Hi, all -


There's a question after this long intro, I promise!


Our 6 year-old son has ADHD as well as another bowl- full of alphabet soup
diagnoses (GAD, ODD, ?AS..). He's been medicated since age 4 and we
continue to search for the right combo to best help him (and us) manage his severe behavioral dyscontrol. He's currently treated by both a child psychiatrist and a developmental pediatrician who specializes in ADHD.

Catapres was good, but not enough... Each time we wean him off we again realize that he was pretty depressed on it.

Stimulants very clearly help him, though he is a fast-metabolizer and only gets about 4 good hours from XR stims (generally meant to last 7 hrs).

He is also on Risperdal for aggression and just failed a long, discouraging trial of Trilaptal. We start Lamictal today in an effort to get some mood regulation.
(The jury is still out on whether he also has BP but we generally think not).

His insurance will not yet approve the Daytrana patch. He doesn't swallow pillls- takes Focalin beads in pudding and Ritalin crushed in juice.
(pharmacist and our docs came up with this plan- your mileage may vary).

His current meds :
Focalin XR 10 mg and Risperdal .5 morning
Focalin XR 5 mg early afternoon;
Ritalin 5 mg 3p
Risperdal .5 6p

3 mg Melatonin at bed-time (really, really helped shorten onset to sleep)


Question/problem: The mornings are, at best, awful. He is too off-task to takes his meds and cannot settle until meds kick in. I've tried waking him to give them to him but only managed to scare him and wound up with stimulant concotions all over everyone.

I've tried giving Risperdal first but, short of prying open his mouth, no real way to do that with an unwilling and moving target.

We have tried bringing meds to him the second he's up, but he's irrational and hyper and silly and simply will not take them.
Yet he knows they help and he needs them.
Well, he knows that when he's medicated. Nice Catch -22.

We're working morning-med compliance into his never-ending behavioral plan but no real success yet.

Though we love him dearly, he is unbearable and, frankly, crazy-making, until the meds kick in. He is really an unregulated, unreasoanable, unmanageable mess for that first hour. His propensity toward violence in no way makes this easier.

After perhaps 20-minutes of insanity, we are generally able to get him to focus long enough to take the stims. Those 20 minutes are enough to make me want to leave home. When it takes an hour I'm close to a breaking point.

I recently told my husband that the true marker of ADHD must be this: parents feel better when the kid takes his meds.

(Though we probably sound completely nuts and very green, we are doing better than 3 years ago and have a good team of therapists and behavioral
specialists. Ironically, I am a therapist - which obviously helps not at all with my own son)


Anybody have any strategies to combat the morning insanity?
Anyone else have a 4-foot whirling dervish in the morning?!

(forgive any typos- cannot find a spell-checker in this thing)
Thanks, all.

Amy and the circus in PA

Ironically, I am a therapist - which obviously helps not at all with my own son)Not at all. Therapy doesn't work for everything and childhood ADHD is one of them. When you wrote ?AS, does this mean a possible diagnosis of Asperger Syndrome or Austism Spectrum Disorder?

Hi and sorry for the confusion- AS=Aspergers Syndrome (he has traits but
doesn't meet criteria for the full diagnosis).

And, about being a therapist...
What I meant to say was that my
training is generally useless in this aspect of my life.

I am humbled by my impatience when he is "wild". I am
surprised at how often my rational brain goes missing in the mornings.

Suggestions for the pre-med madnesss?????

Thanks, Amy

Hi Amy,

That's a tough one.

Hi-

I'm hopeful that somebody has found something that works even a little..

I assume that we love our kids enough to keep learning -and to ask for help in forums like this. If we're posting here, we probably haven't thrown our pre-medicated kids out the window. If we haven't thrown them out the window, we're doing something right. I know- that's a lot of assumptions, but still...

I tag-team with my husband in the awful mornings. Not every house has two parents. Our very high-maintainence child is our only child-a good thing, in retrospect. Other families have more than one exhausting child.

So if it's this hard for us -what's it like for the rest of you?

How do you get an irrational , four-foot dictator to take his meds so he can
become a rational member of the family? And how very sad it is for him, for us (for you?) that he is so unbearably annoying without the meds on board.

I'd welcome some input. I think I'm asking for validation as much as
suggestions. It's hard to know what is "normal" in this situation.

Our family and friends may love us but they've not had to say things like:
"we'd love to stay for dinner, but it's medication time" or

"we'd love to come to the dinner/party/whatever except his meds will be wearing off then and he's likley to hurt your kid...an hour later would be good, though..except then he won't be hungry" or

"yes, he did just hit me. We're working on it..he has impulse control problems and he's over-stimulated and tired and doesn't transition welll and I so
cannot get into this right now because he's crying and starting to melt-down.
Come see our charts and books and services..we're working on it...we're
trying hard to just get through the day and remember that we love him".


