New medication choices

[MICHL]

Hi all, I haven't posted for awhile. difficult child is now 13. His diagnosis is Pervasive Developmental Disorder (PDD)/not otherwise specified, ODD, ADD. He's been on Abilify & tenex for a long time, years. We've kept him on those after trials of many other medications, as these worked out the best. difficult child is maxed out on the dosage for both. He's still very defiant & oppositional & easily agitated/aggressive & has trouble working in school or homework. Without his current medications he would be much more so however. New psychiatrist presented 3 options to consider: 1)Leave ability, add lamictal (slowly get rid of tenex) 2) Change Abilify to Invega 3) Leave Abilify & add Vyvance.

My concerns are these 1) difficult child has tried mood stabilizers with previous psychiatrist (depakote, lithium, trileptal) and they didn't work. These were tried while difficult child was also on risperdal. 2) Abilify & Invega are in the same family, so I don't see any advantage of switching 3) difficult child has never done well on stimulants (trued concerta, ritalin, adderall, straterra)

Out of the 3, I may try to add the lamictal, but why? ...he never did well on the other options. When we were with previous psychiatrist I had asked her about lamictal, and she didn't want to try it.

Any advice is appreciated. **p.s. recently saw movie "stepbrothers" and they reminded me of my difficult child in some ways.

Also, is there a trick to getting previous psychiatrist to mail new psychiatrist or give me a copy of difficult child's records? they faxed a request a while back & called,& still no copies.

Thanks

difficult child 13, Pervasive Developmental Disorder (PDD)/add/odd

 

[gcvmom]

I don't know the reasons for your difficult child's defiance/opposition/agitation/aggression... BUT, I will say that Lamictal has well known antidepressant qualities and we saw it in action firsthand with my husband and difficult child 2. For husband, it really, really helped his mood reactivity. He was very negative and I guess you could say oppositional (more so at home than work, although at work, he was always getting dinged for being argumentative (he called it playing "devil's advocate")). It just really smoothed things out for him.

For difficult child 2, it helped him with his emotions -- less crying, emotional instability, etc.

I would give it a try because it works a bit differently that the other MS drugs out there.

As for the AP switch, can't really offer advice there as to one working any better than the others. I think when one stops working (providing it's being given for the right reasons) you need to consider other options. We've tried Risperdal, Abilify and Zyprexa. difficult child 2 maxed out on Risperdal and we switched to Abilify, which worked for a while. He could not tolerate Zyprexa due to a severe dystonic reaction (and after that, couldn't take any of the AP's, so now he's on Seroquel).

I mentioned in an earlier post that we're on drug #16 in 8 years... so you're not alone in having to "sample" a lot of different things before you finally find the right combo for your difficult child.

As for uncooperative doctor's offices, you'll probably just have to call yourself and be the squeaky wheel. Maybe give them a deadline? Or perhaps if you can just pick them up yourself and hand deliver them to the new doctor?

 

[Marguerite]

There is no drug treatment that will remove oppositional behaviours. If there were, our political leaders would put it in the water right before every election, to make sure they got returned with an increased majority...

With the alphabet soup of labels your child has, I would think that the ODD behaviour you see could simply be due to him trying to assert some control back into his life in desperation to cope with a confusing, unpredictable world.

Mind you, this is still a problem if you are trying to assert yourself right back. He will always be more desperate than you for control and eventually he will be winning the battles every time (assuming he's not already). A parent should never lose a battle; but we often forget that the alternative to engaging in battle and losing, is to not engage at all.

We have eliminated most of the ODD behaviours by using "Explosive Child" techniques. The behaviours that remain, we have chosen to live with and manage in other ways because a lot of it is simply the Pervasive Developmental Disorder (PDD) and the way our child copes. If your child has anxiety, for example, and yells at you to not give him peas for dinner because he hates peas, this is not necessarily rudeness or lack of respect; it's often a panic reaction. he will be more inclined to panic if this is something that happens even occasionally, especially if your response is to make him eat what you serve up, peas or no. If your reaction instead is to reassure him and say, "It's OK, you should know that I won't make you eat peas," you can lead him towards apologising for the reaction.

The flip side of this (ie adult reacting this way) is a parent screaming at a kid who is about to step out in front of a bus. If it were another adult you were screaming at, the other adult's initial reaction would be, "How rude! That woman is screaming at me!" followed (once they realise) by relief that your motivation was to keep them safe.
Our children don't see that motivation when we shout at them. Pervasive Developmental Disorder (PDD) kids especially, see us yelling at them, or us being strict with them, as us modelling the right way to behave.
We also need to see that our Pervasive Developmental Disorder (PDD) kid shouting at us is often the same panic reaction as a parent seeing their child step out in front of a bus. They will shout in panic, but once reassured, can be reasoned with (providing we haven't escalated it by getting cross at them for the yelling).

We need to think - surely our aim is to help them change their problem behaviours? So how do we do this best? We do it best by making sure that the doors to good communication and learning are always open. Once you start yelling, especially at an anxious/Pervasive Developmental Disorder (PDD) kid, those doors slam shut and the kid feels resentful. It doesn't matter that they have no RIGHT to feel resentful; once they do, they won't learn anything positive.

As for the ADD stuff, we DO medicate for that and have found that it is taking almost maximum dosages to get the benefit we need. Not good, because it can heighten the anxiety. It is here that every kid is different and you need to consider the whole kid and how they present (as well as the underlying reasons for a lot of the issues) so you can fine-tune their treatment as best as possible.

With medications, Temple Grandin talks about the "wow" factor. if you try a medication and see an almost miraculous improvement, like, "Wow! I LOVE what this does for him," then it's worth sticking with. But if you don't see much if any change, then chances are there's no point sticking with it.

Different things at different times for different kids, even in the same family. For example, we found difficult child 1 couldn't take risperdal except at miniscule doses. difficult child 3 on the other hand could much it like Minties. Both boys showed little improvement on it and it was expensive so eventually we stopped it.

On the other hand, stimulants (dexamphetamine, in our case) work brilliantly with both boys. We get bad rebound with both boys on ritalin (or Concerta) so we stay with the dex. But another kid we know with similar diagnosis to difficult child 1, has rebound on dex but not on ritalin.

I can't help you any more than this. I hope you can find something to help your child.

Marg

 

[JLady]

Marg,

What an insightful post. Thank you so much for that. Your reasoning with the child makes so much sense. Since my son started medications, when someone yells at him he looks at them and says "STOP YELLING AT ME!" How can you argue with that? No one likes to be yelled at. Your description below reminds me of me and I'm trying not to yell anymore. I've spent years over reacting and yelling at the older two. It always worked with them but doesn't with difficult child. I'm finding I have to make changes within myself to deal with him.

Thanks for what you shared.