Anonymous wrote:*Cross-posting from the Tweens and Teens forum*

I'm the adult sibling of a teenage (16 yo) boy. My brother was diagnosed with ADHD as a child and has been on medication for the better half of a decade at this point. Recently I have learned that he is having severe difficulty falling asleep at night because his adderall dosage was doubled over the past year. He also has trouble waking up in the mornings and has been allowed to not attend school or go in late due to lack of sleep (e.g. falling asleep at 3am and waking up at 6am).

To my knowledge, increasing the adderall dosage was an extreme measure to take because his dosage went up by the same percentage increase between the fifth and tenth grades (e.g. puberty) as it has this time and the current increase happened because "he felt like it" and "thought it would help him in school" (there's typically nothing wrong with his performance as a student). He also takes beta blockers to counteract the effects of his adderall at nighttime and had those increased as well, but apparently he's so stimulated that they have become useless. The psychiatrist he sees recommended putting him on anti anxiety medications as well to help him fall asleep, which as of day two seem to be making things better, although he is still groggy in the mornings.

I think he is EXTREMELY overmedicated and have thought this for years. He always seems to be taking an adderall to help him with his homework at all times of the day, up to as late as 6pm. His use of medications has only increased with age, not decreased. There seems to be minimal emphasis on proper time management or getting better at executive functioning, which IMO would decrease the need for heavy levels of medication. He is pretty sedentary overall (no team sports, gym class as primary physical activity, town doesn't have sidewalks) and doesn't have a particularly healthy diet (very limited fruits and vegetables, heavily protein based). I also don't think he's that overscheduled because he's taking a rigorous but not completely backbreaking course load and doesn't have extreme extracurriculars. My mother doesn't *completely* believe that he is super overmedicated but is starting to think he might be "a bit overmedicated." She also seems to be expecting immediate results for him to have a perfectly healthy sleep schedule again when I don't think he ever truly had one and it took a year for him to reach this point, which makes me think it'll be a process for him to reach healthier sleep patterns again and not feel so groggy in the morning. Another family member also recommended talk therapy which I think would be helpful, but I don't think my brother or mother are completely on board with the idea.

What would you do or suggest in this situation? I have tried repeatedly to emphasize proper diet and exercise over a span of at least two years but it's fallen on deaf ears. I have tried to offer advice for what I do as someone who can have trouble falling asleep myself, albeit from an overactive brain and anxiety rather than stimulants. I don't live with them anymore but am getting increasingly frustrated with this situation because I offer suggestions and they don't want to do anything except rely on medication when I think it's just making the situation worse. As an aside, I find it really problematic that he was just able to double his dosage no problem and my mother signed off on it without thinking something like this could happen, and that using pills to counteract pills is the most appropriate measure. I'm also under no doubt he's feeling stressed from normal teenage life and that this isn't helping at all.