Forgive my rambling....I appreciate the space to vent.

And, I'd still welcome some morning tips :)

Amy

I'm hopeful that somebody has found something that works even a little..

I assume that we love our kids enough to keep learning -and to ask for help in forums like this. If we're posting here, we probably haven't thrown our pre-medicated kids out the window. If we haven't thrown them out the window, we're doing something right. I know- that's a lot of assumptions, but still...People assume I am blindly pro-medication and believe nothing else works for ADHD kids, but my children were not medicated when they were young. My son was of legal age when he started medication. My daughter has never been medicated other than a trial of Ritalin for a short time. I wasn't medicated when my children were young so we had an unmedicated parent parenting two unmedicated kids and although it wasn't always easy, we didn't have to deal with the behaviours you are describing and my son could easily have been the poster child for ADHD.

As a therapist, I assume you have connections with professional help. Has nothing helped? How does your son manage in school?

Hi, again.

I truly had no pre-conception about you or your stance on meds... I do appreciate your questions, though. My apologies if I somehow offended you.
Since so many parents post on these boards about their kids' meds , I assumed someone might be able to relate to the tyes of behaviors and difficulties I described.

An avid lurker, I rarely post and usually do so only when things are really bad.
In a week or so I imagine I will feel more hopeful and less afraid.


I agree, some kids with ADHD do just fine without meds- especially those with relatively mild symptoms, strong support systems at home and school, and little or no co-morbid diagnoses.

My son isn't in that sub-group. He was dangerously aggressive by age 2 and diagnosed at 2.5. We got him (and us) into therapy and instituted a behavioral managament plan before adding meds when he turned 4.

At 6 3/4, he's a bright and verbal little boy with emotional and social skills much like a 4 year-old. His ADHD is severe and complicated by
anxiety, gross difficulty with social cues, and a mixed bag of other issues.

We have tons of services: a psychiatrist, an ADHD specialist, therapists, wrap-around services at home and a 504 plan at school. Fortunately, insurance pays for most of those resources.

Incentives, positive reinforcment, modeling, and enoromous doses of attention and patience help. And it's still often hard to stay hopeful.


He begins first grade in three days.

Last year he was able to hold together through 1/2 day kindergarten and
would explode when he got home. No telling what this year will bring, though
the school is willling to help and he has a 504 plan in place.


I imagine that these posts have been a virtual shout into cyberspace - to see if anybody's out there, if anybody gets it, if anybody is a bit further along the journey and able to share some wisdom or hope...


Thanks again for taking the time to respond.

take care,
Amy

Hi, I can feel for your pain in the morning with your son. You are trying so hard to help him and to teach him to help himself. It is obvious your have tried/learned alot about his condition. My daughter is horrid in the morning as well. She would try the patience of a saint. She sets out to annoy everyone in the household. Her ODD kicks in big time. She is now 8, in the third grade. Though we do not have the cocktail of meds you need, here is what we do.

I try to stay as calm and quiet as I can, repeating if necessary but keeping her focused on one thing. First we put her daytrana patch on so it begins to work then we do her pill. We have finally come to an agreement to take the pill with a bite of food of her choice-granola bar, pb toast, sandwiched between cereal flakes, whatever. I have found that a regular dose of B12 helps her attitude tremendously, but I have mid this her responsibility. We found a sublingual tablet she is willing to take. I set the bottle on the breakfast table in the morning and don't even acknowledge its existence. It's up to her. If she has difficult experiences with people and disciplining herself when she's taken her meds, it's generally due to the absence of B12 but just one day doesn't make a difference. The consequences of receiving continual correction is hers. Once she has taken the pill, she has the choice to stay with us and cooperate pleasantly or go to her room for 20" until the pill kicks in during which time she should be doing her AM routine: bed, dress, straighten up her room. She generally chooses to return to us in a matter of 5-10 minutes and behaves fairly pleasantly. I am not obnoxiously perfectionistic about this. I know it is very difficult until the meds have kicked in completely. In the morning before school she is expected to complete the AM routine and practice her piano. Then she has free time until I drive her to school, which I encourage to be outdoor and active. By the time she arrives in school she is the model student. We keep the patch on during the early evening, deal with this behavior again in the evening, but a melatonin has worked wonders for us to shorten this timeframe and settle her down satisfactorily.
Since she doesn't have the aggression your child as just obnoxious persistent defiance in the AM I am not sure if this routine will help you or not. I'd work on the priority med that helps him to be cooperative and put the others into a later time frame if that is possible. Just a suggestion. I wish you luck.

Hi, again.

