When to start/take meds

[anon4now]

Hi everyone.

I have a feeling I'll be in here A LOT over the next couple of months. My DH and I are going to start looking into ADHD medication for my son. A little history, my son was diagnosed at 6. He's 9 y/o now in 3rd grade. He's very smart, loves all subjects. I was going to say he loves math...and social studies...and science...and english...ok, so yep all subjects. He's currently working on a book about a boy who is raising a dragon and they end up being town heros. His newest "profession" is a scientist. He's very eager to invent something so he can be on The Ellen show. He's already working on division problems, and has memorized his times tables and is learning to add fractions. And every day he comes home with history stories that I always felt were boring, but he tells the stories with such enthusiasm and interest.

His biggest obstical is impulse control. Especially if left to his own devices. His teacher has made a few comments about how she has to watch him 24/7. And if she turns her attention elsewhere, he instantly acts out. I see this at home too. We can't let him play in his room alone, or play outside on his own. He just does stuff. Whether it's throwing a ball at a car, or knocking down all his stuff off his dresser because he was climbing the drawers. Who knows!

I talked to the psychologist a little about starting medication to see if it helps him. I'm hoping to help with his anxiety, and impulses. I had tried ritalyn before and it just didn't work. He passed out on the couch and then when he woke up he couldn't stop moving. He was just running around like a mad child. So the doctor (who I don't see anymore b/c he's in CA and I'm not) told me to flush it. He suggested I take him to a neurologist who dug into our family history a little. We found out there is history of bi-polar in the family. So he suggested depakote but I never tried it. I sort of freaked and just stopped everything.

My questions so far to you are:

Who is the best person to see about managing ADHD medication. Should I just start with the Pediatrician (who doesn't now him that well) or should I look for someone who specializes in this and start a relationship with that person.

When is the best time to start taking it? The psychologist suggested I start next september. But I feel like there are problems at home too, so why wouldn't I try it during the summer to see if it works for him. I mean, if a drug has a reaction like the ritalyn did, I would hate for him to be in class and just pass out. And then I'm remember one drug takes like 6-8 weeks to get into your system and work correctly. So starting in September just doesn't make sense to me. What are your thoughts?

When do you give the medication? Do you only cover during school? Or do you cover during home time too?

At what age do you let your child get involved with choosing to medicate or not. I don't want to force my son to take medication if he doesn't want to. And I hope to have the oppurtunity to encourage him to handle his differences without medication if that is the route he wants to take. I had two ADHD friends growing up. One hated meds and resented her parents for forcing her to take the medication. And one girl loved them, and felt very lost without them. (She even told me once that she ran out and I would have to help her during class to pay attention.) But I'm not sure if age 9 is the right age to do that. But I'm wondering about your experiences.

Ok, thats all for now. Thanks in advance for your help.

Anon

[bugsmom]

Anon...I think the best place for you to start would be an evaluation with a Child Psychiatrist and/or a Neuro-Psychologist. These are professionals that can give you a clear picture of what is going on with your son. Since you have Bi-polar in your family tree, a pediatrician is not going to be able to help you with this. Personally, I just feel a regular pediatrician is not qualified when it comes to our kids. Not to say people don't have great docs, but for this type of evaluation, leave it to the professionals.

If you do decide to try meds, I would most definatley NOT wait until September. ADHD is not just an 9 to 3 school issue. Our kids live with this every moment of their day. This summer would be the perfect time for you to start a new med so that you can really watch him closely and see how he reacts. If you do choose to try meds again, don't be surprised if the first med doesn't work. All of our kids are different and react differently to each med choice. It may take a couple of different tries to see what one works best for your son. Don't give up...it can be discouraging and you'll want to pull your hair out, but most of us get there.

As for when you give the meds...it depends on the med. Some are long acting, others are not. Right now my son is taking Strattera and Tenex. The strattera is once a day, in the mornings. The Tenex is 1/2 a pill, morning, noon, and night. So, as you can see it will differ.

