I'm not sure what my next step should be with my nine year-old son. We see a pediatrician who specializes in ADHD. For the past 4 years we've done one med after another and we ALWAYS have the same two issues. First, to get a high enough dose that actually covers all his symptoms he basically is an overmedicated zombie, and second after anywhere from a couple of days to a couple of weeks he becomes an emotional mess and seems very depressed. He talks about how worthless his life is etc. When we take him off the meds, like we did this summer - he is a happy, cheerful little guy but he's so hyperactive that he's like a small tornado. Basically we've kept him on meds and somewhat depressed just so that he can function at school - but it's not a good long-term solution and of course as parents we feel really bad for him. Doc says keep trying meds. So far we've tried: Ritalin LA, Focalin XR, Adderall XR, Concerta, and now the "Patch" - same exact problems with all of them.

weez

Just in case read my post linking ADD/ADHD to sleep disorders like sleep apnea.

http://www.healthboards.com/boards/showthread.php?t=485553

They tried labeling my son with ADHD but he was not. He could concentrate and was extremely smart, he just had to be interested in the topic.. he just refused to sit still, was loud, disrupted class. These things turned out to be his way of staying awake; because, he would fall asleep when he got still. This was all due to sleep deprivation induced by the severe OSA (obstructive sleep apnea) my son inherited from me. There is nothing scarier than finding out your child stopped breathing 30 times an hour, and that of the ten hours of sleep he was getting only four hours of it was true sleep.

I am not saying that your pediatrician is wrong.. I know ADHD is a valid and difficult disorder to deal with.. but if there is a sleep disorder aggravating things maybe my post will help in your treatment of your son.

Sincerely,
MG

weez,

In addition to mkgbrook's excellent suggestion, may I also add that your son just may not be a candidate for drug treatments. If it turns out that there just isn't anything that he can take without such strong side-effects, there are a couple of things you might think about:

mkgbrooks's suggestion about sleep apnea, of course.

Food allergies (red dye, etc).

It may be that he just needs a really different environment than a traditional school classroom. He may actually need more opportunity to incorporate physical activity into his learning situation. If he learns how to channel all that energy, he may grow up to feel positive about himself, and be able to find a job that requires quick reflexes, creative responses, constant change and challenge to keep his active mind from becoming bored.

One thread that made an impression on me is by Dutches, "help what is going on with me?!" at http://www.healthboards.com/boards/showthread.php?t=509307

She talks about a life of traveling the world and dancing for a living. The wonderful thing is that she is able to live with a hyperactive form of ADD without having to force herself to fit into a corporate mold.

I appreciate that you have your hands full with an active child, and you are concerned about his health if he continues to take drugs, and his academic performance if he doesn't take drugs. Perhaps others will have more suggestions for you.

--Rheanna

Thank you both for your suggestions. I did read the thread about Sleep Apnea but I really doubt this is his problem. There are certainly no symptoms that suggest it other than the ADD symtoms themselves. Also, his older brother also has ADHD but it's very easily treatable with meds in his case. we've already had him allergy tested and nothing showed up so I don't think that is it either.

I certainly have thought about keeping him off meds permanently. When he was young we worked with a private behavioral specialist but unfortuntely it didn't help which is why we turned to the drugs. My son is so hyperactive and innattentive that it's our opinion that he can't learn. We originally thought that he might have a learning disorder in addition to his ADHD because when he was younger he didn't know his colors, his ABCs, etc. until much, much later than his peers. Testing later showed that he's very smart - he's just not picking up much of anything from his enviroment. And it wasn't until we put him on meds that he actually caught up academically with his peers. Now he's doing fine except for his writing (but that's another topic).

I've looked at various schools around here, and my options seem quite limited. Most private schools only want cream of the crop type of kids and my son would need to be interviewed etc. There is one private school for milder special-needs kids but the tuition is so high it's not even a remote possibility. But I'd like to research this some more. I'm just not sure what kind of school would take a kid like mine unmedicated? He shows STRONG signs of being a good future engineer or architect and we were hoping that this would be something we could foster.

Thanks,

weez

Weez,

It is a "mind" field worse than prescription drugs, nevertheless, you may find something usefull by wrenching your way through the labyrinth of alternative herbal and nutritional supplements.