I truly had no pre-conception about you or your stance on meds... I do appreciate your questions, though. My apologies if I somehow offended you.None taken. It's funny, because of the difference meds have made in my life, my son's life and other people I know, there are people on these forums who will tell you I am very pro-med and they would be correct. Because of the way you worded your question, it occurred to me that even though I am now pro-med and whatever else works for the individual, I have forgotten that my family achieved success by any standard without meds. Would I do it the same way again, given a choice, no bloody way! :D

Since so many parents post on these boards about their kids' meds , I assumed someone might be able to relate to the tyes of behaviors and difficulties I described.I don't think I got this on the first run through, but am I correct in saying that because your son's behaviour is extreme enough to require meds, you were hoping other parents whose children are on meds are dealing with the same behaviours?

I agree, some kids with ADHD do just fine without meds- especially those with relatively mild symptoms, strong support systems at home and school, and little or no co-morbid diagnoses.I'm not sure that our family life was just fine when our kids were young, but my saving grace was probably being able to stay at home for eleven years and the extra time to spend with my kids was priceless. If things had been different, our diagnoses may have come sooner than they did.

My son isn't in that sub-group. He was dangerously aggressive by age 2 and diagnosed at 2.5. We got him (and us) into therapy and instituted a behavioral managament plan before adding meds when he turned 4.

At 6 3/4, he's a bright and verbal little boy with emotional and social skills much like a 4 year-old. His ADHD is severe and complicated by
anxiety, gross difficulty with social cues, and a mixed bag of other issues.You have a lot to deal with and I wish I could offer more suggestions.

Last year he was able to hold together through 1/2 day kindergartenThat's great!

I imagine that these posts have been a virtual shout into cyberspace - to see if anybody's out there, if anybody gets it, if anybody is a bit further along the journey and able to share some wisdom or hope...Well, Dove's already contributed a very good description about what works for her daughter. It's the weekend and the last day of summer vacation for a lot of us.


Thanks again for taking the time to respond.

take care,
AmyYou too. :)

Thanks, Imnapl for reminding me that it is a holiday weekend. We
came home early from a tantrum-ruined vacation and I literally forgot
the date....And I appreciate your patient responses to this cranky, long-winded poster.

Thanks, Dove..you gave me some ideas! I think we'll try not having him join the family until he's taken his meds. He is absolutely horrible before them -he wants to be with us but seemingly has zero contol over his obnoxious demeanor until the meds kick in.


I'll try bringing the meds to his room and having him come down only after he's taken them. His violence has decreased to the point that this may be do-able...Maybe.

Thanks so, so much for reminding me we're not the only ones. In
the middle of a horrible day/week/month I often feel like we're the only family living with this chaos. Therapy and books and all of that are good, but sometimes I just need to hear from someone else in a similar situation.


We are leaning toward the Daytrana patch, though insurance is unwilling to pay for it yet...I often fantasize about taking my unmedicated darling to the
ins. co's corporate office, and leaving him there until they decide to pay for whichever med they denied that day :)


Questions: after you put on the patch, how long until you see some effect?
I'd happily awake at 4a to put it on him if it meant he could be quasi-human by 7a.

If your daughter used oral meds fist, do you notice much difference in appetite and rebound with the patch v. oral? Do you see fairly even coverage throughout the day?

I think I read that you'd tried Melatonin with your daughter-
I'd not heard of a chewable form- who makes it?

(Our son takes 3 mg. at bedtime -crushed in juice- and we are astoinshed at the difference. Even before he was on stimulants it would take him 2-3 hours to fall asleep. Now he's asleep within 30-minutes and more often sleeps through the night)


Thanks again, and I'd like to hear about your Daytrana experiences.

Take care,

Amy

(where is spell-check, anyway??)

Hey Amy.

First thing is I'm not a parent and probably have no idea what it's like.

I have had some experience baby sitting some extreme ADD children but realize this is nothing compared to full time parenting.

I think maybe giving him more control over the situation could help? maybe not.

Have you heard of love and logic type parenting? I think it's a style of doing things that might help but I'm not 100% sure.

"We get kids to be responsible by holding them accountable for their actions. Sometimes this causes them pain....but this is when lessons are learned. We do this without anger, lectures, warnings or threats, but with empathy. This is the key to big behavior changes. When kids feel the pain of their poor decisions and we are there with empathy rather than salt to rub into the wound, we become the good guy and their poor decision becomes the bad guy."

Maybe try giving him the 'choice' to take his meds, explain to him that if he doesn't there will be consequences he may not like. Try rewarding him for making the right 'choice' in whatever way you feel he would reason with. If this means extra toys or videogames or whatever he really wants, it might work.


things you've prob. already tried but worth mentioning:

- heavy cardio exercise 5 times a week for 20-40mins, helps with sleep and has been proved to be effective in managing ADD. Not as effective as meds but worth a try.

- diet change, cutting out most sugar and food colorings etc.

