Medication for J

[Malika]

Thanks, Rabbit Well, it's all charting an uncertain course... he doesn't seem tired during the day any more, and was much less oppositional today (but really I think that's because I put a lot of conscious effort into being "with" him). On the other hand, he seems just as hyperactive, really, and just as impulsive. I KNOW it all takes a long time, even many weeks, to see results with this medication. I've found someone to help him with Arabic, a school student, and he came for the first time today. J managed to concentrate for about 20 minutes, then it was all out the window. The boy didn't understand why he couldn't go on for longer but I knew that this was GOOD!

 

[whatamess]

I tried Strattera twice with my son. Both times we found initial positive effects and after 2-3 months the moodiness, irritability and general lack of happiness caused me to discontinue use. My son's exuberance, playfulness and really happy outlook was diminished. It's such a balancing act. I hope J finds good results.

 

[Malika]

Thanks, whatamess. One of the things that really surprises me about these medications is how totally individual the results seem to be for each child. So I cannot base anything on someone's good experience or on someone's bad experience! I'm sorry it didn't work out for your son. Did you try other medications and was there one that worked in the end?

So far I'd say J has had only negative effects, not yet positive (I did think he seemed a bit more mature one day but really that could just be him on that particular day) but to be honest it's rather difficult to tell. One starts not knowing what might be due to the medications and what one might be imagining is due to the medications... When I gave him the increased dose on Saturday, he was very irritable all day but this seemed to have worn off yesterday and he was his usual (mainly) happy self all day.

Most difficult thing, really, is to ward off hope and expectation and just be open to what happens, ready to discontinue (and abandon dreams of improved concentration and impulsivity) if it all just goes downhill.

 

[InsaneCdn]

psychiatrist told us Strattera takes min 4-6 weeks to see positive effects... hang in there!

 

[Malika]

Thanks... another big daddy of a meltdown tonight... as usual, because J cannot accept "no". His uncle was here and they went out to buy chewing gum and to ask his friend to come back and play at our house but the friends were all out... J went into big tantrum mode and the uncle looked disgusted, fed up, angry (welcome to my world), then J swore at him and the uncle went ballistic, shouted at J with absolute fury, stopping J in his tracks...

This goes on and on, this pattern. J is exhausted in the evening (but, unlike his Moroccan peers, is always in bed by 8.30) and there are always these meltdowns when he can't play with his friends at night. Since he has been taking Strattera, the meltdowns (screaming, shouting insults, throwing things) have been double or triple intensity. So if that continues... we have to part company with the medication.

 

[whatamess]

Hello Malika,
We tried many adhd medications. The only one that seemed to work with minimal side effects was Ritalin (not the long acting version). But he was still cranky when coming off the medications and just as impulsive during the 'off' hours.

 

[Malika]

Yes, it's the devil and the deep blue sea, isn't it? Personally I can still very well visualise us doing this thing without medications at all although of course... I long for J not to have the social and educational problems he does. There are other weapons to bring to the battle (not sure that's a good metaphor but anyway...) even if they are not as all-round successful as a successful medication.

Just trying something out here... got to be open to trying. Day four of 18 mg and he is again very tired - couldn't get him out of bed this morning and he told me he went to sleep at school today. He's also been quite oppositional, angry and aggressive (of course he is anyway at times). I am determined to give the experiment a good two months at least.

 

[Malika]

Still hanging in there - no positive effects of any kind that I can positively see and another vicious meltdown last night. He is sleeping and eating well, though.

 

[InsaneCdn]

that's how many weeks now?
The other factor is, no benefits until you get to an effective dosage, so that might also be a factor.

 

[Malika]

It is now nearly three weeks. Two weeks on 10 mg, six days on 18 mg. He weighs about 26 kg so the target dose is 25 mg (because I cannot afford to buy two separate boxes of medication) but you never know if a lower dosage is effective so we have agreed to try him on 18 mg for four weeks and perhaps longer.

