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Speaker info:
Dr James Wiley, MD, FocusMD
Dr David Aversa, MD, MPH, CT Psych and Wellness/Beacon
Ragini Sanyal, Head of Clinical Research, Qbtech
Why titration demands more than intuition, and how objective data is changing everything
For decades, titrating ADHD medication has relied on observation, anecdote, and a healthy dose of clinical intuition. But in a world where every person metabolises medication differently, and treatment timelines are getting tighter, that simply isn’t enough.
Clinicians are facing a new kind of pressure: to optimisze ADHD care quickly, safely, and in a way that builds trust with patients and families. The answer? Objective data.
In this episode of Rethinking ADHD, Dr James Wiley MD and Dr David Aversa, MD, MPH joined Qbtech’s Head of Clinical Research, Ragini Sanyal, to unpack what modern medication management looks like and how tools like QbCheck are helping clinicians titrate with greater clarity and confidence.
Titration is not a standardized process, and it never has been
The challenge at the heart of ADHD treatment is simple: there is no universal “right dose.” As Dr Wiley points out, the effectiveness of stimulants isn’t based on age, weight, or severity of symptoms, it’s based on how each individual metabolises a specific molecule.
“It’s so very specific to the individual” added Dr Aversa.
The old rule of thumb, start low and go slow, still applies. But in a system plagued by time constraints, teacher feedback delays, and parental concerns, clinicians often have to make key medication decisions without consistent input.
That’s where objective testing can fill the gap.
When “better” isn’t good enough
Clinicians often hear parents say, “Things are better,” and assume the goal has been reached. But as Dr Aversa explained, this can lead to premature plateaus in care.
“They're so ecstatic that things are better and they might just stop. And you're like, well, okay, let's just see where we are. And then you do the test… and you can say, look, there's still room for improvement.”
Without objective testing, families may settle for progress that doesn’t go far enough and miss the opportunity for full symptom remission.
Dr Wiley shares a powerful case: a child had been on the same ADHD medication for two years with no change in dose. Despite worsening behavioral symptoms and being prescribed additional psychotropics, the ADHD remained under treated. A Qbtech test confirmed zero treatment effect. After switching stimulant classes and titrating up, the test normalized and all additional medications were discontinued within three months.
Remote testing is reshaping the titration process
In a recent Qbtech study, baseline and follow-up QbCheck assessments were conducted entirely outside the clinic — with meaningful results.
“All of the QbCheck assessments were done remotely, both baseline and post-treatment follow-up.” - Ragini Sanyal
The ability to track progress outside the clinic can have massive implications. It reduces the need for repeat visits, supports asynchronous care models, and gives clinicians more flexibility in how they monitor and adjust treatment.
It also reinforces the idea that ADHD isn’t a school problem, it’s a life problem. Symptom control should extend beyond classroom hours, helping patients regulate in relationships, routines, and everyday decision-making.
ADHD care is evolving and clinicians are leading the change
The shift toward data-driven titration reflects a broader evolution in ADHD care. Clinicians are no longer just managing symptoms, they’re optimizing outcomes, empowering families, and advocating for more precise standards of care.
It’s a nuanced process. Too slow, and motivation drops. Too aggressive, and you risk side effects or mistrust. But with the right tools, it doesn’t have to be guesswork.
As Dr Wiley said: “I don’t call it trial and error anymore. I call it trial and learning.”
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