- maybe try cutting down on stimulants if that's even a possibility.
does the anger problems he have stem from using the stimulant meds at all? switching meds and trying to find one with more benefits than the others is a good idea, talk about it with his doc. if you haven't already. It's ideal to have as few medications as possible. The heavy exercise and change in stimulant med. might mean he doesn't need the Melatonin and Risperdal. But it also might not.

Have you tried Dexedrine yet? I hear people having good results with this one all the time, less of the Ritilan and Focalin side effects type side effects.

Hope this stuffs helps you a little bit but I'm not very experienced in this sort of thing. I'm sure a one of the regular Mums that post here will reply to your topic soon..I think they will be able to help the most.


peace and good luck

Thanks for your thougtful response, OzChris!

We had also wondered if the stims worsened his anger and took a
(very ugly) stimulant-holiday. He is actually less angry and violent
on stims than off.

Although I'd not heard of Love and Logic methods before- I like it..sounds similar to the Collaborative Problem Solving strategies we've been trying.

Thanks again - your input helps - it's good to hear from someone who's not a parent-you offer a different perspective!


Thanks and take care,
Amy

Thanks, Dove..you gave me some ideas! I think we'll try not having him join the family until he's taken his meds. He is absolutely horrible before them -he wants to be with us but seemingly has zero contol over his obnoxious demeanor until the meds kick in. I can see the times when my daughter is not able to stop her activity and when she is intentionally refusing to comply. For the first I try to make it a teaching time to make her aware of her behavior, body and other's impressions but this may mean she will still be separated from us for awhile. For the latter reasoning with her is useless at these times, she is removed and later we can talk about it. She is becoming much more aware of herself and others reactions to her behavior this year. I think this is a maturity level.


I'll try bringing the meds to his room and having him come down only after he's taken them. His violence has decreased to the point that this may be do-able...Maybe.
I'd like to know how this works for you.

Thanks so, so much for reminding me we're not the only ones. In
the middle of a horrible day/week/month I often feel like we're the only family living with this chaos. Therapy and books and all of that are good, but sometimes I just need to hear from someone else in a similar situation.
I think we all should try the nonmedication route as much as possible but for us my health issues pressed the medication route when I otherwise might not have gone that way. The difference in just 24 hours was night and day. I realized my daughter was incapable of functioning as we were expecting her to do without the meds. Though when we started ritalin tablets she began to sleep better once she was asleep, it was the melatonin that was a true awakener for her. For the first time, she realized what it was like for others to begin to feel sleepy and to learn to respond to her body's signals. Our horrid nights have finally ended.


We are leaning toward the Daytrana patch, though insurance is unwilling to pay for it yet...I often fantasize about taking my unmedicated darling to the
ins. co's corporate office, and leaving him there until they decide to pay for whichever med they denied that day :)
Haha, this is was convinced our family practioner to take the step. He didn't want to 'for my health' but her uncontrolled activity during the course of the interview tipped the scale.


Questions: after you put on the patch, how long until you see some effect?
I'd happily awake at 4a to put it on him if it meant he could be quasi-human by 7a.
I was putting it on her about 6AM when I woke up until I realized they have a time restriction on the patch. I now wait until she is up (about 7AM) and we keep it on until late after noon early evening. Which is still longer than the prescribed time, but she seems to do well with it. We are awaiting a session with a pediatric psychiatrist to learn more about this drug and its use.

If your daughter used oral meds fist, do you notice much difference in appetite and rebound with the patch v. oral? Do you see fairly even coverage throughout the day?
Advantages to the patch is the very even coverage throughout the day, there is rebound but not as severe as with oral ritalin. We experience frequent bleed through with her behavior just prior to the next dose and for a period until it kicked in for her. The ups and downs of the day frustrated and disrupted her activities and the family. It also doesn't seem to affect her stomach and eating as much as oral meds, but we have found she needs one 5 mg ritalin in the morning for a boost. Within 20 minutes she is responded whereas with the patch alone it takes an hour or more. The effectiveness of the patch is harder to determine as it is more a gradual process than an abrupt kick in the the oral med gives. We have tried to have several days without that booster tablet in the mornings and it just doesn't work. The downside is she resents how it makes her tummy feel. Her main eating time is right away in the morning and later in the evening.

I think I read that you'd tried Melatonin with your daughter-
I'd not heard of a chewable form- who makes it?

(Our son takes 3 mg. at bedtime -crushed in juice- and we are astoinshed at the difference. Even before he was on stimulants it would take him 2-3 hours to fall asleep. Now he's asleep within 30-minutes and more often sleeps through the night)
The melatonin box says it is distributed by Concepts in Health, Inc. The web site is www.midnitesleep.com (http://www.midnitesleep.com) Hope this helps.