medication Merry-Go-Round

[AllStressedOut]

I really hate playing the medication game. I know I'm not alone in this. It's even harder when you aren't familiar with a new psychiatrist.

I don't know if I should trust this guy or run screaming from his office.

I had all 3 difficult children tested by a neuropsychologist at the end of July and this is what he thought:

difficult child 1 (11 yrs):ADHD, Asperger's, Major Depression he put "maybe bipolar" Behavioral Observations: mood was dysphoric, affect seemed mildly labile? (what is that!?) Visual Motor Skills he scored in the 18th percentile which put him at a 8 yrs 4 mth age.

difficult child 2 (10 yrs):ADHD, mild mood disorder

difficult child 3 (7 yrs):ADHD, Asperger's, sensory and developmental delays that in his words were "indicative of an austistic spectrum disorder", and he felt some ODD traits as well

I gave his reports to the new psychiatrist and the new psychiatrist believes that you must balance the moods out prior to taking care of ADD/ADHD. I AGREE with this part. However, he seems to think all 3 difficult children are bipolar. This, I DO NOT agree with. I can see it in youngest and oldest, but not middle.

The new psychiatrist thinks many of middle difficult children ADHD symptoms are actually bipolar. I guess he could be right, I don't know everything there is when it comes to both DXs.

Okay, now to the medication game. Last year, all school year, here are the medications my kids were on at different times, with all different levels, but the highest level is what I posted.

Youngest difficult child-25 mg Seroquel, 50 mg Zoloft, 40 mg Foclin
Middle difficult child-25 mg Seroquel, 50 mg Zoloft, 20 mg Foclin, 40 mg Straterra
Oldest difficult child-200 mg Seroquel, 200 mg Zoloft, 80 mg Straterra

Youngest difficult child was also on an extremely strict diet for what the old psychiatrist diagnosed as "reactive" hypoglycemia. Well, we had him go through another glucose test with the GP and he says he doesn't see hypoglycemia or diabetes, but if he were leaning towards either, it would be diabetes. I'm waiting for husband to get him into a pediatric endocronologist. But as far as medications went for him, his behavior got better than worse.

Middle difficult child went from being a sweetheart who would do anything for anyone, to a total jerk. He would get mad at the simplest things and get loud. His fuze was the size of a matchstick. Speaking of his fuze, I just heard him go off on one of his brothers in the other room. husband is home so he handled it. As for his grades, they improved dramatically and he went from struggling in class to very high A's in everything.

Oldest difficult child was still arguing with teachers. Very disrespectful at school. He would leave places the teacher sent him and everyone in school would be looking for him. He would get in arguments or shoving matches with other kids. He and his brothers hardly ever got along. However, he was getting good grades. Not high A's, but middle-low A's and high B's.

Over the summer we took all 3 off of everything. But even after removing middle difficult child from medications, I didn't get the same old kid back.

School is now 6 weeks along. Middle difficult child and oldest difficult children grades are lower than usual. Very low B's. Which makes me think that the Risperdal isn't enough. But I also think it was the Staterra that was causing middle difficult child to have such a short fuse. Well, guess what psychiatrist added? Straterra! 40 mg for middle difficult child and 80 mg for oldest difficult child. He also upped the dosage of Risperdal for all 3 boys. He wants youngest difficult child on .5 mg in the morning and at night. Middle difficult child on .5 mg at night. Oldest difficult child on 1 mg at night. Oldest difficult child is also more argumentative with me and his teachers since starting risperdal. Middle difficult child is actually more off task and also disrespectful to teachers at school since starting risperdal.

Youngest difficult child is still having trouble staying on task at school. His teacher thinks he shows more signs of ADHD. The psychiatrist doesn't. He thinks he needs more risperdal to balance out his moods. This new teacher is much more structured than any other my youngest difficult child has ever had. He isn't having the same behavior problems he has had in previous years. I don't know if I should attribute this to the risperdal or her structure. At home this weekend he broke down in tears because his sister didn't want him to play a game with her and middle difficult child. Last Thursday he broke down in tears because he moved the ottoman on top of his foot, but he had his shoes on and the ottoman isn't heavy. I put a bandaid on his knee because he has been picking at a scab for more than a month now and I want him to stop so it will heal. Well, as soon as he got the bandaid, out came the drama. The scrape is more than a month old and he started limping when he got the bandaid. I think he's picking at the scab to keep the boo boo so he gets sympathy. He picks at it at night and I asked his teacher to watch for it during the day. I think I'm going to start putting a HUGE bandaid on it at bedtime and taking it off in the morning. I'm not sure if it will heal under the bandaid, but I don't know what else to do.

I have no idea what to attribute any of his improvements to. I feel like I'm nit picking because compared to his past behaviors, this isn't much. I mean, he's not chasing kids around with scissors. He's not urinating on anyone in the bathroom. He isn't exposing himself at school.

I guess my issue is I have no idea what is working. The structure or the medications. If its the structure, then he doesn't need the medications. But how exactly do you make sure he always has this type of structure at school? And why on earth was his bad behavior so bad just because it wasn't structured? It's not normal to chase others with scissors, urinate on others or expose yourself, is it? My 2 PCs never did these types of things. But why suddenly is youngest difficult child not doing it? And if he is still having problems with staying on task and focusing, is upping the risperdal going to fix this or does his teacher get another month of him out of focus and off task?

I'm babbling. If you made it through you deserve a reward.
:bravo:

 

[BusynMember]

First of all, how long did this neuropsychologist spend with each child before coming up with those diagnosis? Often fast evaluations aren't that accurate. I know that first hand!

 

[mrscatinthehat]

Medopoly. Such a fun game. I will tell you from my experience and most of what I have heard Strattera adds aggression. Not all this is simply my experience with difficult child 2 and a couple of other people that have told me similiar things.

