I'm new here, so apologize if this is a fully thrashed topic that I just haven't located yet. My teen has been on most of the methelphendate Rxs - as a child, short acting Ritalin, later Concerta and finally Daytrana. In elementary school, she was very ad/Hd, but seems to have outgrown the hyperactivity. When she hit high school she was taking 54 mg Concerta morning only and started to seem "flat" emotionally. We reduced her dosage to 36 mg, which seemed to help some. Last fall, she switched to Daytrana 30 mg with 10 mg Ritalin to jump start in the morning. Over the past six months or so, she seems to have just completely "checked out" as far as cognitive abilities. Does her homework, then doesn't turn it in, even though I see her put it in her backpack. Can't plan anything in advance, worse with socializing (more withdrawn), wasn't excited to get her license at 16 or shop for a car. We have the car in the driveway, but she doesn't have her license yet b/c we have waited for end of year report cards. However, the enticement of a car didn't make her at all motivated to bring up her almost-failing grades. When we ask her why she doesn't turn in work etc., she says she doesn't know. In April she started seeing a p-doc who has prescribed 10 mg Lexapro for depression. She has been sleeping about 12-14 hours (yes, even sleeping during class when she can get away with it). Although the p-doc feels she's depressed, I think that the Daytrana was too high (based on what I now know about the body metabolizing it differently after about a month). I'm confused about whether I'm seeing depression or overmedication on her stimulants??
Anybody have any similar experience or insight?? Thanks for any advice you can give me.

Could be both (over medicated and depressed). It's not uncommon at all for people with ADHD to have other disorders as well (i.e. depression, bipolar, etc.).

An alternative to the stimulants is Strattera, which was orignally developed as an anti-depressant (some doctors proscribe it for off label use to treat depression and anxiety) but is now mainly an ADHD drug. It's not a stimulant, so it doesn't have the same effects as stimulants.

Also, has she ever been on any of the amphetamine stimulants? (i.e. Adderall, Dexedrine, etc.?). Some people do better on them than they do on the other stimulants like Ritalin and Concerta...

I compare a ADHD teenager with a pre menopausal women. The hormones during these times are not easy to cope with no ADHD involved. When you combine the two together, it can result in social anxiety disorders, depression.

But first, I would suggest that you bring her to her MD and have a physical. Thyroid conditions can cause some of these symptoms. Once you rule out any physical conditions, then I would speak to her doctor about her mediations.

How much exercise does she get? Try a health club membership and hire a personal trainer to keep her on track. It will not only build her self esteem it will boost her dopamine levels.

My son had the same problem, depression medications did nothing for him. I have discovered a huge breakthrough recently. He is now 26 and I suggested him getting a job that requires physical labor. The other jobs he had no labor involved and he got bored and depressed. He is a different person now that he is not sitting behind a desk. He looks better, is much happier and is communicating more than ever.

I hope these suggestions help you, good luck!

re: not getting excited by typical teen milestones.

Isn't another word for ADHD called "reward deficiency" syndrome, or something? Kids/Adults with ADHD just don't get excited about acheivements the same way as others.


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You mention sleeping a lot. (12-14 hrs day is ABNORMAL.)

It possibly sounds like a Sleep Disorder to me;
or meds related.
If your child is overweight, she could have sleep apnea.
SSRIs (Lexapro; isomer variant of Celexa) can cause RLS/PLMs, which can cause oversleeping; severe sleepiness, too.)
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I agree with Sandy 2130 about the exercise thing. Pills are ONE tool, but cannot be relied upon entirely.


Isolation and withdrawn behaviour like you mention make everything stressful worse, in mental health. (e.g. Animal studies show that rats will start to self injure, get abnormal behaviours, get 'rat depression', when they are kept in ISOLATION.) Humans are social animals, too, remember. :)

I don't believe in "overscheduling' kids, but I do thinnk they should do three things/week.
(a) something extracurricular (community service, volunteer job, help a neighbour; if you are religious, something r/t that possibly.)
(b) something musical and/or art related
(b) something sport related

EX (a) girl guides; junior acheivement; help at soup kitchen (alone or with family), (b) music lesson/drama/etc, (c) soccer, swimming, etc

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Exercise is also a way to get her interpersonally functioning UP and out meeting some other kids, etc. which might solve any social concerns. It's hard for kids to not have peers to do stuff with. If this continues, she will become more awkward and isolated with age. Not cool for when you want to grow up and get a job, etc..


