In talking with Kyler's doctor about ADHD and ODD....

[Kylersmom]

We may be putting him on Clonidine or something like that. His opposition is getting worse, he is losing privileges at school, being disrespectful to all adults and making rude and offensive actions to the other kids. I don't want to. He is already on 30 mg Ritilan LA twice a day, morning and late morning, and 10mg methylphenidate in the late afternoon. I am at my wit's end. I don't know what is going on with him. His doctor says hospitalizing him won't do any good because he would be the youngest one there and they would just baby him. He may not even being involved in his Fall Festivities tomarrow.

[Trooper Keith]

I doubt Clonidine is the answer...it's a hypotensive agent, yes, but it tends to be indicated only very rarely in ADHD/ODD. Hospitalizing is never a good option except when actual physical and life-threatening harm is risked.

Those doses of Ritalin are awefully high...the maximum dose in adults is 60mg, unless specifically ordered otherwise by a doctor...70mg for a kid is really a lot. I almost wonder if that might have something to do with it.

Have you tried other stimulant medications? Non-stimulants? I wonder if a benzodiazepine such as Xanax or Valium might decrease aggression enough to be effective and helpful...

I am going to write a post here in the next hour or so about behavioral/obedience theories and ODD...but it is merely conjecture based on some psychological principles, and would only really be effective in mild-moderate ODD, and probably not at all for CD...I dunno. I have theories, will post them shortly.

Best of luck with him...

[Kylersmom]

But I'm confused. She says that he is SEVERE ADHD and ODD. He doesn't seem zombied out. She feels that he metabolizes the medication to quickly. I also have a high metabolism and I think Kyler has inherited my metabolism. I have some Risperdal, but she told me to hold off on giving it to him. She is thinking that he may be mildly Bi-Polar. I am just so confused. Should I find another doctor? Should I stick with her? He is also seeing a therapist, but I am not in on those appointments, it's one on one and the therapist hasn't told me anything. I am almost beginning to think that it's me. I am at the point where I can't handle it anymore. I am at a lost.

[Trooper Keith]

I am writing this paper right now, it's turning out to be quite long and I might not finish until after my last class ends at 3pm, but I think you will find it very useful, and I am quite confident that my hypotheses are sound...

As far as "I'm beginning to think that it's me" ... this is somewhat possible. Often ODD children have a particular authority which they tend to resist more frequently than others. They also tend to be worse at home than at school.

I spent a good bit of time, about 2 hours, in the library yesterday reading on child behavioral disorders because I am very interested in your dilemma...as a special education teacher in training, and a camp counselor who has worked and will work with the occasional ODD child, as well as having had ODD myself, I have a personal interest in this...so I am trying to find as much help as I can and be as helpful as possible.

I would stick with the current doctor unless she is demonstrating some form of incompetence...it seems to me she is following the right course of action for now...

[Kylersmom]

Well, we are beginning to suspect that he may be Bi-Polar. Something I don't like to hear but he is getting to the point where if his behavorior gets any worse I am to take him to the Emergency room. His teacher is taking away the party tomarrow, and he almost rolled himself down the stairs because he refused to get up and walk.

[Trooper Keith]

Does he exhibit both manic and depressive states? I have only heard you speaking of manic type activities...BiPolar doesn't necessarily mean behaviorally problematic. Without the prevalence of both manic and depressive states which swing in quasi-predictable phases, I wouldn't consider BiPolar a possibility. If he _does_ exhibit both manic and depressive states, then yes, I'd say that's likely.

[Trooper Keith]

Also I just remembered...you mentioned that he is taking private therapy? I would recommend before taking drastic actions such as institutionalization, etc. that you discuss with the therapist about what his opinion is. The therapist is probably the most likely to be able to know the inner workings, provided he or she is good at what he or she does. In some cases, these problems come more from an emotional or sociopsychological problem than a psychopathology, and the therapist would be the most likely to uncover that information.

[Davesings]

Hi,
We tried to avoid Risperdal and had our son on Metadate alone but is was not enough to control the angry and tearful outbursts. I have to say that Risperdal was like a miracle for our son and helped him function so much better. Eventually we switched to Abilify because the Risperdal seemed to be causing weight gain. He was taking .75 mg risperdal in the a.m and .50mg at night. Now he is on 10mg of Abilify once a day and Concerta 72mg. This seems to be helping him a lot. He is so much happier and there have been no side effects.
Good luck
David