Its probably not ADHD after all (m)

[Karen & Crew]

R saw the psychiatrist again y'day. The one we see is completing her fellowship in pediatric/adolescent psychiatry and she said y'day that she had taken R's case file to her supervisor for further review. Her opinion is that he's overdiagnosed and that the bottom-line problem is Obsessive Compulsive Disorder (OCD). Her supervisor suggested removing the Zoloft and replacing it with Celexa. He feels if we can get the Obsessive Compulsive Disorder (OCD) under control then the ADHD and tic disorder, along with all the other issues, will at the very least fade into the background significantly if not disappear altogether.

She wrote a letter to the school recommending an IEP to address difficulties with his behavior or learning in the classroom and was not in the least bit amused that the wicked witch teacher more often than not has him sitting at a desk in the hall alone.

The only bad news from y'day's appointment was that he's lost another 3 pounds. We can't increase the appetite stimulant anymore and he's refusing to eat almost everything. She highly recommended nutritional supplement drinks and this morning he was gagging to the point of almost vomiting on them.

I advised the school staff this am of the change from Zoloft to Celexa and am now working on a cover letter to send with the psychiatrist's letter requesting the IEP evaluation.

 

[oceans]

That is interesting. I was not aware that Celexa would be better for Obsessive Compulsive Disorder (OCD) than Zoloft. I hope that it works. I am so glad that you are getting the letter and starting a request for an IEP at school. I hope that you can figure out how to get him to eat! Maybe if his anxiety is decreased, the eating problem will get better too.

 

[smallworld]

Karen, I think I mentioned to you that the effects of Periactin often wear off. So some docs recommend a week on and then a week off to boost its effectiveness. You might want to consult a gastroenterologist about this type of dosing. They use Periactin frequently in their practice.

Also, are you getting rid of the Concerta? That, too, should help with appetite and decrease his anxiety.

If you don't meet with any success, you may need to consult a psychologist or psychiatrist who has expertise in feeding disorders. It sounds as if your son has major sensory food aversions (and yes, these kids are typically very anxious). It takes a special kind of therapeutic intervention. We went to a feeding disorders specialist at Children's Hospital in Difficult Child for easy child because she developed a choking phobia and refused to eat anything at all. It's important not to let food issues spin out of control.

Hugs to you.

 

[Sheila]

<div class="ubbcode-block"><div class="ubbcode-header">Quote:</div><div class="ubbcode-body">and this morning he was gagging to the point of almost vomiting on them.
</div></div>

Poor kid. Sometimes it seems that they just can't win one.

by the way, I have responded to your thread in Sp Ed.

 

[Karen & Crew]

I remember someone mentioning that about the Periactin. He went all weekend without it simply because I forgot to pack it in the bag to take camping. I guess it takes more than 2 days because he didn't seem to have an increased appetite when he was put back on it Monday. His psychiatrist did comment y'day that she was keeping a very close eye on the weight issue and if he had lost anymore when he comes back in two weeks she'll most likely refer for more aggressive interventions there. He did eat really well last night (fast food because it was Cub Scout night) but he had a half of 1 pop-tart this morning. :frown:

I totally agree on the sensory food aversions and I've been trying to get a doctor to listen to me on that one for 7 years (the food aversions were very evident before he was a year old!) but because he's growing and meeting milestones I just keep getting hit with the "he'll grow out of it eventually" line. I'm so frustrated I told my Mom I wasn't even going to bring it up with the doctors anymore. I'll keep trying to coax him into drinking the nutritional supplements and eat the meal replacement bars whenever I can and just have it noted on his chart he's on an appetite stimulant. That was when DCFS comes after me for neglect I have a history of concern documented in his file along with notes about the doctor feeling it wasn't an issue.

Oh, and yes, the ultimate goal is to get him off all stimulants. psychiatrist just wants to make sure that the SSRI is working before Difficult Child'ing them.

 

[smallworld]

One other thought: Because we were worried about disinhibition brought on by SSRIs (because of the hx of easy child's siblings), the psychiatrist prescribed Zyprexa first because it has mood-stabilizing properties and it addresses anxiety. Zyprexa (like many of the atypical antipsychotics) also stimulates appetite in a big way. Because easy child's anxiety was not addressed enough, the psychiatrist added Prozac, starting at 2 mg and going up by 2 mg every 3 to 4 weeks (the adage of start low and go slow). The combo has worked like a charm.

 

[Karen & Crew]

Hmmmm. Never heard of Zyprexa before. We have to go back on the 12th. I'll write it on my list of things to bring up. I doubt she'll do it to begin with, at least not without talking to the chief pedi-psychiatrist.

That aside, though, I still think he needs some sort of therapy to help him broaden his range of acceptable foods. He only had about a half dozen acceptable foods to begin with and he's slowly but surely eliminating those too. :frown:

 

[timer lady]

Karen - sounds like you're making progress in finding answers for your difficult child. :warrior:

 

[Got2Sleep]

Periactin didnt work for us. We tried Megase and it didnt work the first trial..but we trialed again 5 motnhs later and saw drastic change in his eating. He gained enough to ward off his g-tube for a bit longer.

HUGS and hope you find something that works for you!

~susan