No Stimulants work! ADHD/ODD, 7 yr old

Discussion in 'General Parenting' started by Jules71, Feb 9, 2010.

  1. TiredSoul

    TiredSoul Warrior Mom since 2007

    Hello everyone! It's been a long time since I've been here. I have run out of ideas.... and need some input from all you experts out there.

    difficult child, m, 7 yo: diagnosis'd with ADHD combined type and ODD 2 years ago.

    We have tried:
    Bright Spark (

    It seems he cannot tolerate a high enough dose for it to really be effective. He has been taking the lowest dose of concerta for almost a month now and here is what I see:

    Over emotional – hates life, wants new family, going to kill Mom, Dad, & B
    Super emotional, taking off seatbelt on freeway
    Stole alarm clock and remote from Nana’s
    Crying almost every evening – due to frustration or not getting his way (over emotional) more-so in the beginning, tapering off now
    Up late, can’t get to sleep
    Used my cc # online
    Constant profanity
    Nobody at school likes me, everyone is mean to me

    He did the best on Adderall xr 10 mg. but it wasn't entirely effective. When we bumped it up to 15 mg, he got very aggressive, hostile, bad mouth, swearing, stealing, etc.

    So now what? Seems stims aren't the best thing for him. Do we try Strattera? I read that can take up to 6 weeks to kick in. What do we do in the meantime? I hate to keep changing things and I can't bare the thought of him being so unstable for so long. I just want him to be calm and happy and have friends and do well in school.

    He has not had a neuropsychologist evaluation. I am trying to get him in to the psychiatrist our pediatrician. recommended. He did see a psychologist in the beginning who diagnosed him.

    When he is not taking any medications, he is:
    Super hyper
    Purposely annoying – does things over and over to get a reaction or upset someone
    More defiant
    Gets obsessed or fixated on things – won’t let it go
    Mouths objects continuously
    Leans on me (to the point where if I moved he would fall over)
    Hates life, wants to die

    Please help. I am at a loss for what to do next.
  2. smallworld

    smallworld Moderator

    Jules, it's not the fact that the stimulants don't work that concerns me. It's the list of your difficult child's symptoms that tip me off that you may be looking at more than ADHD. Kids with ADHD typically don't hate life and want to die. That sounds like a pretty depressed kid. In addition, a kid that mouths things may have sensory issues. So . . . before you try any other medications, I'd strongly recommend either a multi-disciplinary evaluation at a children's or university teaching hospital or a neurospychological evaluation. It's really important that you nail down the diagnosis so you can put the appropriate internventions into place. And interventions may not only be medications.

    Hang in there and good luck.
  3. TiredSoul

    TiredSoul Warrior Mom since 2007

    Thanks Smallworld. When he was diagnosis'd, the psychiatric also said possibly sensory issues, but we really never looked at it more in depth. Him mouthing objects is the only thing I can think of that he does BIG TIME when he is not on medications - he is a picky eater too. Tags on shirts and things like that don't bother him.

    Since returning to school after winter break - he says he doesn't like school. He had a lot of friends in the neighborhood over the summer, but doesn't really play with any of them anymore. I think the kids get sick of the way he acts and that is why he doesn't really have any friends now - and why he hates life, school, and shows depression.

    I just feel so bad for him. He thinks his family is mean and tells us he wants a new family - and that is usually because we put our foot down and didn't let him have his way. I don't know if he really thinks that or if he is just trying to get under our skin.

    I'm exhausted. :sad-very:
  4. ForeverSpring

    ForeverSpring Well-Known Member

    I think you should take him to a neuropsychologist. His obsessions and mouthing things are red flags for possibly high functioning autism. These kids get VERY depressed because of their frustration level and stimulants often react badly on them. NeuroPsychs are good diagnosticians because they are both psychologists and have extra training in the brain and, best of all, they do intensive testing, which other professionals don't do. I have a few other questions.

    1/Does he make good eye contact with his same age peers?

    2/Does he understand how to socialize with his same age peers? Can he hold a give-and-take conversation or does he monologue at people OR simply answer "yes" "no" or "I don't know." How were his early milestones, especially regarding speech? Can he transition from one activity to another without a meltdown? Is he sensitive to things like loud noise, bright lights, crowds, fabrics? Does he get crazy if things are not exactly as he thinks they need to be (such as in his room). Does he make any strange throat noises or high pitched sounds or does he have any odd movements such as arm flapping or annoying toe tapping?

    3/Who diagnosed your child? Do you have any psychiatric problems or substance abuse issues on either side of his genetic family tree?

