Medication for J

[Malika]

No, it's not a fix-all but it might be a fix-something - and that, I have come to see, is significant.

I think J already "knows" (ie in the way most kids know it, without having specifically been taught) how to socialise appropriately. What gets in the way is his inability to control his emotional impulses, his insufficient inhibition of reactions like getting angry, upset or hostile when things don't go the way he wants, etc. When that is not happening, he is playing and interacting like any other kid. I think... I suspect.... that this is one of the differences between Autism Spectrum Disorders (ASD) and ADHD, for example. Most social situations are at the moment off limits to J, not because he doesn't know how to relate to people or talk to them but because he cannot control his hyperactivity. He is quite happy running over sofas at a party, for example, or rushing in and out of rooms banging into people but I am not - and neither are the other people there. So we rarely go out. Almost never go to a restaurant, unless it is sitting outside on the pavement. That is the kind of thing I meant.

One of the claims for the medications is that they compensate for brain functioning in certain areas so that a child has the kinds of brakes on their behaviour that most other people have. From all my reading and research, I now have some level of faith in the science of this and I am willing to give it a good try.

He does see a woman therapist (who is very good) though she has now gone on maternity leave until at least January.

 

[InsaneCdn]

No, it's not a fix-all but it might be a fix-something - and that, I have come to see, is significant.

Well said! In fact, that is generally the most we can expect from any of the medications. Often, it's about making "enough" of a difference that other interventions (including time and maturity) can have some impact.

You are right about the social skills differences between ADHD and Autism Spectrum Disorders (ASD)... Kids on the spectrum are either seriously delayed in social skills, or really don't get it at all, and it takes a lot of hands-on intervention to teach the skills. Kids with ADHD do have some level of "normal" social skills, although ADHD can cause some developmental/maturity gap as well.

 

[Malika]

Yes, I think that's right. Russell Barkley talks about how ADHD kids are on average 30 per cent behind their peers developmentally - that's a lot. And of course it's uneven. J, for example, has always been more independent, bright and "street smart" than other kids his age but emotionally he is like a much younger child. And that's what other kids find weird - him still having tantrums when he's frustrated, for example - and he has become somewhat of a target for bullies. Standard fare for ADHD kids according to what I've read but with J it surprised me. He seems so tough and macho, but there's a side of him that is quite babyish and vulnerable, very easily upset and hypersensitive, and that part hasn't yet started to mature. Bullying older kids seem to feed on it.

Here's another interesting thing Russell Barkley says (in his factsheet, found on his website) - that it has been found in studies that ADHD kids display fewer symptoms with their fathers and more with their mothers. This is the case with J. He is better behaved with my ex-husband and "listens" more to him. Of course there may be all sorts of reasons for that but I'm glad something I've long observed is actually not just personal to us.

I have to try not to hold out too much hope for the Strattera. It looks like the side effects are settling down somewhat but there are a percentage of children who experience no positive benefit with it. I just feel so uneasy with the stimulants, don't want to live with a child not eating, not being able to get to sleep and having a crashing rebound every day when they wear off... in any case, no stimulants are available in Morocco. So if it doesn't work out we are back to the drawing board.

 

[BusynMember]

Well, I wish you well and am quite eager to see (and hope) that/if these changes do take place. I have spoken to some ADHD kid moms who are very happy with the medications, however mostly they are stimulants. I hope the Straterra helps sweet little J in every way. As you know, since you posted a picture of your precious little boy talking...I have fallen in love with him. He is a little doll. I think you have done a good job on the research end too!!! Crossing fingers, toes, eyes too!!!

 

[Malika]

Thanks, MWM. I will certainly keep you all posted... The decision now is whether to increase to 18mg for four weeks and see how that goes or go straight to 20 mg and then 25 mg.

 

[InsaneCdn]

if you have the option of 18, I'd go with 18... the more you can make each change smaller, the easier it is to adapt.

 

[Malika]

Yes, that seems wise. Would it make sense to carry on with the first box of 10mg until the four weeks is up, I wonder?

 

[InsaneCdn]

Did the psychiatrist give an option? We increased dosages every 2 weeks initially.

 

[Malika]

Well, he initially wanted to jump from 10 mg after one week to 20 mg for two weeks, and then on to 25 mg (the target dose). But he seems very open to going more slowly if that is what I want to do.

 

[InsaneCdn]

We got our initial boxes for free - and only got half a box at each dosage.
I don't see any significant downside to taking longer before moving to next dosage. It just takes longer to reach the target.

The advantage of going slow is that at whatever dosage the positive effects kick in, you will know.

 

[Malika]

J came back from his time away with his dad today. Still sleepier than usual, more irritable than usual (and later very tearful) and less joyful and happy/exuberant than usual. Somewhat calmer I suppose. My ex-husband said that he had been "good", less difficult and troublesome. No increase in concentration.
I am thinking to increase the dosage on Saturday to 20 mg for a week and then to 25mg.

 

[DDD]

Do you have any way of "knowing" what his schedule was like during his visit? I didn't when my children (very rarely, by the way) visited their Dad. I would not think that a medication change could reasonably be based on how a visit went. Hugs DDD

 

[Malika]

The increase in dosage is nothing to do with the visit, DDD - it is confusing, I know! The dosage should have been increased to 20 mg a week ago but I didn't do that because he was going to stay with his dad. Am going to do it tomorrow instead. The hesitation has been whether to increase to 18 mg for a month or whether to follow the psychiatrist's prescription and go to 20 and then 25 mg.
It's like he's a different child, in a way... more mature, somehow, less "silly" and exuberant. But with these irritable/crying outbursts. We just have to monitor it. I wish none of this were necessary, but that is useless thinking. It is this way and that is how it is.

 

[InsaneCdn]

What ADHD medications are supposed to do is enhance brain chemistry for improved executive functioning. So, the less "silly" makes sense.

difficult child says it takes a while to get used to Strattera... so there is hope.

 

[DDD]

I never "knew" whether Ex gave the medications, whether he gave it "on schedule", whether the meal time and bed time was near what was common and home. I also never knew if there was a big dietary change. Coming home from their Dad's was always full of question marks. I'm hoping all ends up perfectly for J. DDD

 

[busywend]

If he did not get it for a week, stay at 10. If he got it all week, go to 20. 18 is not real since you only have 10s

 

[Malika]

Sorry, busywend, I don't think I understand? 18mg does exist. I happened to be in the vicinity of the psychiatrist today so I called in to have a brief chat with mim and he advised that we start 18mg tomorrow for four weeks... so the new box is duly bought and we will begin tomorrow. He said he is being under-dosed at present and there is no point continuing at 10 mg.
Worryingly intense and vicious meltdown tonight (he was very tired) that was worse than usual.

 

[InsaneCdn]

Very tired will always get you an intense melt-down... Hang in there.

 

[Malika]

Yes, thanks. This meltdown was far more ferocious than usual, frightening in intensity... I feel bad that I could not really contain J in it - his anger and aggressiveness brings up an almost unstoppable fear/anger response in me and for all my good intentions, I just got angry in the end because he was throwing sticks to try and break the television, etc. Yet I can see that there is a price to be paid for not staying the course unjudgementally and calmly, however near-impossible that may actually be... J was very withdrawn from me today, won't let me touch him and is playing his tough guy role, which is just a defence.
First day of 18 mg today and no apparent effects other than that he vomited about 7 hours after he'd taken it... he seems slightly less hyperactive. Onwards we go...

 

[Rabbit]

Sending Hugs and prayers. hang in there! Rabbit