Okay, The Concerta Wasn't It - medication Trial #2

[Janna]

I should have known, going through this twice now, the medication trial is going to be a huge PITA. But, silly, stupid me, I thought, just thought, MAYBE, just MAYBE, this kid will be different, and a small stimulant will take all the worries away.

:rofl: :hammer: :rofl: :hammer: :rofl: :hammer:

Hello? Who was I kidding?

He's still ADHD, Combined Type for now. No ODD. No anything else, just ADHD. He's very impulsive. He's very, very hyper. He does not pay attention or focus well. Plays with is pencil during lessons. He's talking, giggling, mumbling, whispering, alot. He cannot keep his mouth shut, not for 3 minutes, ever. There are no rages or tantrums. There is no defiance. He does everything asked of him, it just takes forever. "easy child, it's time to brush your teeth". He'll respond OK, but first he has to fix his toy car, then he has to get a drink, then "oops, I forgot", and something else he had to do, and on and on, and 30 minutes later, he's finally brushing his teeth :hammer:

So, we tried Concerta. 18 mg. Worked okay. No help with attention/focus in school, didn't help with the chattering/talking/playing with pencils, etc, problems in school, but it did calm him down some. But, every day, notes from teacher - "okay day, but.....". So, we upped him to 27 mg., which made him totally comatose (made the teacher happy, but nobody else, and too bad for her).

His eyes were glassy. He was constantly in a daze. The teacher said to me "I see alot of results". So I ask her, with what, EXACTLY? "He's not so disruptive in my classroom anymore, he is very calm". Well, I'm glad my comatose kid is making you happy. Any improvement on focus? Nope. Any improvement on attention? Nope. So, it's not doing it's job. "Oh, yes it is" she says. Dope.

We are now going to try Adderall. Did I hear that Adderall causes increased aggression in kids? I mentioned Strattera (as the cardiologist had mentioned it), but we all know Strattera is an SSRI, and he doesn't want to go that route.

So, we will try the 5 mg. Adderall on Wednesday when I pick up the script.

The thing is, maybe easy child has to LEARN how to pay attention and focus? If the Adderall doesn't work, I think we'll just go back to the 18 mg. Concerta and work on him that way. I thought it was doing okay, the only person that was complaining was the teacher. And in all honesty, that school, it's teachers, and the principal = all dopes.

Janna

 

[Sara PA]

Adderall is mixed amphetamine salts. It can cause aggression and/or psychosis in normal doses in adults or children. You just have to watch, like you do with most of these medications.

Strattera is not an SSRI (selective serotonin reuptake inhibitor) but an SNRT (selective norepinephrine reuptake inhibitor). I suspect that they started looking into the SNRIs to treat ADD/ADHD when some doctors began to notice that some ADD/ADHD kids taking the antidepressant Welbutrin did better. Welbutrin is considered fairly mild by some and acts on norepinephrine more than the other SSRI/SSRI related antidepressants except Effexor and Cymbalta which are quite strong SSRI/SNRI combinations. But all the antidepressants have the possibility of activating mania or mood swings, including Strattera.

 

[DammitJanet]

Well I tend to agree that a pill isnt going to cure all the ills. Jamie was still adhd even on his ritalin, it just made it a bit easier for him to tone it down and get the signal from his brain to his body.

Your son probably does need to learn how to stop and think before taking any actions. Its hard for little boys to sit in a classroom all day and work when all they want to do is be playing and running around. The teacher needs to come up with some strategies to work with him. They used to send Jamie on all the out of the classroom trips. If someone needed something fetched...he was the fetcher. If a blackboard needed erasing...he did it. Anything to get him up and moving because it gave his body a chance to release those wiggles.

I was extremely lucky with jamie and his teachers. They all loved him and he was cute and adorable and made everyone fall in love with him so they wanted to help him every way they could. I never had to fight for anything for him because they just went out of their way to do it anyway. Now cory was a totally different story.

 

[timer lady]

Janna,

The medication alone won't necessarily do the trick - many times, as with wm, it becomes a combination of medications, redirection, new coping skills & problem solving.

Unfortunately, for wm, academics has taken a backseat to the other skills needed so he can learn.

Hope you come up with the right combination of things for difficult child to be able to focus & learn.

 

[Janna]

SNRT. Okay. I can't remember them all :rofl: Thanks, Sara.

Yeah, I think maybe a TSS or some type of aide or something in the classroom may help him. I think I may go that route. The problem is, TSS's - you either get a really good one or a really yukky one. There usually isn't any in between. I think I can speak from experience, but well, maybe someone will surprise me.

I just don't understand, because he did well in 2 years pre-k, kindergarten and 1st. Then 1/2 of 2nd until we moved here. He never (supposedly) had a problem until we got to this town.

But, maybe the teachers just knew I was so strung out with Dylan they didn't want to bother me with another kid :hammer: Who knows.

Thanks you guys. I'm leery of the Adderal, but will try. If it doesn't go well, we'll just stick with the Concerta.