A better evening tonight - no meltdowns, no rages, no cross words, happily to bed and long storytime.

 

[Malika]

I dunno, I dunno.... Yesterday he was exhausted, went to sleep at lunchtime and slept for two hours so that I had to take him back an hour late to school. In the evening he was perfectly pleasant, but very hyperactive and chattering nineteen to the dozen.

Of course 40 mg could be a better target dose for him, not 25 mg. Getting the dosage right with this medication seems very complicated. I have also read a study that showed effectiveness came only after three months of treatment...

 

[Malika]

Basically, he seems to be settling into sleepy and irritable... was highly emotional, weepy and whiney from early afternoon today, dropped asleep at 3pm, slept until 5 and awoke not refreshed and cheerful but grumpy, irritable and rude...
I know one can switch to trying giving the medications at night to try and alleviate side effects.

 

[InsaneCdn]

So much of medications is an individual thing. difficult child takes his in the morning, says it works better for him that way, but... then again, that's where we started, and he wasn't willing to even TRY evenings, so... no advice.

But it might be worth a try. Challenge is you'll be half a day without medications to do it, you need to have a gap not an overlap.

 

[Malika]

A challenge to have half a day without medications? Oh, has it really come to this?! He has spent his six years without medications, we managed okay... frankly it was better than these side effects!
But thank you for the heads up because I wouldn't have known that - I would have given it the same evening after he had taken it in the morning. I'll wait it out in the morning a bit longer because on the 10 mg he seemed to stop being extremely sleepy after a while.

 

[Malika]

Okay, well... I know I mustn't start getting my hopes up too much but today was the first day that we saw some positive effects (3 and a half weeks after starting Strattera). He slept very well, 11 hours uninterrupted, and woke up cheerful and bright. At lunchtime (he comes home from school for two and a half hours in the middle of the day), he was just like this model child - sweet, polite, listening to me, bright and happy. He wasn't so hyperactive, was clearly still a bit sleepy, wanted to stay at home with me reading stories rather than going out to play with his friends here.
After school, definitely hyper, less fantastically good, but still listening to me, not oppositional - and, here is the unprecedented thing, he has been working for half an hour with the high school student who comes to help him with his homework, concentrated and uncomplaining... this has just never, never happened. The boy said he did so much better than usual with remembering the Arabic letters - 12 tonight, where usually it is just two or three, at most.
So... if it carries on like this, it's a fairy tale and I would feel endless gratitude to ADHD medications that I once mistrusted and accused...
But I know it may not carry on like this.

 

[Confused]

Malika, I so happy for you both and the improvement! Its hard to find the right medications, the right dosage and one to where there is no other negative side effects. You did and are still doing wonderful before the medications, and now with them! Therapy or " classes", structure, they help with the medications so you still are ahead

 

[Californiablonde]

I will keep you in my thoughts and prayers and hope this improved behavior continues!

 

[Malika]

Thank you both. It is not just "improved behaviour", though - I don't know that if I could have justified giving him medication in that aim. It is the fact that he is concentrating and learning in a way he has never been able to before that feels exciting. Like I say though, I dare hardly keep my hopes up.

 

[Malika]

Okay so nothing is ever straightforward, right (or only for five minutes)? Having had this remarkable burst of concentration yesterday at around 6 pm, after the school day - on the first day of anything positive happening - today it was clear that the concentration was waning at around 3 pm. He plays football on Wednesday afternoons and he was back to his usual dreamy, inattentive self, making sand castles when he should have been guarding the goal, etc. What does this mean, I wonder - that the dosage, at 18 mg, is still too low? That Strattera never really lasts on into the evening? Not that I am complaining, yet, mind you - grateful for all and any benefits so far.

 

[Castle Queen]

Not really sure what it means but I wanted you to know I am grateful for you recording your and J's journey with this medication. Strattera is one I have been afraid to try for difficult child and this is helping de-mystify it for me- although of course I'm aware of the primary caveat for ADHD medications that everyone responds differently.