Could ADHD medications have been masking other symptoms?

[jennd23]

I need to update my signature, we just changed my son's medications over the Christmas break. He was on vyvanse but his behavior has not been good for a while (since Nov-ish), very moody, angry, agitated, easily annoyed, etc, and he was starting to have problems at school with-putting his hands on people, being disrespectful to his teacher, not following directions, etc. Usual stuff we see before we increase his dosage, usually.


Though while we were at the dr's office, he was picking at scabs, picking his hang nails, just general picking. He did that for a while a few months ago (maybe even last school year), but I hadn't noticed when it started up again recently. Anyway, his dr noticed and said it was likely from the vyvanse, so we switched him to Intuniv.


All of that to say....I am seeing some things now and I'm not sure if the vyvanse could have been masking them or what the deal was. Some of the things I am noticing are:
- "episodes" of being VERY giddy, like crazy laughing, uncontrollable giggling, some forced/fake laughing mixed in
- not as many angry outbursts but the couple that he's had have been the same, clenched fists, clenched face, breathing very hard, talking/yelling through clenched teeth
- Very tired, which I'm guessing is related to the intuniv, but I'm keeping my eye on it
- Very hungry, and craving junk food, which also COULD be related to his abilify, I think that was generally kept under control because the stimulant was counteracting the over-hunger, but he just wants to eat all day. I made sure to buy lots of fruit, yogurt, and healthy snacks for him and will also keep an eye on it
- He has NOT had one crying meltdown since he's been off his vyvanse and those were a daily/multiple times a day problem for the last few years, but he's been on stims for the last 2 years so maybe they're related?
- This one really bugs me....preoccupation with his private parts, his front and rear end private parts. He keeps trying to snuggle but then he'll rearrange himself on me so he is pushign it on me, I don't mean to sound like a terrible person but it really creeps me out and makes me feel "yucky" when he does that. I explain to him that its not ok to do that to other people, his private parts are just for him, and then he'll put his hand over it and say "now just my hand is touching you" but that doesn't really put a stop to it, you know? He has done the pushing against me thing before but I would just say its not ok, and that was usually the end of it (for that time period) but now its like an obsession, and me saying its not ok makes him want to do it more. He's also touching himself more and talking about body parts more, talking about his chest (calling them boobs), trying to touch my backside, etc. I have explained to him that its perfectly ok for him to touch his parts....when he's ALONE, he's not to do it in front of me, or try to touch other people with it, but of course he is afraid to BE alone so it happens in front of me. And he's 7, so I know some of this is exploratory, but the obsession with-it and the almost "joy" he gets out of it when he knows I don't want him to do it to me but he keeps trying really bothers me.
- also having lots of negative self talk, "I'm so stupid" "I hate myself" "I can't do anything right" "I am D.U.M.B.!"

I guess those are the main things I have noticed so far, I'm sure this is long by now, so I'll wrap it up. We go back to the dr later this month for a check in on the new medications so I'll talk about all of this. I'm just really starting to wonder if he might be experiencing some mania....every dr we've met has said he has depression, I've never really noticed much mania, but I'm wondering if the stims could have been supressing that? Or if his anger/rages/irritability were mania and I never put it together. Or I've been surfing the net too long and its time to step away from the google box

Oh, obviously I'm starting to think he might have some signs of bipolar....but I don't want to jump to conclusions. I'll keep a watchful eye on things for now. Any thoughts? I'm sure you have some helpful eye opening ones, you always do!

 

[InsaneCdn]

Two sides to this...

1) If you don't have the right diagnosis in the first place, playing with medications is like playing with fire... high chance of getting burned. Flipping more medications around isn't going to help.

2) Having the wrong medication for the combination of actual (not just "known") dxes and actual person... is almost always disaster (the few that are not disaster are cases where the medications just "don't work"...)

Either way... there's something to get to the bottom of.

 

[shellyd67]

I agree with InsaneCdn, the wrong medications are playing with fire.

Vyvanse has been the best medication for my difficult child so far. We have done the medication-go-round for years and this is the one medication taht seems to fit.

Of course that is not to say it will or should work for your difficult child.

Good Luck and keep us posted...

 

[jennd23]

Well, until now I've assumed we did have the right diagnosis, it never crossed my mind that it could be wrong...until recently. He's had 2 neruopsych evaluations, and multiple evaluations by therapists, psychiatrists, etc. No one has ever suggested anything other than what's in my sig, which could mean I'm over analyzing what I'm seeing....or not, I don't know.

 

[BusynMember]

Both Prozac and Abilify can cause giddiness and silliness and Prozac can cause an inability to control one's impulses...my daughter had this symptom and pulled a knife on herself while on Prozac. This symptom went away once she weaned off of it.

I would think it's more the medication interactions than masked symptoms. May I ask why he is taking the Prozac and Abilify and if he has been better or worse since being on them? in my opinion it's probably more medication-related than any bipolar. Be careful before you accept that diagnosis.

 

[jennd23]

He was put on Abilify last January because of his anger/aggression. He seemed to be somewhat better for some time, but never great, always still very easily agitated and aggressive. Prozac was for anxiety and started in April/May-ish last year, it has seemed to help. These symptoms in the original post just started within the last few weeks when he's been off the vyvanse and on the intuniv which makes me wonder if the vyvanse was just masking them or what....I hadn't thought of interactions or of these being side effects because he's been on them so long. Well....relatively

 

[gcvmom]

I would be questioning the ADHD/ODD diagnoses. The symptoms you are seeing are NOT part of those disorders.

