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Children's Diagnosis & Treatment This forums is for parents to discuss issues related to diagnosis and treament of children with AD/HD

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Old 12-14-09, 09:15 AM
bella3 bella3 is offline
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advice for son medicated for the first time

Hi there,

This is the first time I've posted on this forum. I just want to say a brief "thanks" to all of you out there, particularly the ones who are considerate enough to spend time to help out with advice. I know I have benefited greatly from reading the posts, and I'm sure there are others that feel the same way.

My five-year-old son has ADHD and we tried medication for the first time two and a half weeks ago. He was on the chewable methylin tablets for two weeks (5 mg in morning, 5 mg before lunch). After two weeks of the chewable he was put on Ritalin LA (10mg), given in the morning. His pediatrician had wanted the Ritalin LA as a first choice, but there were insurance problems. After a talk with the insurance, his pediatrician was able to get the Ritalin LA covered...

The first week on medication I observed some subtle but overall positive results. He was less impulsive with neighborhood kids, and actually played pretty nicely with them for the longest we have ever witnessed. His tendency to make noises and overall voice sound modulation reduced considerably. He was able to listen to adults' requests (e.g. "give your little brother his toy back") better. Maybe the best experience was when he told me his experience with his exercise (physical therapist) teacher at school. He went into such vivid detail about all the things he does with her (e.g. yoga, stretching, jumping jacks ) I actually had tears in my eyes listening to him. It was the first time in his life he could actually stop for a moment and relate thoughts without distraction.

I would have to say approximately around day 12-14 of being on the meds other less positive side effects have reared their ugly head. His speech therapist commented at an IEP meeting that he became very angry and was yelling at her because she chose the "wrong bingo cup" for him. His teacher related an incident in the bathroom when he attempted to "swat" at his friend and appeared very agitated. At circle time he became very distressed when another student bumped his knee and began yelling at him. These incidents may seem insignificant, but they are a complete departure from his typical personality. A complete change. His teachers said, "This is just not him. This is not him at all." I've kept a diary and noted that approximately 1 1/2 to 2 hours after his dose he become very unsettled in his own skin... weepy... complaints of anything from his seat belt bothering him (screaming and crying about this, even though this has never bothered him before), to actually saying things like, "Mommy, there are boogies on my legs that are crawling up, going into my belly. They are going to give me germs." (all the while screaming).

You may be thinking, "Hullo. Dope slap to mom for not stopping meds immediately." I appreciate that, but I have to say I've been working in the schools for over 12 years as an occupational therapist and I have worked with several children with ADHD whose parents have tried meds, only to stop them very quickly when the side effects come. (No judgment here, just noting the fact). I want to give the medication a chance.

Ultimately, my questions are as follows: 1) In your experience, has a medication had side effects (e.g. irritability, crying, aggression) that have appeared, but then have either been reduced, or disappeared? 2) If yes, then how long did it take for the side effects to reduce or disappear?

Thanks to all of you out there! This is a tough road we all walk, but it becomes easier when I notice I'm holding the hand of my son during the journey.
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Old 12-14-09, 09:35 AM
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Re: advice for son medicated for the first time

It may not be the right med for him. We first tried Adderall with my son and he became nasty after a week or so which was very unlike him. We switched to Ritalin and it was immediately positive. There are several different types of meds so don't give up if one doesn't work out.
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Old 12-14-09, 11:17 AM
Dizfriz Dizfriz is offline
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Re: advice for son medicated for the first time

Bella3

The statistics on medication are roughly this:

There is around a 90% chance that there will be an acceptable positive response to ADHD medications.

For any given medication that rate is around 75%. This means that about 25% will not respond well to a given medication.

What this really means is that any medication is pretty much a crap shoot. Often you have to try several before you find the one that works acceptably, then tweak that one periodically.

Complicating this is that some are delivery specific responders. As an example some respond well to time release methylphenidate (Ritalin) and not to Concerta or straight methylphenidate. Some are the other way around.

To complicate matters more, some respond best to a combination of medications. This idea is gaining strength for more hard to treat cases.

If you peruse the boards, you will see that many parents have to try several, and in some cases a number, of drugs or drug combination before finding the right one.

But on the brighter side, most hit one that will work reasonably well in the first try or so.

Success usually comes from working closely with a knowledgeable physician.

Good luck. Many have gone through this. Be glad that there are so many possible medication alternatives. When my son was young there was only one.

Dizfriz
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Old 12-14-09, 03:09 PM
bella3 bella3 is offline
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Re: advice for son medicated for the first time

Thanks so much for your replies. I have anticipated that the whole medication experience will be trial and error, and that there is no way around that. I guess I'm still wondering, though, if anyone can answer if certain undesired side effects (e.g. irritability, aggression) sometimes dissipate or disappear in their experiences. How long does one continue on a medication that has these unwanted side effects. The ones my son is experiencing are undesirable, but if I thought they might reduce or disappear in another week or two we would stick it out. Thanks!
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Old 12-14-09, 04:56 PM
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Re: advice for son medicated for the first time

In my experience when working with a child on an amphetimine, such as Adderrall or Ritalin there are almost always side effects. It is very difficult to get the dosage just right and as soon as you do it ends up needing to be adjusted. On top of that, when coming down from the medication it will almost always cause irritability. It will also cause poor sleep quality or limited sleep, which on it's own causes irritability. So, it may not actually be the med that is causing the irritiability and aggression, but the fact that your son may not be getting good sleep quality especially since it took a couple weeks before you noticed the issues. The prolonged sleep deprivation may have added up after the two weeks.