When it comes to letting your child have an input in their treatment...that's a toughie for me. When my son was young, I believe that he really didn't get a choice in the matter. Now that he's older he has much more input. Every summer I give him the choice if he wants to take a med break. Some years he's taken it, but now he's pretty much like your friend and doesn't like how impulsive he is. Last summer he didn't take the break. He's able to really verbally tell me how his meds are working for him and that is really a God Send. He's very involved in the whole process now.

Hope this helps. I know how hard it is to finally come to a decision to try meds again. It's agonizing, believe me, I've been there.

[charliegirl]

I agree with Bugsmom. If there is a history of bipolar in your family, the last thing you should do is give him stimulant medication before you know for sure whether he has bipolar. You can still give them but the bipolar needs to be controlled first. Find a psych who is very experienced in dealing with ADHD and bipolar in children and let him guide you.

Do you know what his IQ is? He is excelling in everything in school. Did you know that some kids with high IQs are actually acting out of boredom and misdiagnosed with ADHD? Also, he could be twice exceptional, meaning he has a high IQ and ADHD both. If so, he may just be bored and that could be causing his ADHD symptoms to be worse.

I would want to start trying the meds during the summer. It will give you a chance to find the one that works best now, before he has to deal with school. If you hit on the right one quickly, it will give you a chance to tweak it so he can start the school year with the maximum advantage. If there are side effects or you just don't like the way the med affects him, it won't affect his performance in school.

[jj]

I think Bugsmom and Charliegirl pretty much covered everything but I just wanted to add.....

I think you need to talk to your son and make a deal he try the meds for a certain amount of time and tell him you want to know exactly how it makes him feel. Some kids will say they hate the way it makes them feel and I think you have to trust that and try another med.

Also, if he has difficulties doing his homework some parents would use a short acting med just for that.

And some parents do not give meds on weekends or holidays and even stop them in the summer but that has to be between you and your doctor as stopping any med without a doctors approval is not a good idea.

I agree that trying them out before school would be the way to go because the first med may be totally the wrong med and you may need to try another.

[anon4now]

Thank you for the responses. They are right on with the way I was thinking. I just talked to a doctors office and they say there's a "shortage of psychiatrists in our state." Figures.

When my son was 6 he was tested (I don't remember if it included his IQ) but he tested very well in half the subjects, and low in the other half. That is why the psychiatrist diagnosed him with ADHD. I wonder sometimes if the low half was only because he hadn't had any schooling in it. He didn't go to daycare (babysitter) and they were testing him at the begining of 1st grade. I know some of the things he was "weak" in has changed.

In school, his teacher is great, and we had a meeting at the begining of 2008. He was being disruptive in class during lectures. I asked the teacher if his test scores on the lecture are low. And she said no. So we worked out some extra work for him that he can pull out whenever he wants. That way if he is bored with the lecture, instead of being disruptive he can do something productive. He gets to choose from a few subjects, that way it's something he wants to do at that moment. And he doesn't have to ask the teacher to get it for him, it's just inside his desk.

I went to a ADHD workshop last week. And that helped me a lot with understanding what is happening with my son's biology. I can see the layers that have been slowly developing. It started out with hyper-activity and impulse control. Then he was diagnosed with Type I Diabetes, and he had a hard time handling that responsibility. He would get in trouble for eating food without asking, and he's developed a problem with that. We push for honesty so much, that I think he has an anxiety problem now. And now that's getting topped off with depression.

I want to slowly remove those layers and help him through each one. But something will trigger (ie: He got into a fist fight at school yesterday) and his first reaction is deny, deny, deny. Then he's essentially called a liar. Then mom and dad are mad, so he's a bad kid. Then he thinks who could love a bad kid, so mom and dad don't love him anymore. Then he's stupid for doing what he did and reacting the way he did, so he feels worthless. Then he starts to hurt himself and talk to himself about how stupid he is and if he were to just disappear everyone would be so much happier. So he contemplates running away, which he knows will affect his diabetes care which eventually means he will just die.

