View Full Version : ADHD ODD worse with meds -what's next?


Duckgrl
02-06-17, 11:58 AM
My 8 yo son was diagnosed with ADHD and ODD last year and we are kind of at a loss about what meds to try next. He is very aggressive and disrespectful if he doesn't get his way, very jealous of any attention paid to his little sister, and its affecting our family. We do see a therapist for PCIT and follow this at home, but we think we need better medication support to help with his emotional responses. What i've read suggests stimulants for ODD and if those don't work, strattera or tenex. But what next if those aren't working?

We tried ritalin initially, and he became more emotional and aggressive so we moved to adderall. This seems to work a bit, and he has been taking 5mg xr for several months. We tried to increase the dose but this caused more aggression/irritation. Now, when the meds wear off in the evening, he has meltdowns (screaming, slamming doors, saying hateful things). We are willing to tolerate this to a degree, if he can keep it together while in school. However, I am concerned that he is so irritable. Our once bubbly gregarious kid is now surly (not all the time, but a lot), irritable and socially isolated. He is academically gifted, but struggles socially. He just doesn't know how to 'play' with kids his own age, even though he's very social. I think he's becoming aware of this, which maybe makes it worse.

Recently we tried strattera and then tenex (combined with the 5mg adderall) and both made him more aggressive/irritable. I am at a loss of what we need to do next. His ODD seems to be getting worse. He is so uncomfortable interacting with people and we are getting emails that his disrespectful behavior is increasing at school

He told me last night that he is scared of going to school because he's afraid he will behave badly. We have long wondered if he has some social anxiety that manifests differently from most kids. When he's in a new situation or feels uncomfortable, he becomes awkward, loud, talks in a baby voice, does silly things. But, he can talk to adults all day long one on one.

We are meeting with his psych on Wednesday and wonder if we need an SSRI for anxiety/depression, but we are concerned about side effects and that it will take so long before we can evaluate whether it works...

I'm sorry this this so long. I'm just so frustrated that nothing we try seems to help. Anyone with a similar experience?

dvdnvwls
02-06-17, 01:58 PM
I hesitate to suggest anything because I know that parents in your situation have generally "turned over every stone" several times already. But when ODD gets worse with medication it makes me wonder what is tormenting him inside. I know that's not really what you came here to ask about, but it's hard for me to avoid thinking of it.

Caco3girl
02-06-17, 03:34 PM
Maybe this is just MY experience but I could tell in 2 days if a medication was having an affect on my son. The let down after Vyvanse turned my kid into what you are describing, so that stopped on day 2. Ritalin seemed to make him jumpy, Aderal XR worked okay but wasn't enough, concerta worked really well but made him loose too much weight because he felt like he couldn't eat. Dr. finally said 20 mg aderall XR in morning and 20 at lunch, that seems to work really well for my son, without any let down issues when he comes off of it.

Can you talk with your Dr about how long you are suppose to give each of these medications? I'm thinking when you find THE one you will know it pretty fast.

dvdnvwls
02-06-17, 07:41 PM
Maybe this is just MY experience but I could tell in 2 days if a medication was having an affect on my son.
Sure, it's easy to spot when the dose is way too high or it's just a bad match - but noticing when it's just right is hardly ever that simple.

Duckgrl
02-07-17, 10:33 AM
Thanks all. While stimulants are fast acting and you can see their effect very quickly, meds like strattera (an SNRI) can take weeks to be effective. The realization that it wasn't working kind of crept up on us over the holiday break. Tenex on the other hand was immediate anger (the exact opposite of the expected reaction) - about an hour after the pill (.5mg). We only tried that 2 days.

I do think he has some emotional challenges we need to get to the bottom of. In addition to meds, we are going to circle back for some individual therapy/skills development for him; he just wasn't ready for that at age 7, but hopefully he will now.

He was adopted at birth (no trauma or drugs in-utero), but i think this weighs on him. ADHD and difficulty regulating emotions are most certainly inherited in his case (tho we don't have formal documentation). He also has multiple food allergies so there is some anxiety here too. His neuro psych evaluation suggested he may also have some autistic qualities, but this was unclear. He goes to vision therapy and he's not sporty and kids don't want to play with him because he doesn't have the social skills, so he has a lot of things he probably thinks are 'wrong' with him. He told me he's scared to be at school because he is afraid he'll have bad behavior and he's really not himself when i drop him off. He goes and gets a book and sits alone in a corner. Maybe this would be ok if he were a shy or loner kid, but he desperately wants to be with others.

