When we tried stimulants, we saw improvement with the first dose. If the child is taking short-acting medications, you should see improvement within half an hour, often less. That peaks at about the 2 hour mark then anothertablet is needed. It was explained to us that we needed to get blood levels up past a certain threshold, then keep the level topped up throuh the school day then let it wear off at the end of the day so the appetite suppressant/insomniac effect has worn off so he can have a good evening meal and a good sleep. If possible dose after breakfast for the same reaons.
We used to time the medications wearing off so by the time the kids got home, they were getting their appetitw back. Often they hadn't eaten their packed lunch so I either didn't pack much, or got them to eat their lunch when they got home, and supplemented it with fruit or vegetable sticks.
When your chhild is first put on stimulants they try the short-acting first, just to see if it works, what dosage seems to work best (it varies from child to child, not really dependent on size) and to make sure there are no problems. After a time, maybe a month, the doctor will suggest a longer-acting version of the same drug. With ritalin, that is Concerta.
Our kids are now on another stimulant, dexamphetamine. It is not officially available in long-acting form so we get it privately compounded into long-acting. To get this you need to search out a compounding pharmacist and makearrangements. We have to do this in management with the prescribing doctor so we can coordinate prescriptions.
We've found more rebound problems on ritalin than on dexamphetamine. difficult child 1 was on ritalin for some years and we changed him to dex because of bad rebound (getting worse as he got bigger). He never tried Concerta. We were told that reboundwould be less or nonexistent on Concerta - difficult child 1 wasn't game to try it. We tried it with difficult child 3 and found rebound was a problem, so we switched him back to dex and found things were a lot better. We use a combination of shot-acting and long-acting to get his levels up fst enough in the morning, and then keep the levels up through the day. Even thoguh he is nowat home during the day, I still find it easier to use the long-actin medications because the levels are more even, more stable. Fewer peaks and troughs in the medication levels through the day.
When the other kids were in mainstream and needing to be dosed at school, we found compliance was a big problem. The kids would sometimes forget and the school insisted they had to learn to be responsible and so wouldn't chase the kids up - so who is teaching responsiblity here? And the kids were not mentally capable of learning responsibility at that level.
Of course we had all sorts of problems with the kids behaviour and learning ability with all the mucking around they were going though. These eased off greatly when we switched to long-acting medications.
We recently tried Strattera (a year ago) for difficult child 3 because concerns had beenexpressed at the very high dose of dexamphetamine he's on, considering his high level of anxiety. But there was minimal benefit with Strattera but some very bad and increasingly scary side effects. The night difficult child 3 attacked me and was clearly very agitated and not really in touch with reality, had us scared for him. He'd been on strattera for five days and had been getting worse each day.
We stopped it cold turkey. Couldn't get in touch with the pediaitrician for days so thankfully he endorsed our actions retrospectively.
difficult child 3 does not have BiPolar (BP) in any way, but his reaction to Strattera (and difficult child 1's rebound problems on ritalin) could easily have been mistaken for psychotic breakdown. For us the measure has been the fast rate at which we could reclaim stability.
Rebound - it's as if all the symptoms you've kept at bay all day, suddenly all hit hard as the medications wear off at the end of the day. Or if medications are missed, the bad behaviour hits hard. It's not merely a return to difficult behaviour, it was aggression, violence, attacks on people, a short fuse, extreme impulsivity. difficult child 1 got jostled on the train to school (while unmedicated) and smashed a bottle to attack the kid with it. I was grateful to the school for how they handled it - they rang me to let me know, let me knowv that while aiting outside the principal's office (difficult child 1 now medicated) the two warring boys had made friends and sorted out their differences; but a dangerous attack had nearly happened so there had to be punishment. Between us we decided NOT on suspension, but on difficult child 1 getting clean-up duty at the railway station, sweeping up broken glass and other rubbish after school for a week. Under supervision of the railway station staff with feedback to the principal to make sure a good job was done.
A highly appropriate logical consequences response which taught difficult child 1 a good lesson.
I hope this can help a little.
Marg