    These will help us help you.
  5. neednewtechnique

    neednewtechnique New Member

    I agree that it sounds like this could be something besides ADHD. I would agree with MidwestMom, possibly high-functioning autism....or my other thought was Bipolar Disorder. The reason I say that is because Bipolar in children is VERY FREQUENTLY misdiagnosed as ADHD, and the kids are given stimulants. a kid with a mood disorder a stimulant, simply makes them turn into miniature demon terrorists...
    I definitely recomment the thorough evaluations, neuropsychologist, the whole be sure...but I think in the meantime, definitely talk to doctor about the stimulants. Not taking them won't correct his problems, but giving him the wrong medications won't either...
  6. TiredSoul

    TiredSoul Warrior Mom since 2007

    Thanks MWM!

    1/Does he make good eye contact with his same age peers?

    2/Does he understand how to socialize with his same age peers? Can he hold a give-and-take conversation or does he monologue at people OR simply answer "yes" "no" or "I don't know."
    He usually only wants to talk about himself. He is more take, than give and take. He does answer yes, no, I don't know a lot though.

    How were his early milestones, especially regarding speech?
    Excellent. Above avg.

    Can he transition from one activity to another without a meltdown?
    He has a hard time if he is really into something and he doesn't want to transistion.

    Is he sensitive to things like loud noise, bright lights, crowds, fabrics?
    Not really. Sometimes if he is trying to hear the tv and everyone is too noisy.

    Does he get crazy if things are not exactly as he thinks they need to be (such as in his room).
    No. He is messy and unorganized.

    Does he make any strange throat noises or high pitched sounds or does he have any odd movements such as arm flapping or annoying toe tapping?

    3/Who diagnosed your child? Psychologist.

    Do you have any psychiatric problems or substance abuse issues on either side of his genetic family tree?
    Depression, anxiety, alcoholism, suicide of great grandparent
  7. TiredSoul

    TiredSoul Warrior Mom since 2007

    Thanks NNT!

    I fear bi-polar. I don't know of anyone in the family who was diagnosis'd with it, but it could very well have been the problem for my grandfathers dad who commited suicide when he was a baby. I used to think maybe Aspergers but he just doesn't really fit that. Some of it but not a lot. He is very smart, high IQ, is interested in things most kids his age are not, knows a lot about technology - the computer, cell phone, fax machine, etc. Good at math, science, reading. Writing takes too much effort, would prefer to type. He used to carry on better conversations with adults than kids. He does not really empathize with people. He is selfish and everything is all about him.

    Actually he used to get so angry in Kindergarten when kids would not play the way he wanted them to. He is much better at that now. But he is still bossy, wants to be in charge, etc.
  8. neednewtechnique

    neednewtechnique New Member

    WOW...sounds VERY much like my 7yo. She has Bipolar. She is sooo intelligent, she has a whole library of books to read, and we set her up with a computer, and she loves that kind of stuff. She too likes to be bossy, thats a word her teacher uses regularly to describe her.
    Melatonin is good for at night...helps them sleep. I don't think mine would EVER go to bed if I didn't give her that. I don't know about where you are from, but around here, Melatonin is very hard to find sometimes...the doctor told us if we ever find ourselves in a pinch and cant find it, we can use Benadryl instead. She actually prefers that because she said its "plastic and doesn't taste like chalk"... :) She turns 8 in a few days, and for her birthday, we decided to rent the children's science museum in our town for her party...she is SOOO EXCITED!
  9. TiredSoul

    TiredSoul Warrior Mom since 2007

    Does anyone else in the family have BiPolar (BP)? Were they hesitant to diagnosis her that young? I use Melatonin myself nightly - can't sleep with-o it. I give it to difficult child too but not regularly. I probably should because the other night he was up until 2 am, and last night it was after 10 pm. I thought he would be out early because of the night b4.

    What a fun birthday idea! Have a great time.

    My difficult child gets so obsessed with the computer, wi-fi, internet on the laptop, printer, webcam, web chat. He obsesses until it gets resolved or working, then he moves on to something else. It is all about what is next.
  10. neednewtechnique

    neednewtechnique New Member

    There are a few on my side of the family that have the diagnosis, but none that are biologically related to step-father does, and so does our oldest difficult child...but she belongs to my husband and not me, while the little one belongs to me and not my husband, so again no biological connection...
    I don't know much about the medical history on her dad's side of the family though, so maybe...
    I took her to a child psychiatrist and explained what was going on...told her that my gut says she doesn't have ADHD, and that I would prefer to steer away from Stimulants if possible uniless everything else was ruled out...and she agreed with me. She did the testing and said bipolar and we hit it right on the head. They weren't reluctant to diagnose it, but medication was hard, because they all seem to want to use Abilify for BiPolar (BP) kids, and it made her too tired during the day, and I asked for Lamictal, and at her age, it was not the first choice...but eventually they did it and it all worked out. I even let her keep the Abilify at night so she could sleep...
    Anywho, it was very nice chatting with you...I am off to work, but I will be back at some point tonight. I hope we get a chance to talk some more--seems we have a lot in common! or, at least our difficult children do....
  11. nvts

    nvts Active Member

    Hey! Take a look at Aspergers - yours sounds exactly like my son (difficult child 1) at 7.

