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This is especially important for younger children who struggle to get to the "zone" of the appropriate treatment due to being so busy and overwhelmed in their daily lives. The schedule of titration varies from patient to patient, however, it is generally a matter of increasing dosage in small increments every one to 2 weeks. Once the child is taking a prescribed dose and is performing at their best with no adverse side effects, the doctor will decrease the dose to a maintenance dose. You should also discuss with your titration prescribing doctor the best time to take the medication. In general, it is recommended to take it in the morning, so that your child is able to concentrate during school. However for some patients taking the medication later in the day may be beneficial because they may use it to complete their homework or concentrate while driving. It's also recommended to take your medication on a regular basis to avoid missing doses or forgetting to take them. Monitoring The aim is to find the ideal balance of medication to help reduce ADHD symptoms with minimal adverse negative effects. This balance could take 3-4 weeks of carefully adjustment. It is crucial that the physician and patient closely monitor the the effectiveness of the medication and any adverse effects. The patient should complete rating scales for each dose, such as the free Follow Up Vanderbilt forms or Adult ADHD Rating Scales from Frida can help physicians to track the effectiveness of the medication in a more objective way rather than relying on subjective parental and teacher ratings. The response to a particular dose of stimulants may differ significantly among individuals. This is why patients should be gradually ramped up to avoid overdosing. Certain people are not able to process drugs and will exhibit symptoms and signs even at very small doses (eg the atomoxetine drug - in 7%-10% of the population) (Belle et al. 2002; Hechtman, 2005). It is also recommended to slow down the titration process for patients taking any drugs that block CYP 2D6, like SSRI's. This will help prevent patients from developing a drug tolerance (eg bupropion or clonidine, atomoxetine, etc.). Monitoring long-term medication maintenance must be a continuous process. It should include evaluation of symptoms to be monitored, including the ability to complete homework and school related activities, as well as reviewing the effect on sleep and appetite function as well as asking parents and teachers for a regular rating of the impact on the individual child's behavior and functioning and self-ratings from adults and adolescents. [CG] The process of titration is often frustrating for some patients and their families. Understanding the rationale behind the medication and the expectations of efficiency and tolerance will lessen frustration and disappointment in the family. 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