It is also scary in my opinion about the damage amphetimines can do to the heart after prolonged usage. Generally, I always recommend ruling out all other possibilities before medication and then starting with a non-stimulant, such as Strattera. I was diagnosed with ADHD as an adult when I was in college and took Adderrall for a short period of time. I can personally testify that at first it worked really well, but over time I became irritable, emotional, and paranoid. It was after that which in my work I decided to research and apply natural treatments whenever possible. Applied Behavior Analysis techniques are very beneficial and I have been reading recently that children diagnosed with ADHD have been also known to have an omega-3 deficiency. A study showed that after 3 months of putting the children in the study on an omega-3 supplement there were significant improvements in ADHD symptoms.

I would not continue a medication longer than one month, which is typically the time psychiatrists have said to try a new medication for the individuals I work with. However, I have had some cases unfortunately where after that month on a new med the new behaviors established and continued even after medication removal.

Last edited by Lady Lark; 12-14-09 at 08:32 PM.. Reason: removed weblinks
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Old 12-14-09, 05:57 PM
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Re: advice for son medicated for the first time

I dont think irritability and aggression are side effects that go away. However, they could be caused by something else. Lack of sleep, poor nutrition, trauma in some sort of life experience?

Anything like that going on?

Stimulants do work well for some people, and for the long term. Anecdotal descriptions of bad experiences have no bearing on whether they will work for you or your child.
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Old 12-19-09, 12:03 PM
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Re: advice for son medicated for the first time

Interesting (sad, but interesting). Stopped the ritalin last 5 days ago. Pediatrician consulted with a child psychiatrist from Mass General in Boston and told him the whole story and he recommended stopping and trying Adderrall. 24-36 hours after stopping the Ritalin my very happy, smiling, silly five-year old son was back... (Along with his typical incredibly high activity level, I may add, and his typical extreme impulsivity).

I tried him for the first time on Adderrall this morning. Within an hour he was almost in tears watching a shark get hurt on television. He complained that his coat was really really bothering him (the same one that was fine last night). He told me his legs felt wobbly. He became irritable. At karate class he was the most focused I'd ever seen him. When he won a game of dodge ball with the eight other kids they all ran over to high five him and he only had a slight smile on his face (normally he'd be ecstatic).

Obviously the side effects are bad. Should I take him off? It's only been one day. My mother said to take only half the doseage but it is a capsule form with little beads that I sprinkle on applesauce. Would I sprinkle only half the amount? Obviously these questions would be better answered by his doc, but she is off for the week before Christmas..... HELP!
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Old 12-19-09, 04:15 PM
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Re: advice for son medicated for the first time

What's the dose?

My son was on Adderall XR - 5mg. We had his dr.'s approval to move up 5mg at a time as needed. 5mg was ok and we wanted to try 10mg. That was too much. I toyed with splitting some of the caps to make 7.5 mg doses but gave up on it because I just wasn't sure how they'd turn out. I was told half the beads are immediate release and the other half are extended release--but they're all the same color!

Based on what you described, though, it might be best to discontinue it until you can speak with the dr.
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Old 12-19-09, 04:44 PM
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Re: advice for son medicated for the first time

Thanks for your help. I didn't know there was 5mg of Adderral XR... Maybe that doseage would be better. He is much calmer now, but his personality is a little flat... Thanks!
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Old 12-21-09, 02:19 PM
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Re: advice for son medicated for the first time

It's only the first day, wait about 2 weeks if you can. What is the current dosage now? If he's not complaining terribly, then maybe let his body adjust. Try eating high different foods with it? Look into another type of Med w/o methamphetimenes (sp?), you know... there's other meds w/different combinations in them. I am not knoweldgable enough to quote that information to you but have read here in the forum about different meds. My daughter had similar effects and we hung in there for about 6 months, we had to switch her. She was hearing voices and seeing things, never slept and also had very bad anger issues. After other med trials and years later, she's been on Folcalin now for 3 years and it's worked great. However, she does have a med combo of abilify and wellbutrin w/the folcalin. Just thought I would share that... Otherwise, ask the doctor to change the dose, but DO NOT separate the capsoles... like the post said previously they are mixed and it would be horrible to happen to give him the beads that are IR and not ER.
Keep us updated
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Old 12-29-09, 03:39 PM
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Re: advice for son medicated for the first time

My doctor has had us split up capsules into one half dose, or even a two thirds dose. It is not that hard, and the exact amount does not matter that much either. The beads of the ir ane er medicine are blended in the capsule. It is not like they make pills with small incremental dose differences.

I think it is a bit cruel to make the child just tough it out until they get used to the medicine. I think it is better to just start with smaller doses and then slowly go up.

Everyone reacts to stimulants differently. Some people only need a very small dose.

Of course, discuss it with your doctor.
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