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Old 07-27-12, 12:01 PM
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Emotional Weepy 7 yo

Hi all!

There was a 2 year old thread on this, but I thought I would start a new post rather than ressurect an ancient one. I'm sorry this is so long. If you skip to the end, there are 3 questions that kind of sum everything up.

My 7 year old daughter started Vyvanse sometime around March. Her pediatrician and I (and possibly neurologist) are not entirely sure if she has ADHD, but she does have serious attention problems.

She started out on 20 mg. and her kindergarten teacher saw a HUGE DRAMATIC difference. She filled out the Vanderbilt Behavior Rating Scale before and after meds and, while I feel that she ~may~ have slightly exaggerated the positive effects, it was like night and day with school work.

At home, she was generally more cooperative and focused and was actually able to play nicely with her sister alone and stay in her seat and watch an entire movie at the theater for the first time.

But every once in a while, we would see this zombie-like behavior. Staring off into space, really hard to talk to her or get her attention. Then we started to see the extremely sensitive, emotional, weepy behavior. She took her medicine at about 8am and these behaviors would show up at right around 3 pm EVERY DAY almost like clockwork.

It didn't seem to matter if she had a school day where she had to work hard and focus for several hours or a weekend day where she didn't.

I mentioned the emotional behavior to her neuro and he said that she was burning through what is advertised as a 14 hour medicine in 7 hours. OK - I take the same medicine and it wears off in 9 hours, so I could buy that.

Sorry, this is getting ramble-y, but it might be important. Right before her neuro appointment, we went on vacation and her 20 mg. prescription was due to be refilled right in the middle of the trip. Rather than trying to hassle with getting it refilled in a different state, and since we were on vacation anyway, I just opened the capsule and gave her 1/2 dose to stretch the medicine out. Seemed to work fine for her ~on vacation.

So when we got home and gave the 30 mg Vyvanse to her, she started to get EXTREMELY weepy and easily upset. Much much worse than before. It started around noon and would spring back up anytime she got the least little bit upset ALL DAY LONG. We couldn't tell her "no" without a complete meltdown. Totally out of character for her as she is REALLY easy-going.

I've been breaking open the 30 mg and giving her about 10 - 15 mg a day instead. It works OK for us right now (we are still on summer break) without the emotional mood swings.

I guess my questions are:

1) Does anyone know what causes the zombie like staring & emotional lability? and/or a way to make it better?

2) Should I try to follow the neuro's instructions to increase her doseage and find a way to deal with the troublesome side effects? I know you are likely not a Doc, just your opinion. If I increase, how long should I wait to see if these side effects diminish over time?

3) Is the Neuro likely to get ticked off and think that I am being non-compliant? Obviously, you probably don't know him, but if you have experienced something similar, how did it play out? I'm not trying to be intentionally defiant, I just don't like to see my normally happy little girl become withdrawn, or zombie-fied, or emotionally distraught and unable to explain why.

Thanks for taking the time to read all this!
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Old 07-27-12, 12:41 PM
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Re: Emotional Weepy 7 yo

1. Overmedication

2. My opinion is stay at the lower dose. Children only have behavioral means to communicate distress. Side effects can feel nasty.

3. No, you're responsible for your child's well being, you are front line and need to make executive decisions regarding the state of her health. Be prepared to show your reasoning and write it out if need be.
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Old 07-27-12, 01:08 PM
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Re: Emotional Weepy 7 yo

HI,

We had similar results with Vvanse. My 7 year old started it in Feb. At first it seemd like an amazing solution to her Inattentive and impulsive nature. We had to go through about three weeks of weepiness, emotion upset which was unlike her, but that settled down and we had about a month of calm. Then in May, so about month 3, the teacher began to mention she was again having trouble in the afternoons. We tried upping to 30 mg for a bit in June, but it made her really emotional. She was inconsolable some days. Her perfectionism became unbearable ( I'd rather her be spacey and a perfectionist because then she doesn't even attempt instead of attempting and going into a full out meltdown when it's not right) She started regretting her past choices. As in "I wasted all my time" if she chose to do A instead of B. Obviously in this instance I couldn't help her because the time/activity she missed had past and as much as I explained (over & over) that I couldn't turn back time she was inconsolable for very long periods of time.