Did the psychiatrist give a reason why he wanted to go back to that? Did you mention (I am sure you did but have to ask) about the bad behavior on it?

Good luck!!!

Beth

 

[AllStressedOut]

Well, between he and his therapist, they have spent now 3 sessions, probably 4-5 hours in total, with us and the boys. The put it all into some computer program that is specific to psychiatric evaluations. Not sure if its their own made up program or not.

I did mention that both boys have been on straterra before and that both had behvior/aggression issues on it. But he brought up that oldest difficult child had behavior/aggression issues prior to straterra as well as middle difficult child continuing to have aggression issues after stopping it. I couldn't argue with that.

Now I'm at a loss. Not sure if we're headed down the path of doom yet again.

 

[Mrs Smith]

A red flag to me would be that he's recommending a medication that has had unacceptable side effects in the past. Another red flag is that he is using the same drugs on all of your kids despite their different diagnoses. And finally, the last red flag is that he is disregarding your imput. I would shop for another doctor if it were me.

I went through half a dozen at least until I found the right one. Afterall, you have to live with the consequences of his medication choices. Don't accept anything that doesn't both dramatically improve behavior and has no negative side affects you and your child can't easily live with.

It's exhausting to retell the same histories over and over so maybe write it down once so you can hand over a written copy. I wish I had done that when I was going through it. Good luck! You will eventually find the best combination of medications, therapies and educational accomodations for your kids.

 

[BusynMember]

He saw ALL of you only three-four hours??? in my opinion he certainly didn't do enough testing. I agree that he is treating your kids as a team. in my opinion, I'd get another opinion and see another neuropsychologist or a Child Psychiatrist. Something in my mommy gut tells me that this professional is trying to do a three-for-one with your kids. When I'm in doubt, I always go for a second opinion. My son had exhaustive testing, but it paid off. Good luck!

 

[smallworld]

You don't need to consent to any medication changes you don't agree with. You can tell the psychiatrist you tried Strattera, you didn't like the side effects and you want something else.

I agree with the need for further evaluation and a new psychiatrist. It doesn't sound as if you've really nailed what's going on or located a psychiatrist who is a good match for your kids.

 

[AllStressedOut]

Oh Midwest, I was in such a hurry earlier, I thought you meant this new psychiatrist. The neuropsychologist spent about 2 hours with husband and I on our first visit. Then he spent 1 1/2 hours with each difficult child. Then another 1 1/2 hours with husband and I. So in all, he spent about 8 hours with us as a family. The new psychiatrist spent 4-5 hours with us in addition to the neuropsychologist reports.

The psychiatrist put the staterra addition to us this way. He said, oldest difficult child was already aggressive and angry prior to staterra so it wasn't the straterra doing this. He then said that middle difficult child is angry now because he can't focus in class and this is why he is showing it even after coming off the straterra. I guess this makes sense, but I'm still worried it was the straterra making them both angry and aggressive.

 

[flutterbee]

That's very, very fast for a neuropsychologist evaluation. They typically do 6-12 hours of testing and then additional time with parent input and going over results. My difficult child had 6 hours of testing and the neuropsychologist said she could do more if we needed more info.

You seem to keep finding psychiatrists that want to treat your children as one child instead of individuals. Maybe they need their own individual psychiatrist? Might be easier said than done depending on the number of child psychiatrists in your area.

I'm confused, though. He said he wants to treat the BiPolar (BP) then treat the ADHD (which is right from what I've read), but the BiPolar (BP) isn't stable and he's added an ADHD medication. Strattera, if memory serves, is an antidepressant not a stimulant. Plus, as you and other's have mentioned, you're children have responded to it negatively before. Didn't Carl Jung define insanity as doing the same thing over and over and expecting different results? Plus, risperdal is an anti-psychotic, not a mood stabilizer. He seems to be moving very fast with all these changes.

I don't envy your position. (((hugs)))

 

[neednewtechnique]

Red flags are going up all over the place with your account of the way things are going. I would agree with him that if the agression is there whether the straterra is there or not, then it probably isn't the cause of the problem. However, he seems satisfied that it isn't causing the problem, but doesn't seem interested in trying something else that might HELP the problem...

I agree also that he is trying to get a three for one on your children. This is sad, but the fact is, that it does happen. Doctors can bill for three kids and still only take up one slot!!!

 

[smallworld]

Heather is right. Strattera is an antidepressant used to treat ADHD. It frequently makes kids moody and irritable, even those without BiPolar (BP). My son's psychiatrist said he'd never recommend it for my son because of his BiPolar (BP)-like mood disorder.

Risperdal is an atypical antipsychotic, not a mood stabilizer. Kids with BiPolar (BP) need a true mood stabilizer over the long haul. However, kids with autistic spectrum disorders frequently do well on a combo of Risperdal and an ADHD stimulant like Ritalin. So that's why it's important to know for sure what you're treating.

My son had 10 hours of neuropsychologist testing. The neuropsychologist then met with husband and me for 2 hours to go over his findings. He also provided us with a 37-page report that included test results, interpretation and recommendations for interventions.

 

[susiestar]

If he wants to treat the bipolar, why hasn't he given you a mood stabilizer? What is his thnking?

Strattera and zoloft both can cause aggression. Several of us have had very serious aggression while our kids were on zoloft.

Why does he now want to add lithium or depakote or another first line mood stabilizer? Does he answer this, or just direct youback to strattera?

If he thinks your kids are bipolar, neither zolof or strattera is a great medication, not unitl moods ar stable.

This does not make sense.

I might be looking elsewhere if he won't give nad explanation that makes sense.

Susie