I do fairly well on 60mg Ritalin during most of the day. ADHD rebound makes my evenings anything but relaxing. So I am always on the lookout for something better. I have been experimenting with DMAE and synergestic compounds such as choline with some encouraging results.

Let's call a drug a drug. We are talking about OTC drugs that can have some pretty nasty side-effects. Beware.

Your boy's hyperactivity and his adverse stimulant history may warrant a trek through the maze.

I know one thing for a certainty - channel his energy and nothing is beyond his grasp.

Bob

Thanks Bob! I agree it's just such a maze and it's so frusterating trying endless things that may or may not help. OVer the years some things we have tried include sensorty-integration therapy (he doesn't have any real sensory issues but we were told it would help ADHD). We also ordered all these vitamin/herbal liquids from some highly recommended lab. Also tried fish oils, the Fiengold Diet, and probably a few other things I've forgotten.

I'm starting to get interested in taking him to see Dr. Amen in California.

weez

I agree with addprogrammer, if your son finds something he is interested in, he will do extremely well. My own son never at all interested in school found computer programming and now he is so into it he wants to get a masters to teach. This is the same kid who would barely do homework, hated school, got those "disruptive in class" notes sent home every report card. Sometimes it does take a bit longer for such kids to find their thing but these intelligent kids do well with their chosen field. He didn't take meds because in the 1980's Ritalin and the like were around but not pushed as much as now.

you know, even though your son doesn't test postivite for food allergies, doesn't mean food isn't adding to his problem... if my daughter doesn't stick to a strict "natural" diet (whole grains, fruits, vegetables, fish, poultry, very little red meat, legumes.....), she turns into a hyperactive SPAZ!

also, my older brother had behavioral problems in elementary school for years, and they FINALLY (when he was 11) figured out he was just too smart (genius smart) for his classes!

just a couple of ideas... good luck!

Weez,

First, I feel for you. I, too, have an incredibly hyperactive son for whom it soon became apparent that medication wasn't the answer. Talk about a rock and a hard place. It stinks, doesn't it?

This is what I suggest.

First, I think you should leave this thread for a day or two and then come back and read what you have written. I think that you will see it with "new eyes".

What I think you'll find after leaving this thread for a little while is that it's hard to justify an overmedicated zombie who is an emotional mess. Surely, success in school isn't worth that.

Is it?

If, after that time, you decide you still want to try medication for your son, here's a suggestion. Strattera had a very nice anti-depressant effect for my son. It helped alot with the hyperactivity, but didn't really help his attention span. For a while, he took Strattera and Metadate together. IF you still want to try medication, you might look into the combination.

I gotta tell you, though, that although the combination worked quite well for my son, he began to complain of cardiovascular symptoms: rapid heartbeat, feeling weak, etc. At that point, I decided it just wasn't worth it. No amount of success in school could justify risking his health.

I don't know what the answer is. My son is now turning 17. He is no longer as hyper as he was, but his attention span is still f-a-r from average. I'm not sure that he will graduate on time and I'm not sure that he'll be able to go to university.

Go back and reread Rheanna's response to you as well as ADDprogrammer's. Search for the thread Rheanna mentioned ("Help what is going on with me?") and also read the later part of the thread "ADHD is a disorder" where the two of them gave me advice about trying to force my hexagonal son into a round/square hole. Alot of wisdom in those two threads. Gave me a different perspective.

I don't claim to have the answer. But, I do understand what you are going through.

Good luck and God Bless!

Thanks index! I've reread the thread several times and even had my husband read it at lunch time. I've obviously in my post not told the 'entire story' which of course had I done that, may provide additional insight into my son's situation.

My son had been off medication this summer until very recently and every summer before that. Each time hubby and I decide that in spite being happier, he is better off for a ton of reasons being medicated. It's a very tough decision and it affects not only him but every member of our family. In his cases he would need to be declared special needs and he would probably have to go to the emotionally handicapped kids school or the pohi school where they learn to stamp license plates from an early age (ok I'm exaggerating). Last year on meds he got all A's and B's.

So we are not ready to give up on it just yet. Basically like many of you I believet that ADHD is a medical disorder/mental illness/brain dysfunction etc. and I think it's very risky to not medicate if the symptoms warrant it. Unfortunately in some cases like my son's, it's not a simple matter. My husband grew up as an unmedicated ADHD person and has described to me in great painful detail exactly what it was like. He really wishes there would have been something to help him.