She also started having problems regulating her temperature. This may sound weird, but I had to send different changes of clothes because she would call crying because she was too hot and needed shorts and t-shirt. She had always been my easiest kid in terms of clothing. Then she started asking not to take it, that it made her feel yucky and weird. Sweaty, but cold at the same time.

Sooo.. We stopped it altogether a few days before school ended and just faced the consequences ( as in the teacher didn't even want her there if she didn't finish all her work).
She has been without the Vyvanse all summer and she is back to my sweet girl again. I love her this way and I'm not sure what our plan will be for the fall. Most likely start her off with no meds as we haved enrolled her in a different school that will be more her style of learning and allows free movement during lessons & less pen/paper work, more attention. Our Dr. offered a different med. (biphentin)for her so that is an option as well if she still has trouble focussing at the new setting.

Sorry I don't have any advice other than to say that more Vyvanse was not the answer for my daughter. My only advise would be to NOT think of yourself as being defiant. Think of yourself as being an advocate for your child. You are the one who knows her best, loves her most, cares for her future and has to live with seeing her in distress. If you feel that that the lower dose is best then go with your instincts. I know lots of people here talk about ir boosters for short periods in the afternoon. At her age I can see that you'd not want to be giving too many things, but if she needs something to get through activities in thew PM, then maybe that would work.
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Old 07-27-12, 02:05 PM
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Re: Emotional Weepy 7 yo

Has the neurologist ruled out a seizure disorder? The staring off and not responding to her name in an inconsistent manner makes me wonder.

Vyvanse is advertised to last 12-14 hours. Find me anyone who actually gets that mileage out of one dose! A higher dose won't be of any help. You could argue for an afternoon booster to get her through the day and mitigate the rebound, but does she really need that if she's doing well at a lower dose?

Look, these are doctors, they're not God. You don't own them blind obeisance. Your first responsibility is to your child.
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Old 07-27-12, 02:37 PM
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Re: Emotional Weepy 7 yo

My pdoc said that Vyvanse can make some people more emotional (I am paraphrasing) but that was usually a problem with people who were more emotional to start with. My sister was getting a little more emotional- but it was hard to tell the cause as she is at an age where girls are that way (14). She is off medication for the summer (and is her usual laid back self) and I don't know what the school year plan is. Her doctor consisdered changing her to Concerta.

Maybe a change to another stimulant?
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Old 07-27-12, 04:34 PM
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Re: Emotional Weepy 7 yo

Crud. Just wrote a bunch of stuff and it erased itself. Blast you, computer!

Longish post short, I guess I am looking for reassurance that I am not going to make her suffer by telling the truth and ticking off her doc. "Difficult Mom" written on her medical chart kind of thing. We don't have many pediatric neurologists in the area and no others in my town, so I don't want to arbitrarily tick him off by telling him more than he needs to know.

I am paranoid about stimulants. Pharmacists in my town have made me feel like I am looking to get "high" just by taking this medicine. I don't want to put black marks on my daughters chart if I don't have to.
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Old 07-27-12, 05:15 PM
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Re: Emotional Weepy 7 yo

Do you respect the guy? I respect my son's doctors, they're the medical experts, but I'm the expert on my kid. How are they supposed to render the best care if I can't tell them what's going on with DS in a matter-of-fact, non-confrontational way?

I'm not really sure what to say. I can't believe anyone would think poorly of you for wanting to give your child less medication. You aren't displaying drug seeking behaviors. I don't think anyone is going to blacklist you or your child. If you think this doctor is prickly or needs his ego stroked then do what you have to do to get the care your daughter deserves.

