New and questions about Intuniv

[swimmer]

My 7yo son has been in behavior therapy for 18 months. He has crying fits when he is given bad news or something doesn't go his way. He sometimes throws things but generally is not too violent. He has a hard time taking ownership of his actions and yells. He also says a lot of depressing things about himself.
About 4 months ago his therapists suggested that it was time to see a psychiatrist. After a long wait for an appointment and for someone who took our insurance we finally saw someone a couple of weeks ago. The dr. said that he has ODD, Anxiety and Depression. He was borderline for inattentive ADHD. He was started on 1mg of Intuniv. During his 2nd week he got into his first fist fight and was so depressed and irritable. We bumped him up to 2mg and the first couple of days I was amazed at his lack of tantrums but then by day 3 it all went south. She did a Connors assessment before/after medications and things look worse in the after but his teacher also admitted that he is getting to her and she is losing patience more. His regular therapist says that she is concerned because she has never seen him so depressed. We are 1 week into the 2mg and his psychiatric said that we can ween him off and try something else in a couple of weeks but the "depression" could be sleepiness and may go away. I'm scared to send him to school because of a potential phone call that he has been suspended for fighting again. Should I stick it out and give it another week or is the Intuniv just not the answer? I'm inclined to try Prozac next as I'm beginning to think that the depression was not the secondary diagnosis but maybe the primary one. I'm so new to all of this and am really struggling. Thanks!

 

[InsaneCdn]

Hi, and welcome.
Can you tell us a little more? What kinds of things led up to him being in therapy in the first place? What was he like as a baby, toddler, etc.? Has he always been difficult, or did it start at some point in time?

Depression as a primary diagnosis would be unusual in a child so young - but not impossible. There's probably more going on. (just a parent opinion...)

 

[EC24]

Hello
I am new to the group too and need help so I dont have advice but I can tel you... We tried Intuniv for about three and a half weeks. We slowly increased dosage and it was horrible. It was like my baby was stuck in a dark hole. She was sooooo angry. She also had her first detention for hitting a child at lunch for "no reason". However, she did tell me she just did not like sitting by him cause she just did not like him. (not a reason at all but at least she gave me an answer other than I dont know)

 

[swimmer]

He was a colicky baby and a difficult toddler. I even took him to his pediatrician as a toddler and asked why I was working harder than other moms on the playground. The answer that I got was that he is a boy and is fine. We initially started taking him to therapy in Pre-k but she was awful and we self-corrected those issues by putting him back in his old pre-k even though it was across town and a toll on a pregnant me. He had been throwing chairs across the room but once he switched back was fine.

We took him to the new therapist when he entered Kindergarten and was having issues acting out. Have I mentioned that husband is in the military and deployed? husband was home for a little while and was even home when we got a referral to the psychiatric so I don't know how much bearing that has. DS is incredibly resistant to change though and life has changed in the past few months.

 

[InsaneCdn]

it was time to see a psychiatrist. After a long wait for an appointment and for someone who took our insurance we finally saw someone a couple of weeks ago. The dr. said that he has ODD, Anxiety and Depression. He was borderline for inattentive ADHD.

How much testing was actually done? Did you just have a 1-hour appointment, or was this an all-day or multiple-appointment evaluation?
Has he ever had an Occupational Therapist (OT) evaluation for sensory issues and motor skills challenges?

 

[swimmer]

How much testing was actually done? Did you just have a 1-hour appointment, or was this an all-day or multiple-appointment evaluation?
Has he ever had an Occupational Therapist (OT) evaluation for sensory issues and motor skills challenges?

It was multiple visits with the first visit being 3 hours long. Pages of questionnaires for us and for his teacher. I did feel better getting a diagnosis after these visits and that medication was not thrown at us after one visit as I've heard from others No Occupational Therapist (OT) evaluation has ever been mentioned. I never considered sensory issues but there are no issues with fine or gross motor skills. As far as academics go, he is above his peers per his teacher and my observation.

 

[InsaneCdn]

Sounds like sensory integration may be something to pursue with an Occupational Therapist (OT)... but if you're going to be there anyway, I'd still be tempted to get motor skills tested... just to rule it out.

And then... how about an Speech Language Pathologist (SLP) evaluation? I would NOT expect to find language processing problems, from the sounds of things - but he could still have auditory processing problems - such as auditory figure ground, where the brain doesn't filter background noise well, which means that the person does wonderful in a quiet room working one-on-one - and horrible in a classroom, fighting to "hear"... this is NOT a hearing problem, but a "making sense of what we hear" problem, Know what I mean??

And then... how is his sleep? both quantity and quality? Does he get up every single morning rested and ready to go? or... draggy. Hard to get to sleep? or asleep before head meets pillow? (both are a problem) Sleep problems make any other problem far worse, AND sleep problems alone can directly cause all sorts of behavior issues.

 

[swimmer]

Thank you so much for all of your help. I would never have thought to look at everything.

Sleep is good. He has to read in bed starting at 8pm and lights out at 9pm. Sometimes he doesn't make it until then but either way he sleeps until 7am and wakes up in a good mood. I admit that most (all) nights he ends up or starts in my bed when husband is deployed.

 

[TeDo]

Many of us here don't necessarily consider ODD as a "valid" diagnosis. It is simply a description of the behaviors. In many kids that have been diagnosis'd ODD have been tested further only to find there was a REASON the kid was being defiant. You need to find out what the reason for his original behaviors were. You might want to read What Your Explosive Child Is Trying To Tell You by Dr. Doug Riley. It gives some ideas about what various behaviors might REALLY mean and ways to help change it.

by the way, has anyone considered doing testing to rule out Autism Spectrum Disorders (ASD)?

I agree that you should get Occupational Therapist (OT) and Speech evaluations done. THOROUGH ones. Motor skills aren't the only things Occupational Therapist (OT)'s look at. Our Occupational Therapist (OT) found some hidden reading issues that NO ONE else thought to even look at. My son's brain doesn't process black letters on white paper very well. I mean, who'd have ever thought of that. Our Occupational Therapist (OT) checked everything under the sun. Speech evaluations are also more than what most people think. There are LOTS of things they can test for.

As for the medications, we've gone through many trials but two caused SEVERE aggression followed by SEVERE depression. I would suggest you NOT go in and ask for a specific medication. Let the professionals decide what might work best. If it doesn't, you try another one until you find the right one or combo. Some people have VERY bad experiences with any given medication that other people find the most helpful. Every person is different.

To protect him at school, I would put a request IN WRITING immediately to the principal and the Director of Special Education for him to "be evaluated for special education services including but not limited to thorough academic, psychological, behavioral, Occupational Therapist (OT), and Speech evaluations". Getting the request to them ASAP and having them sign something saying they received it (if you deliver it in person). The day they get it puts Federal timelines on them as well as provides SOME protection for your son in regards to discipline.

Welcome to our little corner of the world. Others will come along. Weekends tend to be slower than weekdays.