I guess at this point what I was looking for was suggestions from others who have experienced this emotional lability from meds and if there was some combination that worked or even some specific therapy that they used in conjunction etc. My older son who is ADD-inattentive went through the exact same problems with the emotional lability when he was younger, then was successful on Adderall as he got older (now he's ready to go off meds we think!). ANyhow, the ADHD doc doesn't like to prescribe only Strattera these days as he thinks it's quite ineffective for more severe cases. I'm going to ask him about a combination with it and another drug.

Thanks SO much everyone - I really appreciate all your responses!

weez

Hey index, your son is exactly what happened to my nephew...the Adderall caused emotional lability and they had to stop it, then the Strattera worked but then the fatigue and physical stuff caused them to give that up too!

I don't have the answer either but just to let you know my nephew really improved with tutoring and my son who I thought would never do anything in life has finally, at age 29,(EEEK) figured out what he's good at and is going for it! In other words, these brilliant kids usually take wayyyy longer to get there BUT they get there...

A few years ago my son figured out he liked computer programming and can sit and do it for soooo long it's ridiculous ;yet when in grades 1-12 it was all he could do to sit down for 10 minutes for homework.

So maybe your son will find "it", that thing that he wants and can focus on because he likes it and is good at it!

Don't despair, I hope he'll find it someday. My husband and I have really been waiting sooo long for this but now it's finally happened. My son still has awhile to go before he graduates, but at least he wants to get a masters degree and teach it (since he doesn't like the office setting most programmers get stuck with who do it full-time) and that's a career. Right now he freelances. And if it wasn't for him, I wouldn't have such a high speed computer with all sorts of features for as cheap as I got it(he built it, he networks all our home computers, etc.) so I'm grateful:)

Maybe your son can do some exploration in community college, that's how both my kids found "it" (daughter loves mathematics). At least community college is less pressure and cost too!

Going straight to university isn't always the best. My mother in law is a retired university professer and she even recommends community college first. University is a big step directly from high school, so big that alot completely drop out. Community college is a gentle stepping stone and also an inexpensive way to explore things while still earning credits for the university.

This may even be what happens to your son, weez, so don't be discouraged either. I think grade school and even high school does not necessarily dictate the future of a child.... my kids did nothing in grades 1-12 that actually lead to what they are doing now.

... ANyhow, the ADHD doc doesn't like to prescribe only Strattera these days as he thinks it's quite ineffective for more severe cases. I'm going to ask him about a combination with it and another drug.


I agree with your doc that Strattera alone probably won't be enough for your son. I do think that it's worth asking him about using it in combination. One nice surprise of the combination was that my son's appetite acutally improved from what it was on one medication alone.

If you do try Strattera, give it to your son at night and with food to minimize the potential stomach upset and grogginess that it causes at first.

Keep us posted on how things go, okay?

Thanks everyone!

I don't think that there is anything wrong with attending community college - I started there myself. But it's a little early to be thinking of that IMO ;) At this point we are choosing the path that says he can be what he wants to be when he grows up. We may have to modify that based on how things go over the next few years, but he's 9 and we are not giving up on academics just yet.

We are obviously not going to keep him in a zombie-state or an emotional mess just to make good grades at school. If that was the case, I wouldn't be posting here - I'd just do it. Our back-up plan right now if we can't find an effective med, is to go back to perhaps Ritalin LA or Aderall and only give him a tiny dose. It's enough to take away the hyperactivity without giving him the emotional side-effects and allows him to interact more normally with others. However, doses that small don't cover other symptoms but it's probably better than nothing.

I've decided to stop working part-time and focus my enegies entirely on my getting my son settled/stabilized -whatever that may be. I'm also going to get him a tutor like Jennita suggested to help him with his writing. He's going into 4th grade which is a tough year in our district and I feel quite worried. I'm mostly worried about all the homework since he always seems so drained at the end of a long day.

Another thing I'm going to do is to focus more on his strengths. He is very very talented in any type of design, engineering, electronics area for his age. He takes motors from some appliance and hooks it up with all sort of things and converts it into another tool for example. He loves Lego and builds very complex structures with many moving pieces - pendulumns etc. So I'm thinking of getting him into an after-school program that focuses on some of these things.