Yeah, I had a pharmacist give me the stink eye when I used her pharmacy to fill a prescription for meds that my usual pharmacy was out of. Maybe I'm just old and don't care anymore, but I'm not doing anything wrong and I had no problem staring her judgemental a@@ down as she handed me my DS's meds. It was a case of mind over matter--if you don't mind, it doesn't matter.
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Old 07-27-12, 11:22 PM
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Re: Emotional Weepy 7 yo

Ms. Mango -

I don't know him well enough to respect him that way, but what you say makes perfect sense.

Thanks for the advice everyone. I feel better know!
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Old 07-28-12, 11:15 AM
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Re: Emotional Weepy 7 yo

Why does she see a neuro? Is it for a reason other than the ADHD? Neuros don't seem to be that helpful in the maintenance/treating of ADHD; is there a child psychiatrist experience with treating ADHD in children you could try?

Your observations of your child are very important and valid; doctor's orders aren't literally orders unless they are backed-up by a court of law.

You could use a dated journal or agenda book to keep track and have more specific/timely information to show the doctor. Sometimes doctors want a child to spend more time on a medication to see if a problem is just a part of the adjustment (though sometimes the side effects are just unacceptable to you) but your dd has been on this medication for awhile. Being overly emotional/weepy is a negative side effect that can't be mitigated the way dealing with a suppressed appetite can be and I wouldn't stay with a medication with this result; the spacing out is concerning too--medication is supposed to help with this, not cause it.

I would also look into doing a more comprehensive evaluation that evaluates for LDs and processing issues.

I wouldn't worry about the pharmacist; just act like it's business, not like you are guilty of something. It's annoying if they are behaving that way but if they go so far as to check up on you they'll only find that you are filling one prescription from one doctor.
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Old 07-29-12, 12:18 AM
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Re: Emotional Weepy 7 yo

happytexas -

She has other reasons for seeing the neuro besides just the attention. She used to have low muscle tone (although she seems to have outgrown it), but she has seen a Neuro since about age 1 because of ataxia (uncontrolled muscle movements), delays in physical development and speech, coordination, balance, and processing issues.

Experts seem to agree that the muscle control problems are neurologically based, but her MRI was clean and we have done pretty much all the tests up to genetic testing and some of the more invasive stuff like muscle biopsies and spinal taps. Her doctors tell us that any answers that we get at this point would not change her treatment plan and have supported our decision to ~not~ persue a "formal" diagnosis right now.

The reasons we have chosen not to push for a diagnosis are 1) if it won't "cure" her, we don't want her to go through these painful invasive tests just to satisfy our curiosity 2) We are concerned that she will be diagnosed with something like Cerebral Palsy and have trouble with health insurance (CP is the #1 most expensive diagnosis to an insurance company) and 3) She may still be too young to get an accurate diagnosis.

I agree about testing for LDs. I know that she had a pretty comprehensive eval when she transitioned from a special needs preschool to mainstream kindergarten. But I don't know how much they can test for reading disabilities before the kid can read. Not trying to sound rude there. I honestly don't know.

The Neuro has some blood tests that he wants done and we do a follow-up with him in a month or so. Unless there is some other reason to see him more often, we will go back to her pediatrician for medication management. She's known my daughter since she was a toddler and she listens and works with me rather than giving "doctor's orders" if you know what I mean.

As for the pharmacists, I try not to give my money to the ones that act like jerks, but from what I can gather, they make up their own rules. And they have certainly found ways to make my life much more difficult and irritating than it needed to be on several occasions.

Much as I understand how helpul a dated journal might be, its unlikely to happen anytime soon. That seems to be one of the special bugaboos of my particular brand of ADHD. Best of intentions and all that.

I'll tell you, though... I used to get a little irritated when I would read that a parent would give their kid medicine for a day or two and abandon it because of side effects. I have much more sympathy now! I don't want to abandon the stimulants (or even Vyvanse) altogether, but seeing my sweet happy little girl so upset was tough. When she was only having 1/2 hour of being out of sorts, we could deal with it. Its when it lasted all day long it was too much.
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