Exercise is also best done, I find, in a family setting. (Or 1:1 with a loved one.) It should be playful and fun, not a chore.


Exercise is also a proven antidepressant and antianxiety intervention.


Exercise also improves sleep architecture.... (improved sleep quality & sleep efficiency means reduction in oversleeping).

Thanks to those of you who responded. She gets quite a bit of exercise because she plays club volleyball. Practice is about 6 hours a week, plus daily volleyball conditioning class at school. There are also two and three day tournaments a couple times a month. She interacts well with her teammates and has a couple friends on the team that she sees socially about once a month. They don't go to her school, though. She's also in choir and art (and is quite talented in both), so that aspect is covered. She's not very willing to do the service/religious activities, but has done a tiny bit of that. Since I posted, I've slowly weaned her of the Lexapro and the stimulants. She's been on Straterra 40 mg for about a month, and right now that, 960 mg Omega 3 and a multi-vitamin with B complex and magnesium (i.e., Centrum) are the only things she's taking. She has an RX for Focalin 20 mg that was prescribed by the p-doc who prescribed the Lexapro. I'm going to start her on that now that everything else has "cleared out" of her system. I'm wondering if thats a high starting dose, so we'll see how that goes. I don't really know what too high a stimulant dose does to a person, so if anyone can give me examples of behavior, attitude, etc. I'd love to hear from you.
Thanks, all.

Over the past six months or so, she seems to have just completely "checked out" as far as cognitive abilities. Does her homework, then doesn't turn it in, even though I see her put it in her backpack.Have you given the heads up to her teachers so they can remind her from that end?

Can't plan anything in advance, worse with socializing (more withdrawn), wasn't excited to get her license at 16 or shop for a car. We have the car in the driveway, but she doesn't have her license yet b/c we have waited for end of year report cards. However, the enticement of a car didn't make her at all motivated to bring up her almost-failing grades.Young people with ADHD do better with more immediate rewards, as you have just learned. High school is pretty overwhelming to lots of kids and more so for kids with ADHD. Girls especially have a very difficult time because of hormonal changes.

Wifeandmom, your situation is way too complicated to do it justice with brief answers on a forum. The son of a friend slept so much in grade eight that he finally had to drop out of school. Tests were inconclusive and everyone was worried about why this young, healthy teen couldn't stay awake. Eventually, it was discovered that he has muscular dystrophy.

If a psycho-educational exam didn't show any Learning Disabilities and a complete physical didn't show anything, I would want to learn what I could do to support her so she can be more open with you about what she is struggling with. You couldn't pay me to be a sixteen year old in high school again. :eek:

Just one more question: you mentioned in an earlier post that you husband also has ADHD but he is untreated. Did he get a formal assessment and diagnosis? Are his symptoms so mild that he doesn't need treatment?

Have you given the heads up to her teachers so they can remind her from that end?

Yes, I was in frequent contact with her teachers. We had a meeting in the Fall and agreed that I would get weekly updates on missing work, major assignments, etc. so I could follow up with DD. She didn't have a 504 or IEP plan, so it was hard to get consistent feedback from some of the teachers. A few teachers advised me she was sleeping in class, so I made them aware that she was on an anti-depressant. One never mentioned it to me and just let her sleep, then griped about her at the end of year conference :\. Anyway, the teachers would walk up to her and ask her for the homework and she would say, "I'll get it in a minute" (trouble switching tasks) then that would be the end of it.

She's been thoroughly checked out and doesn't have an LD or a physical problem. However, I will say that she doesn't sleep so much now that she's off the lex. She's been a LITTLE better this summer.