I'll keep you all posted.

weez

That sounds like a great plan, Weez! My son has had tutors since the first grade. I'm amazed that your son is able to focus on things like Legos. Until high school, mine was never able to sit still long enough. Is your son able to do that in the summer when he is unmedicated?

Ahh, the dreaded homework. It seems almost cruel after a long day at school, doesn't it? At that age, I helped my son ALOT with his work. I also negotiated with his teachers for him to do less of it WHEN he could demonstrate that he got the concept with less work. In other words, why do 20 math problems if he can show in 10 that he understands the concept? So, I might write his teachers a note that I allowed him to do only the 'evens' and to please accept it for whole credit. They were very good about it. Or, I might do every other problem for him. If he didn't understand what they were doing, though, he needed to do them all.

Likewise, for written assignments (on really heavy homework days), I occasionally let him dictate his answers to me. I'd send in a note saying "Although this is in my handwriting, it is Joseph's work". Again, because the teachers knew the situation, they were very good about it.

weez,

To this day - 47 years since age 9 - still can't do cursive. Curse? Yes but not cursive. I print or type. Problem solved.

Work-arounds exist for many ADHD caused difficulties.

We do much better one-on-one than in groups. We do things backwards better than forward. Assign son a project, say, build a computer and teach him engineering/mathematics/programming in the process. Chances are, you'll need only supply the parts and the books - boy will do rest. He'll build and program a computer before he knows how.

Or an radio controlled airplane - same as above.

Or, you name it.

And, I want to underscore your thought of taking him to Amen's clinic. Amen's style? Let's do what works - diet, nutrition, exercise and, if necessary, rifle targeted meds based on subtype(s) of ADD rather than a shotgun blast in the dark approach.

I think you got a super-charged brain on your hands. Somehow figure how to keep him on the pavement.

Bob

Thanks bob and index!

Working around ADHD problems is a great idea. In my son's case he can do cursive but not print! It apparently has something to do with the starting and stopping of each line versus a continuous flow. Each to their own, right! My ADD hubby can only print - so go figure!

I have never tried asking his teachers for accomodations for his issues. I may just do that this year. But unfortunately from what I've heard from other parents at our school, the teachers aren't very agreeable unless you have a 529 (is that the correct term) or IEP. Isn't that sad?

That reminds me of another question. I think I'll start a new thread.

weez

Thanks bob and index!

Working around ADHD problems is a great idea. In my son's case he can do cursive but not print! It apparently has something to do with the starting and stopping of each line versus a continuous flow. Each to their own, right! My ADD hubby can only print - so go figure!

I have never tried asking his teachers for accomodations for his issues. I may just do that this year. But unfortunately from what I've heard from other parents at our school, the teachers aren't very agreeable unless you have a 529 (is that the correct term) or IEP. Isn't that sad?

That reminds me of another question. I think I'll start a new thread.

weez

From your description of your son in posts, sounds like you have an engineer or physics major on your hands! And writing is overrated, writing is always harder to read than printing. I prefer printing myself. Why do they have you print, not write, important info on forms? Because most people's writing sucks, that's why.:cool:

Anyway, at 9 years old he has a way to go but he sounds very bright.

weez,

I had my shrink appointment yesterday and he gave me a possible solution to my problem of evening ADHD rebound that may help you.

If understood correctly your boy gets depresssed not long after initiating any stimulant med. Incidently, that is not at all uncommon.

Couple of point to keep in mind.

1. I'm "in-process" with my own ADHD management.

2. ADHD med management is more complicated than anything I previously attempted.

3. What works for me, may or may not work for others with ADHD. The billions of variables between people is why.

That being said ...

Shrink suggests that I add Welbutrin to my mix and lower dose of methylphenidate because Welbutrin is a "stimulating" antidepressant hence the possibility of over-stimulation - that zombie effect.

Welbutrin might manage your boy's depressive reaction and lower the dose of the stimulate med to boot.

Talk to Doc about it.

Bob

Weez, but also discuss the issues with antidepressants in children which have shown increased possibility of further depressive symptoms and possibility of seizures, mania, or even suicidal thoughts.

Maybe a less stimulating AD might work for the depression. But all AD's are cautioned for children under 18 for the reasons above. Or perhaps a natural way of helping depression like fish oil could be added?

