concerta and paranoia in ADHD child

[jmcdelaney]

Hi, I'm new here. I posted this same note on the concerta forum, but wasn't sure if it would get read there. I have a 10 year old son who was diagnosed by his pediatrician with adhd in April of this year. We started on the lowest dose of concerta and saw hints that it was calming him down, so the Dr. upped the dosage to 26 mg (I think it was 26...somewhere in the 20's). We noticed that he immediately stopped spinning (literally) while he was talking to us and we were able to get through most of the homework without tears of frustration. Unfortunately it seemed to wear off part way through homework and I also believed he was getting a "crashing" effect because he would become extrememly disagreable around 4pm every day. The Dr. upped him again to 36 mgs which he has been on for about 6 weeks. Because of the irregular summer schedule, there seemed to be one day a week where I would forget to give it to him. The first day on 36 mg he was very disagreable and argumentative, it seemed to dissapate over the next couple days. Then I forgot it one day. The day I forgot it he was well behaved, the next day when I gave it to him again he was back to being a bear, again disapated over a couple days. The last 3 weeks I have not forgotten to give it to him at all, we have been very consistent. His attitude every afternoon is intollerable, having to send him to his room to "adjust his attitude" numerous times. Monday, after being sent to his room for the 5th time, and my husband having to yell at him for being extrememly disrespectful to me, he had a melt down. I think he experienced some paranoia. At first I thought he was being mellow-dramatic when he said he wasn't worthy of taking karate and that he couldn't leave his room ever again because he was ashamed of himself, but then he went into a short tirade about what if there was a bully and he....then what if it was a terrorist....then what if the terminator came to his school and....then what if there was a nuclear war...then what if the sun blew up and God couldn't catch all our souls before they burned. With the first few what if's I tried talking to him about how to handle things. But when he started pushing at his face/head with his hands like he was trying to push his brain out of his head (by the way, sobbing through the whole thing) I just totally changed the subject to "let's go make a peanut butter sandwich" and he finally stopped. He has been fine since (although back to spinning while talking...) We called the pediatrician and have completely stopped the concerta. We have an appointment to see a psychologist tomorrow, the pediatrician on Friday and are in the process of trying to set up an appointment with a psychiatrist for a med evaluation. Any thoughts on what is going on, and whether or not we should persue another medication or just back of meds altogether would be greatly appreciated.

Worried mom

[paulbf]

Wow.
He he, the peanutbutter seems to work though, sorry for making fun but I also love peanut butter. Wish I could be more help. It does seem the meds are not right for him, who knows maybe something else entirely but that's scary. What was he like off meds? It seems just getting some extra attention helps.

[jmcdelaney]

"How is he off the meds?"...funny you should ask. Prior to the meds and now that he is off them, he has always been a "deep thinker". For example, last summer we were headed to the beach, now most 10 year olds would talk about digging to China...not Jake, Jake says "So if you dig a hole all the way to the other side of the earth and then went downt the hole, because of gravitational pull would you stop when you got to the middle or would you continue falling?" Now he was not worried about falling to the other side, just contemplating the "what if". He has always been a bit of a "worry wart", not to the point of crying or saying he couldn't leave his room, but when we pray at night he ususally throws in some topic most kids wouldn't pray for, like for "armagedon" to never happen, or for all terrorists to go away. All that being said, Jake prior to meds, and again now that he is off it is an elated child. I say "elated" because happy doesn't cover it. We have been told numerous times that he NEVER stops smiling and the energy level is tremendous (spinning in circles while talking incessantly). How he sits still at school I just can't understand. I am fairly certain he wasn't depressed while on the Concerta, just much more calm and a bit more serious. He still was "happy", just not "elated". When I watch him I almost think "manic", but he doesn't seem odd, just very happy. Sigh. The good news is we have an appointment to get a med eval done by a psychiatrist....can anyone tell me what this entails?

Thanks, Joann

[paulbf]

Sounds like a great kid! My heart goes out to him. That makes your initial paranoia story make a little more sense & a bit less frightening. Maybe the word paranoia is too strong, I think a better term would be "over-sensitive". Hmm, I don't know but you might find this thread interesting:
http://www.addforums.com/forums/showthread.php?t=7360

If you don't get more response, ask a moderator to change the message title. There are so many messages here it helps to have the right subject. I wish I could help more.

[jmcdelaney]

We just got home from seeing a psychologist. It went very well. We started by him reviewing the IQ results from tests given at school. He interviewed me at length while Jake politely circled the room, arms flapping, trying to burn off energy. Then he asked Jake a lot of questions about what he thinks about and how much he worries. We were in the office for an hour of productive "interview". Bottom line, he believes the Concerta may have been too strong causing Jake to be bilidgerent (sp?) because without the meds he is as cooperative as an adhd 10 year old can be. He also believes that some of us ARE just "deep thinkers", and that the "episode" was triggered by my husband "blowing up" at him. Jake, not having been yelled at much by his dad, was really taken aback, scared and worried that if his "protector" would "turn" on him this way who will protect him from all the "what if's" that he typically ponders without worry. Jake's IQ is pretty high, that combined with the adhd his mind can really fly and so he thinks about the what if's more than most people, but because he is so young he needs more concrete answers to the what if's than an adult needs. An adult can conceptualize that God could grab all the souls at once where Jake thinks of him running around trying to collect them before they burn. From a 10 year old point of view, when dad has always been on your side and suddenly (and loudly) sides against you, all the what if's become too scarey.