He's a great kid and over the top smart, but his social challenges and emotional management are really hindering him. Thanks for listening.

sarahsweets
02-07-17, 11:47 AM
Thanks all. While stimulants are fast acting and you can see their effect very quickly, meds like strattera (an SNRI) can take weeks to be effective. The realization that it wasn't working kind of crept up on us over the holiday break. Tenex on the other hand was immediate anger (the exact opposite of the expected reaction) - about an hour after the pill (.5mg). We only tried that 2 days.

I do think he has some emotional challenges we need to get to the bottom of. In addition to meds, we are going to circle back for some individual therapy/skills development for him; he just wasn't ready for that at age 7, but hopefully he will now.

He was adopted at birth (no trauma or drugs in-utero), but i think this weighs on him. ADHD and difficulty regulating emotions are most certainly inherited in his case (tho we don't have formal documentation). He also has multiple food allergies so there is some anxiety here too. His neuro psych evaluation suggested he may also have some autistic qualities, but this was unclear. He goes to vision therapy and he's not sporty and kids don't want to play with him because he doesn't have the social skills, so he has a lot of things he probably thinks are 'wrong' with him. He told me he's scared to be at school because he is afraid he'll have bad behavior and he's really not himself when i drop him off. He goes and gets a book and sits alone in a corner. Maybe this would be ok if he were a shy or loner kid, but he desperately wants to be with others.

He's a great kid and over the top smart, but his social challenges and emotional management are really hindering him. Thanks for listening.

I think its a fantastic idea to get him some therapy. Very often the underlying reasons with ODD are just as important as ODD itself.

luckBeIllusory
04-12-17, 06:00 PM
My son is 7 and was diagnosed at 5 yrs old. I would describe what we went through as exactly what you wrote. The methyl phenidates made him aggressive and moody. The adderall only worked okay and the side effects he had coming off of them were an emotional nightmare for everyone. After 2 years of "playing with medications" we finally found HIS right medications. For his ADHD he takes Dexedrine. It only has the d-amphetamine in it as opposed to adderall which has 4, I think. Removing the L-amphetamine, which is responsible for the "energy" aspect of that medicine (I think) and the d-amphetamine is a "calming" agent. This difference was a major improvement for my son. I realized that when Riley was coming off of the adderall, he wasn't misbehaving but was extremely uncomfortable with the edgy feeling from coming off it and he expressed his discomfort the only way he knew how.

With the Dexedrine xr(not the ir) he comes home from school, does his homework, isn't moody anymore and he falls asleep easily with melatonin. He also doesn't fight me every time I try to give him his medicine in the morning. (We both take this medicine and I also get very calm but focused when I take it and in the evening i don't get the irritable, jittery or anxious rebound effects I got from the adderall and methylphenidate.)

I should make a note, my son also takes 0.1mg of Clonidine at night for sleep, 0.5mg risperidone morning and night for his ODDand 25 mg of Zoloft in the morning for also for his ODD and ADHD, he also got very depressed. He wasn't fitting in at school, kids made fun of him, and he would get embarrassed after the meltdowns.

He has a therapist go to the school each week, which is an awesome program his psychiatric center does, then him and I go to therapy together every other week. Since amphetamines depletes bodies of vitamins and minerals (mainly potassium, magnesium, B1,B6, and B12) we both drink chocolate carnation instant breakfast and a banana with our morning gummie viatmins, he drinks water throughout the day and at night we drink orange juice to flush whatever amphetamine is still in our bodies.

I'm going to stop here because I would have been bored reading this halfway through. ;)

Duckgrl
04-14-17, 02:52 PM
Thanks for your reply. We ended up adding prozac into the mix and the change in his oppositional behavior was almost instant. I can't explain how that's possible, but it happened. He went from arguing/screaming about every little thing, walking on egg shells because we weren't sure what side of the bed he would wake up on - to responding politely and being more agreeable. We were on 5mg for 3 weeks then bumped up to 10mg for the past 6 weeks. He did have some side effects, particularly around week 3 (feeling sick, naughty behavior), but overall we are reporting that his anxiety seems reduced and overall he seems happier. He is still hyper and has many social challenges that affect his self confidence and he tries to hide these until they all come tumbling out. We will need to keep up on that. But the happier and less defiant behavior is impossible to miss. We may end up increasing the prozac and possibly the adderall (and i'm still not sure it's the perfect med for him). We are also planning to meet with a therapist to work on coping mechanisms, social cues etc.

Seeker12
04-24-17, 03:30 PM
Hi there,
Saw this and wondered how things are going a week or two later? Do you think a lot of the aggression was due to anxiety that is being addressed with the Prozac? My son is only 6 and he is often cranky, low frustration tolerance, has a lot of trouble with transitions throughout the day. His focus is a lot better on the stimulants, but aggression and anger is worse, especially in the mornings before meds and at night when they wear off. We've always thought that anxiety is playing a role, but interesting to hear about your results with Prozac. Let me know!