I just look at that process and think, where the heck do I start? The beggining, the end, somewhere in the middle? Can we get his impulses under control so he doesn't throw the punch. Can we give him security so he feels safe enough to tell the truth. Do we assure him no matter what we love him and he's a good kid that makes mistakes sometimes because everyone does. Do we explain that running away is not a solution and offer new solutions. Does he know how permenant death is?

Ok...I'm done. I'm sorry I went off like that. It's bottled up, and I'm struggling. Now I have to call 100 doctor's offices.

Thanks for listening.

Anon

[charliegirl]

You already know the answers to some of your questions. Of course you explain that he is a wonderful kid who just happens to do bad things sometimes, as we all do. Of course you assure him you love him no matter what. You tell him over and over that he is a blessing in your life and you are so glad he is yours, that you will help him any way you can to get through all this. From your previous posts I'm sure you already do that.

About the lying... Its very important that he not feel threatened when you talk to him about any incidents you confront him with. He needs to know you will hear him out and listen to his side of things without you reacting until he is finished. You then need to stay calm and discuss the different aspects.

Its very likely that he will have a long, drawn out explanation of what occurred and why it happened. He may even seem to contradict himself. Remember, he has impulse problems so its going to be hard for him to understand why he did what he did, let alone explain it to you. Let him do his best, then try to calmly ask questions to clarify.

Many times his perception of what happened will be different from the facts you know or think you know. The important thing is to find out as much as you can about what was going through his mind and help him figure out better ways to deal with situations.

I don't know how many times I would be confronted with something I had done and my mind would freeze. I would deny it. I really didn't remember it that second because I felt very threatened and then when given the chance, I could explain what happened and why. I hated when people would believe the worst and not listen while I sorted it out in my mind and told the truth. I wanted someone to help me figure out what I was doing wrong and why and how I could do the right thing the next time something similar happened.

It was liberating when I knew someone believed in me and would hear me out instead of judging me because I couldn't express myself well. I still have problems expressing myself vocally.

People are very quick to judge you by the first few words out of your mouth. ADHDers think differently than other people and we express ourselves differently. What one person can say in a few words might take several sentences for us. That takes patience on your part but it will bless your relationship with your son if you can learn to do that.

[puzzled]

Oh anon, your explanation of how your son reacts to being in trouble brought back memories. Jonna, my oldest, who turned out to be undxd ADHD inattentive, used to go into her room starting at about age 3 and give herself those little talks every time she was disciplined. "I am just so stupid! I knew better, but I did it anyway! No one should care about me, I am so dumb!"

As for the med question, I have always, from the beginning with my son, asked for his input on the meds, as has our wonderful pediatrician who has cared for him since he was 2 weeks old. We ask him how a med makes him feel, if he thinks it is working, if he wants to take med breaks for the summer (the first summer he did not want to, the second one, he did, and this will be the third, I think he is going to take a break), but he is only inattentive, and not too much of a problem when he has no homework to get done, so summers are a breeze. He has always had some mood issues, and aggressiveness that we handle with tenex, which he never takes a break from. He will be 12 in July, and we have always made him an important part of his treatment since he was dx'd at age 9. We have discussed with him that when he is old enough to drive, he will most likely have to stay on the meds fulltime to help him to be at his most attentive when behind the wheel.


I am hoping that since he totally understands what the meds do for him, and why he has to take them, he will be less likely to want to stop them at any point. Who knows if my theory will stand the test of time?

[dimples74]

I will say a prayer for you tonight because the med decision was so hard for us and it is still hard trying to get the right ones! A pediatric neurologist is in my opinion, the best place to start. Don't wait until September. If you go ahead and get going on things, then when school starts up again in the fall, you will be "set" well hopefully, will have or be closer to having what works for your child. It would be easier than toying around with meds during the school year.