I know low-self esteem is a major problem for her, which breaks my heart. She's very good looking, high IQ, athletic (played in the US Junior Olympics this summer with her club team, but won't try out for school team), artistic, musical, funny, etc. (she's adopted, so I feel like I can say those things since I don't get to take credit for the genes). She used to have a good figure, a large circle of friends, pretty good class standing, etc. However, she's very sensitive to high school "drama" and I think that's made her unreasonably self-critical, and ultimately self-sabotaging. She's admitted this summer that when she got into high school, she just basically gave up on everything, but can't really articulate why other than she didn't like herself. I guess that's a good first step.

However, I think that if she felt more COMPETENT she'd feel more CONFIDENT. I just haven't seen any of the meds help much with anything other than ability to focus better/longer. They haven't helped with memory, follow-through, interpersonal skills, etc. So she constantly fails - forgets to turn in homework, can't finish projects, doesn't get that she's annoying some people or others are trying really hard to be friends with her, etc. - which just makes things worse in her mind.

I remember being her age and feeling bad about myself most of the time. But I did at least try to have good grades, join clubs that the other "geeks" were in, etc. But she's far from the awkward dork I was.

And btw, dh's diagnosis was only by him and me after dd was diagnosed. He's untreated.

She's very good looking, high IQ, athletic (played in the US Junior Olympics this summer with her club team, but won't try out for school team), artistic, musical, funny, etc. (she's adopted, so I feel like I can say those things since I don't get to take credit for the genes).We grow where we are planted. You have every right to appreciate her talents and ability, in fact, I worry that you feel you shouldn't shout it from the rooftops. Seriously, this kid needs to hear this and hear it often.


She used to have a good figure,OUCH! However, she's very sensitive to high school "drama" and I think that's made her unreasonably self-critical, and ultimately self-sabotaging. She's admitted this summer that when she got into high school, she just basically gave up on everything, but can't really articulate why other than she didn't like herself.:soapbox: O.k. the apple lady is on her soapbox. My very ADHD daughter was named citizen of the year when she was twelve years old and in grade seven. The person chosen was voted in by staff and the student body of her school. She was a passionate, kind, caring, brave, confident girl who was her own person and didn't fall prey to peer pressure. She started in kindergarten as a champion of the weaker students and never stopped.

Junior high happened and my grade eight daughter wore snow boots if she felt like it and I was impressed. You see, there are "rules" in high school and if you don't know what I mean, just watch the movie "Mean Girls". Our district shows this movie as part of the anti-bullying component of the Career and Personal Planning course. Grade eight was a great year, no different than grade seven only the phone rang even more often from all the new friends she made in the bigger school. :eek:

Grade nine started out just the same and I'm not sure, but it was probably midway through grade nine that we were out clothes shopping and my daughter said, "I like it, but I can't wear that colour to school." So it began. The "rules" were putting pressure on her. I remember feeling angry that "they" had even gotten to her, the most independent, stubborn toddler God put breath in, had caved to peer pressure. Clothes, hair, weight, body shape, etc., started to be too important. I don't know why, but this period of self-consciousness didn't last long and the old girl was back in grade ten, thumbing her nose at the "rules" and even adding some very bohemian friends to her life. She was one of three students from her school to receive a citizenship award for making a difference in her school.

What does this have to do with your daughter. Everything! If they got to my feisty, out there, in your face, bite me, girl, they can get to anyone. Because she is who she is, she only faltered briefly.



I just haven't seen any of the meds help much with anything other than ability to focus better/longer. They haven't helped with memory, follow-through, interpersonal skills, etc.We are not born with social skills, we learn them from other people. I will go and take apart the sticky re: medication for you.

So she constantly fails - forgets to turn in homework, can't finish projects, doesn't get that she's annoying some people or others are trying really hard to be friends with her, etc. - which just makes things worse in her mind.Did keeping an agenda fail? I'm sure you've already heard all the supportive things you can do from her teachers. Did you receive any information about your daughters birth family? Have you tried family therapy?

I remember being her age and feeling bad about myself most of the time. But I did at least try to have good grades, join clubs that the other "geeks" were in, etc. But she's far from the awkward dork I was.Did you have ADHD?