    I think that's why so many people are recommending a neuropsychologist and/or a multidisciplinary evaluation - there are so many people who've had different diagnosis's with a lot of the same symptoms! Arrrgggghhh! Can we say "overlap?".

    Welcome to the crowd!

  12. TiredSoul

    TiredSoul Warrior Mom since 2007

    Thanks Beth!
    How are you able to to have difficult child 1 medication free? My difficult child is creepy smart too. Yes there is a lot of overlap in all of this stuff. And actually I don't really care what we call it, I just would like to find something that helps. I want him to be happy, have friends, feel good about himself - etc. You know.... it's what we all want for our kids.

  13. JJJ

    JJJ Active Member

    Bipolar and Autism jumped to my mind as well.

    Have you talked to your doctor about Clonodine? My son cannot take stims and his psychiatrist started him on Clonodine and it has been wonderful. His dose was as high as .25 mg and now he usually doesn't need his midday doses, so he takes .15 mg. It's a small dose with a great impact.

    Also, any talk of a mood stabilizer???
  14. TiredSoul

    TiredSoul Warrior Mom since 2007

    Hi JJJ,
    I did ask about Clonidine once because my nephew takes it before bedtime for sleep. Right now we are just seeing his pediatrician and there has not been any talk about mood stabilizers - I don't think she is comfortable with that which is why she referred us to a psychiatrist. I am waiting for a call back to get in to see him.

    I read that clonidine was effective for hyperactivity and impulsiveness. How does it work during the day? Does it make them sleepy? I was even just wondering if we did try Strattera if we could take clonidine too until it kicked in. Would love to know more about it.

  15. JJJ

    JJJ Active Member

    My son that can't take stims couldn't take Strattera either. It took my son about a week to adjust to the Clonodine without falling asleep so if the psychiatrist does give it to your son I would start it on a weekend.

    I would definitely get to a psychiatrist (psychiatrist). Why in the world did your pediatrician not admit she was over her head several stims ago???
  16. TiredSoul

    TiredSoul Warrior Mom since 2007

    Is it (clonidine) something you can take alone? Do you think we would see any benefit from just taking that - until we can get to the psychiatrist and/or get re-assessed? Will it take the edge off and help with his impulsivity and hyperactiveness?

  17. JJJ

    JJJ Active Member

    Tigger was already on Depakote when the psychiatrist added Clonodine. You'd really have to talk with a doctor about medications. I'm just sharing what worked for my children.
  18. miles2go

    miles2go Member

    Mine (then 6-7 y.o.) was also first diag adhd and only later BiPolar (BP).
    Clonidine was suggested (for attention, not behavior) after Abilify stabilized behavior.
    Neednew -- how much abilify/lamictal does your difficult child take?
  19. smallworld

    smallworld Moderator

    I still think you should take your difficult child for a thorough evaluation before medicating. It's very important to know what you're dealing with before throwing medications at a problem. Certain medications like stimulants and antidepressants can make bipolar disorder worse, for example, so you do want to know if that's what your difficult child has. Similarly, you could be wasting a lot of time with medications if your difficult child has an Autistic Spectrum Disorder and would benefit from interventions like speech and Occupational Therapist (OT).
  20. trinityroyal

    trinityroyal Well-Known Member

    Jules, I agree with Smallworld and others who have recommended a thorough evaluation before you determine the right course of medications.

    Not only is there a lot of overlap between childhood disorders, but certain ones mimic the symptoms of others. For example, ADHD and mania look so much alike. But, ADHD is helped by stims, while bipolar is often escalated by them. So...given that stims are clearly not working for your difficult child, then it suggests bipolar might be more likely than ADHD.

    Now, my difficult child has both Asperger's AND Bipolar, which makes finding the right medications combo even more complex. The approach his psychiatrist took was to get the mood issues sorted first, and then tackle the spectrum issues, which couldn't be addressed until we had a level of stability.

    Especially if you're dealing with a complex or dual diagnosis, you need to know as closely as possible what you're dealing with so that you can provide the right interventions.

    A neuropsychologist evaluation is probably your best starting point to tease apart what's going on.