at higher risk of heavier use later. We discuss how alcohol and cannabis worsen attention and driving, and he agrees to be screened at each visit.
Monitoring
Baseline and follow-up measurements include height, weight, blood pressure and heart rate. Common side effects, including reduced appetite and trouble sleeping, are monitored. Rating scales from parent, teacher and Marcus are repeated after four weeks at a stable dose. His cardiac history and family history of sudden death are reviewed before starting, and both are negative, so no ECG is required.
Sleep
Stimulants can delay sleep, and adolescents already tend toward late bedtimes. Marcus takes his dose by 7 a.m., stops caffeine after noon and keeps his phone out of the bedroom. If sleep onset is still delayed beyond 30 minutes after two weeks, the dose timing or formulation will be adjusted.
Planning for College
Marcus hopes to attend college in two years. He learns how to manage his own prescriptions, keep medication secure in a dormitory and seek disability accommodations, skills that build toward independent management of his ADHD.
Involving Marcus
At 16, Marcus should help decide. He wants to pass chemistry, keep his driver's license and play baseball. Linking treatment to his goals increases his willingness to take the medication consistently.
Conclusion
Marcus has persistent ADHD with impairment in school and driving. A network meta-analysis supports methylphenidate as a first choice for adolescents, and national registry data show no increase in substance abuse with stimulant treatment. Because many adolescents with prescriptions are asked to give or sell them, his plan pairs extended-release methylphenidate with locked storage, parental dosing, pill counts and a practiced refusal, plus driving and school supports.
References
Chang, Z., Lichtenstein, P., Halldner, L., D'Onofrio, B., Serlachius, E., Fazel, S., Långström, N., & Larsson, H. (2014). Stimulant ADHD medication and risk for substance abuse. Journal of Child Psychology and Psychiatry, 55(8), 878-885. https://doi.org/10.1111/jcpp.12164
Cortese, S., Adamo, N., Del Giovane, C., Mohr-Jensen, C., Hayes, A. J., Carucci, S., Atkinson, L. Z., Tessari, L., Banaschewski, T., Coghill, D., Hollis, C., Simonoff, E., Zuddas, A., Barbui, C., Purgato, M., Steinhausen, H.-C., Shokraneh, F., Xia, J., & Cipriani, A. (2018). Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: A systematic review and network meta-analysis. The Lancet Psychiatry, 5(9), 727-738. https://doi.org/10.1016/S2215-0366(18)30269-4
Wilens, T. E., Adler, L. A., Adams, J., Sgambati, S., Rotrosen, J., Sawtelle, R., Utzinger, L., & Fusillo, S. (2008). Misuse and diversion of stimulants prescribed for ADHD: A systematic review of the literature. Journal of the American Academy of Child and Adolescent Psychiatry, 47(1), 21-31. https://doi.org/10.1097/chi.0b013e31815a56f1
How this PMH 505 Week 2 example is structured
The PMH/505 Week 2 work usually addresses ADHD in children and adolescents. This paper focuses on the adolescent-specific issues, including parental worry about substance use, misuse and diversion of stimulants and driving, and shows how each is answered with evidence and a concrete plan. Students search this week as PMH 505 Week 2, PMH505 Wk 2 or PMH/505 Wk 2; all three are the same assignment.
PMH/505 Week 2 questions, answered
What does PMH/505 Week 2 usually ask for?
Many sections ask students to assess and manage ADHD in a child or adolescent, including medication choice, monitoring and behavioral and school supports.
Does stimulant treatment for ADHD lead to substance abuse?
A Swedish national registry study found that stimulant medication was not associated with increased substance abuse; the rate was lower among those taking medication, and longer treatment was associated with lower rates.
How common is diversion of ADHD stimulants?
A systematic review found that between 16% and 29% of students with stimulant prescriptions had been asked to give, sell or trade their medication.
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