And btw, dh's diagnosis was only by him and me after dd was diagnosed. He's untreated.So his ADHD does not impact his life very much?

Oooh. I know the statement about her figure sounded horrible, but she's gone from a healthy 130 to 170 since she started high school, and at 5'6" it's very noticable. I know it's comfort eating. To try to help her, we've taken just about everything we can out of the house (no snack foods, sodas, chips, cookies, etc.) and replaced them with fruits, vegetables, whole grain bread, etc. but she'll go on carb binges with whatever is available, even if she has to walk to the corner store to buy something. :(

I've read all the girl-issue books, like Odd Girl Out, Reviving Ophelia, Queen Bees and Wannabees, Undertanding Girls With AD/HD, etc. She's been in family and individual therapy for most of the past year without much success, mainly because the counselor (PhD) told her that it wasn't unreasonable for her to have a curfew, lose privelges for sneaking out of the house, shoplifting, cutting classes, etc. DD felt like the adults were all just ganging up on her. But we recently found a social worker that DD seems to actually like, so hopefully that will work better for her. We're presenting this person as a "life coach" rather than a therapist. The SW is going to try CBT. DD seems to misinterpret a lot of interactions. By that I mean, if someone doesn't talk to her in the hall, she interprets is as a deliberate snub rather than another equally self-critical girl thinking to herself, "does my hair look funny, did that guy just look at me, why didn't she smile at me, oh my gosh do I have a tampon?" If someone messages her on myspace and says they want to hang out, she doesn't think they mean it literally - even if they send several messages asking when they're going to do something. If she's made plans with someone, she often accepts a later offer, or just doesn't answer her phone when the other person calls to arrange a meeting time. She doesn't really grasp Covey's "emotional bank account" habit, even though we've talked about it as a family since elementary school.

Yes, keeping an agenda has failed because she can't remember to write in it. In Elementary and Junior High they were forced by the teachers to write in them each class. We tried carrying the same habit over into High School, but it hasn't been very successful. I even went to her old Junior High and got one of their planner books (at DDs request). She would probably do a little better with a tape recorder or a Palm Pilot, but electronic devices aren't allowed in school. I know some schools post assignments on-line, but not in our school. I've tried to get the teachers to email course outlines, assignments, etc. with little success. We are trying to get her a 504 plan, but the school is fighting tooth and toenail over that.

No, I didn't have AD/HD, but I imagine it to be like trying to live your life in a video arcade. I just lost all self-confidence when we moved across the country right before my sophomore year and I was dropped into a completely foreign environment. Think loud yankee girl transplanted to the south.

As far as DH, he's in a field where he can hyperfocus and doesn't have to interact much with coworkers (IT). His main issues are verbal impulsivity and moods. Because he's so good technically, and he's in an industry full of quirky people, it hasn't held him back professionally. Most of his friends are others from his field, so they're pretty much the same way.

Now that I've pretty much decided that some of the problem was that 56 mg Concerta and 30 mg Daytrana were too high/making her "zoned out" combined with low self-esteem, what I'm really trying to learn is this:

Does anyone have any experience with medication working as described in this quote from the sticky at the top of this forum:

Dr. Theodore Mandelkorn of Seattle says that ADDers on (proper) "medication IMPROVE their attention span, concentration, memory, motor coordination, mood,and on-task behavior. At the same time they DECREASE daydreaming, hyperactivity, anger, immature behavior, defiance, and oppositional behavior. Medical treatment allows intellectual capabilities that were already present to function more appropriately.

When medication is used appropriately, patients notice a significant improvement in control. Objective observers notice better control of focus, concentration, attending skills, and task completion. Many are able to cope with stress more appropriately, with fewer temper outbursts, less anger, and better compliance. They relate and interact better with family members and friends. Less restlessness and impulsiveness are noted. . . .Medication allows your nervous system to send its chemical messages more efficiently, and thus allows your skills and knowledge to function more normally. Medication does not provide skills or motivation to perform.

