A few things you should be aware of with Lamictal: First, Depakote roughly doubles the amount of Lamictal in the blood so you actually may not need to go as high for full efficacy if your difficult child stays on Depakote. Second, Lamictal taken at bedtime can "activate" and keep kids up at night. Third, Lamictal helps a lot with depression but doesn't do much for anxiety.
In terms of your difficult child's anxiety (trouble sleeping, picking at nails and sores, getting "stuck"), I'd take a good hard look at the Daytrana. Any stimulant can make pre-existing anxiety worse. The first day my son was in his day treatment program, his attending psychiatrist dumped his stimulant because he said it most likely was making his mood worse and his inattention was due to mood disorder, not ADHD. Just something for you to consider.
Good luck with the Lamictal. My two kids have done very well on it (and we may be starting the youngest on it soon).