FWIW, Prozac and similar medications (SSRIs) can be DISinhibiting for people with mood disorders that fall in the bipolar spectrum. There are other medications that can address the anxiety component that won't result in the giddy, hypersexual, and what looks like hypomanic behaviors. We had problems with this in both my difficult child's and neither one can take medications in this class because of that.

Intuniv can be very sedating -- we tried it for a few years with my difficult child 2 (who does have bipolar and ADHD) and though it did help his focus and attention, it just made him too sleepy when combined with his other medications. He recently switched to amantadine, which is rx'd for ADHD off-label, and it's working well so far.

I think you need to go back to the psychiatrist and have a frank discussion about what you are seeing now. Something's way off.

 

[TeDo]

I just want to ditto what the others have said. If this is new since starting the Intuniv, I would suspect that (alone or in combination with the others) is the cause. I also question the ADHD and ODD. The symptoms of those are also part of the Autism Spectrum Disorders (ASD) diganoses and the anxiety can be explained by this also. difficult child 1 carried those for 3 years and we had PROBLEMS. Prozac made him VERY aggressive to the point that the local police/ER doctor put him on a 72-hour hold in a psychiatric hospital. He had been on it for 6 months before all that happened. Have you thought of doing a medication wash and starting from square one? What were the BIGGEST behaviors you were dealing with before any medications? Just curious. Our old psychiatrist put difficult child 1 on one medication that caused behaviors then added one to deal with what the first one was causing. We took him off BOTH medications (I insisted even though psychiatrist's answer was to increase doses). Just a thought.

 

[jennd23]

We started medications almost 2 years ago due to "typical" ADHD behaviors...I mean the textbook ones, he was also angry and aggressive at home and school, but we didn't medicate to adjust for those. They continued on with-the medications, and about 3 or 4 months after he started ADHD medications we got his initial diagnosis (of Autism Spectrum Disorders (ASD), ADHD, and ODD with-depressive tendancies), here we are now.....still dealing with the same behaviors. Although to be fair, when the dosages are right, things are pretty good....still deal with-some of the meltdowns, etc (obviously) but mostly good. Honestly were it not for the picking we would have just increased his vyvanse and been done for the day.


I have considered doing a medication wash and would like to do it over the summer break. I haven't talked to his doctor about it yet though.

 

[TeDo]

What behaviors did the diagnosing professional say were ODD and not part of the Autism Spectrum Disorders (ASD)? Same for the Anxiety and Depressive tendencies? Just curious because I really can't think of any that can't be explained by the Autism Spectrum Disorders (ASD). My difficult child 1 is also very classic ADHD but all the other diagnosis's he's had over the years come under the Autism Spectrum Disorders (ASD). That is why I asked about the medication wash. difficult child 1 takes a non-stimulant for his ADHD and I'm glad because many stims don't work well with Autism Spectrum Disorders (ASD) kids.

 

[BusynMember]

Have to agree here with TaeDo. I have a kid on the spectrum and every single symptom, including ADHD, can be part of Aspergers. In fact, they usually go together.

in my opinion, taking too many drugs kind of wipe one another out. I never liked the feeling of being on too many medications and they ALL interact with one another. I've been one some sort of medication since age 23 and I'm 58, so I've had a lot of experience...lol. Even if you're stable, once you add another medication, you risk losing your stability. in my opinion a child on the spectrum doesn't need three medications. My own bias, also from experience of both myself and my kids, are that SSRIs should be taken only with extreme caution and careful watching. They can work miracles, but they also have the potential to make things so much worse.

I really get upset when doctors tend to throw medications at kids and not think too hard...sort of give them the medications to see what sticks. I saw a psychiatrist do this to my son and I had to tell him to back off. He had the wrong diagnosis anyway...do your research on both the disorder AND the medication.

Keep us posted!

 

[buddy]

i also agree with TeDo. My son had been on Prozac for several years. It never really did what we thought it should do...especially in the end the "anxiety symptoms" that they were medicating were seizures. but he still had traditional anxiety and it never helped that. BUT as his aggression has increased, mostly due to a medication reaction to a NEW medication it did beg the question of if we should stay on it...so many medications. etc.... so we just got off of it and since he was down to the smallest little dose left he has not had any actual serious aggression (he was jumping on me kicking, hitting HARD etc... on the other medication) but none of it has happened for a week.... even when he was really mad...that fist clenching, red faced, yelling mad...but still hasn't crossed the line. I know he WILL but that is even different than the daily multiple blow up stuff he was doing on the Prozac.

he too has Autism Spectrum Disorders (ASD) and all of the ODD and ADHD symptoms fall under that and his brain injury. i can't think of ONE thing that is really ODD and isn't typical of Autism Spectrum Disorders (ASD). His counselor said today when he had little candy papers and game pieces all over her table, she asked him to pick it up as he walked away and he said no but turned around and did it happily. Really sounds ODD at times but tends to cooperate. just has these automatic rote responses. She said he does not seem ODD to her and she has lots of kids who only are ODD that she sees.