ADDers often complain of forgotten appointments, incomplete work, mistakes in written work, frequent arguments with family members or co-workers, excessive activity, and impulsive behaviors. With medication, many of these problems dramatically improve. Patients successfully treated with medication typically can go to bed at night and find that most of the day went the way they had planned."

That's the effect we're trying to achieve.

http://www.pbs.org/wgbh/misunderstoodminds/attentionbasics.html

No, I didn't have AD/HD, but I imagine it to be like trying to live your life in a video arcade.

Dr. Gross in Santa Clara, CA suggests asking if the medication you are taking is significantly helping with these concerns:
(As in doesn't cure it)
--Academic underachieving and inattentiveness Yes
--Hyperactivity or troublesome fidgeting Yes
--Verbal and/or behavioral impulsivity (blurting out, interrupting others, acting before thinking)Yes
--Difficulty falling asleep at nightYes
--Trouble coming awake (not getting out of bed) in the morningN/A for me
--Excessive irritability without cause and/or easy frustrationYes
--Bedwetting or primary nocturnal enuresisN/A
--Dyslexia with spatial or verbal reversalsN/A to ADHD
--Episodic explosiveness, emotional outbursts, or temper tantrumsN/A
--Unexplained and persistent emotional negativityN/A

Maybe I'm missing something here... but has anyone considered the possibility that the ritalin has stopped working for her ? She is getting older and bigger and has more body mass now, but I see that the total dose has dropped over time. Could this be a factor ?

The symptoms described in the first posting seem to describe unchecked adhd rather well. If you throw in being a teenager as well it could make a lot of sense to think that she is struggling with her adhd as well as struggling with growing up. I don't blame her for being depressed in that situation.

Me :D

As usual, I agree with Speedo. But what I was going to suggest, if the doctor agrees, was a total med vacation and re-evaluate behaviour

you sound like a really awesome Mum, she's lucky to have you.

I'd say trying a few different medications would be the way to go now.

dexamphetamine would be worth a shot. I'm sorry I don't have much experience with meds yet but I'm going to be starting Dex next week and I know quite a few people that have been helped by it.

maybe school just isn't for her? have you thought of maybe switching schools?

Just remember if she has a bad reaction to any medication that you can always stop and try another. sometimes it takes people a long time to find the right one.

CBT is an excellent idea, if she gets into it then I'm sure it will help her with some of the problems you mentioned.

good luck!

When medication is used appropriately, patients notice a significant improvement in control.Yes

Objective observers notice better control of focus, concentration, attending skills, and task completion.Yes

Many are able to cope with stress more appropriately, with fewer temper outbursts, less anger, and better compliance.Yes

They relate and interact better with family members and friends. Less restlessness and impulsiveness are noted Yes

. . . .Medication allows your nervous system to send its chemical messages more efficiently, and thus allows your skills and knowledge to function more normally. Medication does not provide skills or motivation to perform.

Thanks everyone for all of your input and suggestions. I don't think the dose of Daytrana was too low. From what I understand, after a few months, she was basically getting the equivalent of about 80 oral mg a day because of more effective absorption and/or metabolism.

We tried the Focalin XR 20 mg through mid-July and it seemed to be about as effective as the others she's been on, but she wasn't as lethargic. She's been on a med holiday for about a month now. VERY argumentative, can't get household chores (like dishes out of her room) done, stopped exercising, etc. but we survived. DD likes Daytrana the best, but when I ask her to explain why, she just says "I don't know, I just do." Yesterday and today, she's been on 7.5 mg Daytrana. Since it's not recommended by Shire, I won't say how I managed that. We'll try that dose for about a week and see how it works. I'll inch up to half a patch (oops, I mean 15 mg :) ) if that seems indicated. I'm thinking that we should try the Vyvanse, but if DD feels like Daytrana helps her the most, I want to respect her opinion, so I don't know if I'll be able to convince her to try it.

I'm getting sleepy, so thanks again everyone. I'll check back and see if there are other specific responses that indicate the meds should do more for her than they have so far.

Thanks for the link to the PBS site. I sent that to DD via facebook to get her reaction. Very helfpul for those of us who don't have the ADDed dimension.