Thanks for the link. I do see parallels. We always refer to him as "big hearted". He worries how people feel...he cries during movies...he actually cried at the end of Terminator 3 when Arnold died!

All that said, I feel better. I don't believe the Concerta caused a paranoid episode, but I am certain that it made him extremely disagreable. My husband doesn't want to try any other meds for fear of side effects. I need to leave him home with Jake for an afternoon when Jake has been in school all day so he can see the endless stream of energy. The psych. was convinced within the first 3 minutes of being in the office that he has adhd! I just don't see how he will be able to develop successful relationships with his peers, much less get through school without horrible frustration unless we help him with meds. Sigh...

Again, thanks for the link and your thoughts.

Joann

[Tara]

There could be a co-existing condition there too. Stimulants can make many things worse if the co-existing conditions are not also treated. For example if somebody also suffers from anxiety stimulants can make anxiety worse if the anxiety isn't also treated. People can focus a lot better on stimulants but they focus too much on negative things and can begin to ruminate or obsess about certian things.

[jmcdelaney]

Is the anxiety treated with counseling?

[mctavish23]

Yes it is.

Along the lines of other possible comorbid conditions, Sensory Integration Disorder seems to frequently occur with ADHD, altho I don't have any real data . One of the best references around for that is..............The Out of Sync Child.....by Carol Stock Kranowitz.

I'm not saying your child has that (or anything else). I'm just following up on what Tara said.

Good luck and take care.

[paulbf]

Excellent Joann,

I feel so much better.
I think you are on the right track!
I was never quite like that but my heart goes out for Jake & I think he will do well in life with your care & his positive energy. It won't be easy but will be good.

Originally Posted by jmcdelaney

We just got home from seeing a psychologist. It went very well. We started by him reviewing the IQ results from tests given at school. He interviewed me at length while Jake politely circled the room, arms flapping, trying to burn off energy. Then he asked Jake a lot of questions about what he thinks about and how much he worries. We were in the office for an hour of productive "interview". Bottom line, he believes the Concerta may have been too strong causing Jake to be bilidgerent (sp?) because without the meds he is as cooperative as an adhd 10 year old can be. He also believes that some of us ARE just "deep thinkers", and that the "episode" was triggered by my husband "blowing up" at him. Jake, not having been yelled at much by his dad, was really taken aback, scared and worried that if his "protector" would "turn" on him this way who will protect him from all the "what if's" that he typically ponders without worry. Jake's IQ is pretty high, that combined with the adhd his mind can really fly and so he thinks about the what if's more than most people, but because he is so young he needs more concrete answers to the what if's than an adult needs. An adult can conceptualize that God could grab all the souls at once where Jake thinks of him running around trying to collect them before they burn. From a 10 year old point of view, when dad has always been on your side and suddenly (and loudly) sides against you, all the what if's become too scarey.

Thanks for the link. I do see parallels. We always refer to him as "big hearted". He worries how people feel...he cries during movies...he actually cried at the end of Terminator 3 when Arnold died!

All that said, I feel better. I don't believe the Concerta caused a paranoid episode, but I am certain that it made him extremely disagreable. My husband doesn't want to try any other meds for fear of side effects. I need to leave him home with Jake for an afternoon when Jake has been in school all day so he can see the endless stream of energy. The psych. was convinced within the first 3 minutes of being in the office that he has adhd! I just don't see how he will be able to develop successful relationships with his peers, much less get through school without horrible frustration unless we help him with meds. Sigh...

Again, thanks for the link and your thoughts.

Joann

[starzia]

I would just like to mention that concerta caused secondary pyschosis in my son when he was 5, he had hallucinations for 3 days and was extremely paranoid!
I took him off all meds in December, it has been hard, but not as hard as all the different side affects from the mood and stimulent drugs he was taking from the age of four.
He is almost 7 now and I am looking for alternatives to conventional drugs.
Just wanted you to know your not alone!
Starzia.

[jmcdelaney]

Thanks Starzia,

We have been to a few dr. appts. since the episode. After much debate, we put him on 10 mg of adderall (the long lasting one). I was scared to death to try another stimulant, but strattera doesn't have much history and being that we finally decided to get "treatment" for him after 10 years of trying everything but meds I felt like it was the only option left. We started it on Sunday and he has been GREAT! He stands still when he talks now, he comes home from school and sits QUIETLY at the table WITH his brother and flies through his homework without even being told to do it! He has had no mood swings! I just hope it lasts.

Joann