Clonidine, Concerta, medications oh my!

Discussion in 'General Parenting' started by mightymouse, Jan 21, 2010.

  1. mightymouse

    mightymouse Trying to save the day.

    I'm finally getting somewhere with my son!

    My son has had an explosive personality since he was born. When he was 3 I began evaluations with a clinical psychologist whom a friend had recommended to whom she had taken her daughter with ADHD. Big mistake! Within 15 minutes of talking with me he threw out a diagnosis of Intermittent Explosive Disorder (IED) before he even started to evaluate my son. After 3 visits we quit going because the dr kept losing his information and had him redoing the same things he had done during the previous visit and I lost what little faith I had in him. I prayed my way through the next 3 years, hoping he would outgrow the fits and rages, all the while walking on eggshells, trying not to set him off while still trying to maintain boundaries and consistency. Not an easy task! He could hold it together at school so I prayed that he would soon be able to do the same at home. Instead, I paid for all the things that upset him at school when he came home. He is still always defiant and wants to be in control no matter what the situation. If he is starving and I tell him it's time to come eat, he will refuse simply because it wasn't his idea. Over time his fits and rages have not happened as frequently, but the intensity of them has escalated. His rage stops as abruptly as it started and when it's over, he cries and cries and says he doesn't like it when he can't control himself. Around the beginning of November about a week apart he had two rages where he physically attacked me. After the second one he cried for 2 hours. I was so incredibly sad for him. I tried to console him, holding him, telling him I loved him and I knew he didn't want to act that way. His sorrow for acting that way and his remorse for trying to hurt me was more than he could take and he just sat in my lap and cried and cried. I decided right then and there that I had to do something about it and I called our local children's hospital the next day and I set up and appointment with a psychiatrist.

    The difference between this dr and the first one is like night and day. I really like him. He talks to my son like he is a child and yet in a way that makes him understand he needs to take control of his own behavior, which is what he really wants to do. He has been conservative with medications and has been cautious to throw out a specific diagnosis. He said we may be looking at a mood disorder, but will not specifically say it is BiPolar (BP), which is what I have thought for a long time. At our second visit, he prescribed 0.05 mgs of Clonidine at bedtime. It took me a couple of days after the visit & reading anything I could get my hands on about it before I gave it to him. It worked great the first week, but the second week it seemed less effective. After 2 weeks the dr upped the dosage to 0.10 mgs at bedtime. This again seemed to work well for about 2 weeks and then although still working some, was not as effective. At our last visit last week, the dr suggested that ADHD may be a problem in addition to the possible mood disorder. He explained that impulse control is one symptom of ADHD and it can manifest itself in an inability to control the impulse to act out in anger. A light bulb went off in me. This made so much sense. He definitely has problems with impulse control in other areas as well. For example, there have been so many instances where he has gotten into something he knows not to, something he's been punished for many times before, admits he knew not to, but says he just couldn't stop himself. He also can be very hyperactive, especially from about dinnertime to bedtime, but since my first child is a girl and very well behaved, I've always wondered if it's just being a boy. The dr said from his observations in his office, he is definitely much higher than average hyperactive, but definitely not the worst he's seen. So at our last visit, he prescribed 18 mgs of Concerta. He said if it is something that works for him, I will notice it the first day he takes it and I will have a "WOW!" reaction to his improved behavior. He also gave me the Connor's scale to fill out before and after giving him this medication.

    I have been so scared to give him a second medication! I have been trying to find information on how these two medications interact and haven't been able to find anything. It scares me that one was originally a blood pressure lowering medication and the other is a stimulant. Well, I read enough posts on here from people who have had their child on one or the other of these medications that I finally decided yesterday to give him the Concerta. The difference was AMAZING! It made me realize how hyper my son actually is without it. He didn't go through his normal almost uncontrollable hyperactive waves throughout the day. The evenings are usually so stressful with him acting crazy and last night was so pleasant. He did still have some oppositional behavior, but sooo much easier to deal with. But, I didn't give it to him again today because I am so nervous about mixing the two medications. So I would really love to hear from people who have had their child on these two medications at the same time.

    I need advice on another issue too. I have read on this site for the past 3+ years that you should take you child for a neuropsychologist evaluation. What exactly is that and what does it entail? What kind of testing/evaluations do they do? I really want to know specifically what is going on with my son and it seems like this is the best way to find out, as much as we really can find out. This would all be so much easier to deal with if there was just a blood test or brain scan that could be done and a definite answer given!

    Thank you so much for this 'soft place to land'. I've read way more than I've posted and it has been a tremendous help. I've recommended this site to several friends who are fed up with family and friends who just don't understand.
     
  2. gcvmom

    gcvmom Here we go again!

    It sounds like you have found a really good psychiatrist for your son, and that in itself is a huge victory. I would not be too concerned about having him take the two different medications. Just be sure to follow the directions you were given by the psychiatrist. You can certainly ask him to go over your concerns about the medications so that you better understand how they work. Your local pharmacist can also help you with information on why or why not an interaction might exist.

    As for the neuropsychological exam, it typical is conducted over several days with a minimum of about 6 hours of testing. They look at cognitive abilities, motor skills, processing speed, to name a few. Here's a link with more info:

    http://emedicine.medscape.com/article/317596-overview

    Most children's hospitals have a neuropsychologist on staff, so that's one place to look. You can also check your insurance provider's website to see if they list providers of that type.

    I happened to find the one I used just by googling the profession for my area. Your psychiatrist may also be able to refer you to someone.

    Even neuropsychologist exams cannot be 100% conclusive because with some disorders (like bipolar) the course of the disorder can change over time and in a young child things are not always as clearly presented as needed to make a 100% diagnosis. That's another reason why your psychiatrist is likely hesitant to slap a label on your son right now.

    Sounds like you are on a good path now for getting your son the help he needs. It's a long journey that requires patience, but things will get better in time!
     
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