Thanks for the link to the PBS site. I sent that to DD via facebook to get her reaction. Very helfpul for those of us who don't have the ADDed dimension.And thank you for the feedback. I am happy that you found it helpful. I have tried it myself, you know, and while its not 100% precisely how I experience ADHD (and I don't think anything can be until virtual reality is perfected) its so close that its almost spooky.

I have handed out that link to NTs, or to ADDers who have NT partners and wanted them to know what they were experiencing, more times than I can remember--plus my memory is just faulty sometimes anyway ;)--and not ONCE have I gotten bad feedback about it.

And I love that you termed it "The ADDed Dimension"...that shows a lot of caring and respect. Your daughter must love you very much. :)

Well, this was an old thread, but I guess it will get bumped, because I feel compelled to provide an update.

In September, we had a first visit with a new psychiatrist. He wanted to keep dd on the 20 mg Focalin for the first six weeks of school, so that's where we were starting the school year. The Focalin seemed to provide fewer negative side effects than the Daytrana had, but it did zilch for symptom relief. Shortly after that first session, the p-doc went to Europe for 3 months active military duty. Sooo, we had to see a fill-in in October. Because he was only supposed to be maintaining existing treatments while the regular p-doc was gone, he wasn't eager to change the Rx. But when I practically broke down in tears of frustration, he wrote an Rx for 20 mg Adderall XR morning + 10 mg Adderall IR afternoon. I wanted to kiss him! We didn't know if the Adderall would be any better, but at least it was DIFFERENT from years of methylphenidate.

DD has been on the 20 XR / 10 IR since the end of October. The difference in dd's mood has been remarkable. Literally within the first 2-3 days we saw a 180 degree turn in mood/attitude. She doesn't resent us asking about her activities, she maintains curfews, she helps around the house, donated money to a charity at school, volunteered to ring the Salvation Army bell and help with an Xmas party for under privileged kids, she's socializing more (has even initiated a few activities), organized and planned a trip 50 miles away to a day-long concert - drove there and back without incident, has stopped eating huge buckets of carbs and is basically doing a Phase 2 South Beach eating system, asked for a gym membership for Xmas and has worked out almost daily since we joined the YMCA. I could go on, but I'll stop - you get the idea. I'm so grateful to have the girl I know and love back again. :D

The Adderall isn't doing much for executive function areas though, like completing school work, being on time, etc., but at least she CARES about improving those things now. (We've been dancing around with the school for over a year now trying to get her an IEP or 504, but that's a whole 'nother thread.) In December, she started taking 1000 mg of L-Tyrosine + multi-vitamin with extra B complex to try to provide a little more boost of dopamine.

I was so excited that the original p-doc was back after the New Year; we had an appointment last Thursday. I was ready to start actual titration with the Adderall XR. Unfortunately, dd was 30 minutes late because she lost track of the time while working out, so we've had to reschedule for next week. At least the p-doc has a first-hand example of what's going on currently with this med dose!

I'm about 95% convinced that: 1) dd's natural dopamine levels are REALLY low (haven't done amino acid blood testing though, so it's just my theory at this time); 2) MPH at low doses didn't help a lot since it inhibits reuptake of dopamine, but isn't really an agonist to produce MORE; 3) the Daytrana was way too high and caused her to become a "zombie"; 4) she may now actually be hyper-sensitive to MPH since she had a rash that didn't go away for several days at each patch site.

My lessons learned are: 1) you shouldn't give up if you aren't seeing good results on one med or two or five, especially if they're all in the same class/category and 2) you have to do your own research (not even the medical director of the psych department was concerned about Daytrana absorption rates, even though the info is on the FDA site AND he commented that he was "concerned" about the rash from the patches).

Sorry this was so long, but I've been busy enjoying life more, so I haven't be obsessing as much, which means I haven't posted. Thanks again to everyone for your original replies to my questions. I'll post something in the Adderall threads if that's what we continue with after our (rescheduled) visit with the p-doc.

Thanks so much for the update. What a great way to start the new year.