Welbutrin might manage your boy's depressive reaction and lower the dose of the stimulate med to boot.

Interestingly, Wellbutrin and Strattera are chemically very similiar - not identical, obviously, but very similiar. So yes, either can be a help with reducing hyperactivity and depression. {But, Bob - don't start worrying. Wellbutrin doesn't tend to have the same "male" side effects that Strattera does}.

Although Wellbutrin is "stimulating" for some, I believe that it is less likely to cause a manic reaction than is one of the SSRI's. It is more likely to be prescribed for an individual with hyperactivity than is an SSRI. So, I think Bob's doc is right on target and I think that either it or Strattera might be something to consider for Weez's son.

[QUOTE=index.html;3136715]{But, Bob - don't start worrying. Wellbutrin doesn't tend to have the same "male" side effects that Strattera does}.
[QUOTE]

Index,

I KNEW THAT before I left office with script in hand. There isn't many but there is at least ONE thing more important to me than managing ADHD. :D

I know. I'm bad doggey;

hi weez... i just replied to the "other thread" you mentioned earlier... the one about teachers... anyway, i wrote my response there more from a teacher's perspective. now i'll respond from the perspective of one who has ADD/ADHD (depends on the doctor) but wasn't diagnosed until my early 20's.

i have only been on adderall since my diagnosis, and it has been amazing for me! inspite of what your doctor might tell you, adderall XR and regular adderall are VERY different in how they affect your body! i cannot take adderall XR! my doctor insisted i try it because it was the newest great thing for ADD... and i HATED it! it seemed to make me hyperfocus for 8 hours and then it wore off and i just got hyper (when my medicine wears off, i'm not a crasher, i just get extra hyper... i've been told that i can get "perky to the point of people want to slap me!"). i also cannot take generic adderall. it was like taking a placebo! just didn't work! so i stick with real adderall, 20mgs two times a day. i take one first thing in the morning, around 7, and then i take my second one sometime between 2-3 in the afternoon. that way it wears off just in time for me to go to bed!

anyway, my point is, you might revisit the adderall and try it in twice a day doses. it's not as "convinient" as adderall XR, as he (YOU) will have to remember that second dose, but it sure is better than that evening emotional crashing you have described! regular adderall comes in 5mg, 7.5mg (i think), 10 mg, 20mg, and 30mg pills, so you might get with your son's doctor and play with the dosage until you can find the right fit for him. it might be that he takes a higher dose in the mornings and then a smaller dose in the afternoons. back in the day, when i was single and had no kids, i tried taking 20 mgs twice a day, and it was too much for me! so i lowered it to 10 mgs twice a day, but that didn't work either because it wasn't enough! i finally found that taking 20mgs in the morning and 10 in the afternoon, was perfect! of course (sigh) now that i have a husband, two kids, and actual grown up responsibilities, i'm back up to 20mgs twice a day (although i think i'm getting ready to cut back in the afternoons again!).

anyway, you had mentioned adderall XR, but not plain adderall, so i wanted to throw in my thoughts about plain adderall in case you haven't tried that route yet! good luck to you! :)

Can the dose be lowered to cover his symptoms only partially, and then have the method of teaching changed to accomodate a short attention span? It might be far-out, but consider home-schooling: This way you can teach in five-minute bites, and he can run around in between if he wants. (Obviously only home-school if you know you are qualified to teach a child--not a teaching degree necessarily, but definitely a college education.)

Thanks for all the input everyone! I'm really grateful.

Right now the patch is going OK! I'm really hoping that this will work. If not, the Wellbutrin/Stattera combination will be something I will talk to the doctor about. I think he even mentioned that he might try a combo approach. But before that, he wants to try a non-time released type of drug such as short-acting Ritalin. Why? One of the theories as to why some people (kids especially) get 'emotional' issues from these drugs is because of the speed of a child's metabolism. I'm not sure that I fully understand it but some childrens bodies basically can't handle the time release formulas normally, their bodies burn through it too fast and they get too much of it too soon. THis is probably why my older son couldn't do anything other than Strattera until he was about 10. Anyhow, it's just one theory.

Callista - yes, I think taking a small dose of meds just to get rid of some of the hyperactivity and then using other methods for the lack of attention span, may be what we end up doing.

Home-schooling? I'm not interested in that at all, but I would never rule it out.

weez