Janna

 

[smallworld]

Janna, just a thought. If the Concerta worked OK, but the 27 mg was too strong, you have other choices in the Methylphenidate family. My son was on Concerta for 1.5 years (ages 10-11), but he asked us to take him off because he felt flat and inhibited. We have tried a bunch more stimulants (and Strattera) since then, but have now settled on Focalin XR, which is long-acting refined Ritalin. It doesn't last as long as Concerta, but it also doesn't seem to have that clamp-down feeling my son experienced on Concerta. Don't think that if Adderall doesn't work, you have to go back to Concerta -- you do have other choices.

by the way, Wellbutrin works on both dopamine and norepinephrine, which is why it's used for ADHD. However, my son's psychiatrist is underwhelmed with Wellbutrin's efficacy for ADHD symptoms. (That's why my son is on Wellbutrin for depression and Focalin XR for ADHD.) The psychiatrist, our pediatrician and neurologist are all underwhelmed with Strattera's efficacy. They say it works in only about 40 percent of ADHD cases.

 

[Sharon1974]

Are you sure it isn't the teacher. I only say this because while my son ALWAYS showed symptoms of something (ADHD?) it was 100 times worse in first grade. The teacher should be fired. The only time she was happy was when he was on a dose of Adderall-XR that was too high. I was concerned and the doctor lowered the dose. Funny thing was - he started 2nd grade on NO prescription drugs and the teacher got along with him really well. She did report some distraction but was able to work with him by making a few changes in the classroom. We then moved to another state 2 months into 2nd grade and this teacher reports no problems and enjoys having JK in her class. (She does admit he is a little distractable at times, but is also able to work with him).

If your little guy didn't need medication before, maybe a change in teacher would be worth a try, maybe not. Just a thought.

 

[pepperidge]

Janna,

This is my experience--one kid reacted extremely well to stimulants (the one more likely to be bipolar). The other one bombed on all of them. I would venture to guess that if one made him zombie it sounds like e it was "working" just not doing what the teacher wanted it to. We have been playing around with my son's dose of Adderall (either 5 or 10 mg XR) and the 5 works pretty well, 10 seems like to much--a bit too zombie like). I suspect that Adderall will have a similar effect, but not solve the teacher's problem and will likely make him comatose.

Is the blood pressure medicine he is on anything like tenex or clonidine? Those are often prescribed to deal with implusiveness, hyperactivity. (Didn't help my impulsive difficult child#2, only abilify did).

Anyway, good luck on the medication trial, at least the stimulant ones are short and to the point. It is not clear from your post as to whether the problem is only at school. If you don't have a problem, then I would definitely suspect the teacher.

 

[Sara PA]

[ QUOTE ]

by the way, Wellbutrin works on both dopamine and norepinephrine, which is why it's used for ADHD. However, my son's psychiatrist is underwhelmed with Wellbutrin's efficacy with ADHD symptoms.

[/ QUOTE ]
Wellbutrin acts mildly on all three of the common neurotransmitters -- serotonin, norepinephrone and dopamine. It prevents reuptake of all of them, keeping larger amounts in the brain for longer time. However, there is some thought that naturally occurring high levels of dopamine in the brain is what causes or contributes to teens' lack impulse control. It always seemed odd to me to give an impulsive child a medication which keeps in the brain longer more of the neurotransmitter which is associated with impluse control problems. I figured that was why someone went with the idea of an "pure" SNRI (Strattera) instead of a antidepressant that acted on all three neurotransmitters.

 

[Janna]

Chris, he's on Captopril for his blood pressure. It decreases certain chemicals that tighten blood vessels so the heart pumps the blood more efficiently. It is used for high blood pressure. And it's used to help control heart failure. I think it may be in the same line as Tenex/Clonodine. When I brought that to the pediatric cardiologists attention, he said no to using either of those, because he's already on a blood pressure medication.

Funny story. Last visit (as we were discussing ADHD medications) I told the cardio I was suing him. He asked me for what and I told him false representation. When easy child was a baby, this same cardio (he's the head of the Pediatric Cardiology Team at the Children's Hospital here - he's an amazing doctor) told me my son "would tire easily - wouldn't want to play sports - would be very calm - will be my quiet one".

Well, aren't you a big fat liar? :rofl:

Obviously he giggled. So, him not being a psychiatrist, he just said, yes, he has kids on ADHD medications. He liked Adderall and Strattera because they are non stimulating (this is right?) - before the Ritalin/Concerta/Metadate line. But, my psychiatrist prefers Concerta best.

I was happy with the 18 mg. dose of the Concerta for him hyperactivity wise. I think if the Adderall bombs, the Concerta WOULD be fine, but between myself and the teacher, he would have to be taught how to pay better attention. Again, a TSS or something of that nature may come in handy to help. It's just the 27 mg was too high.

We're starting at 5 mg. I'll keep my eyes open. If he gets zombified at 10 mg. (if we get that far), he'll go off that too LOL!

I think if the Adderall is non stimulating, and we have the same result, I would probably prefer to stick with that over the Concerta. Although, easy child has such a low heart rate as it is, the Concerta isn't hurting anything (thank God).

Alot of these problems are the teacher. She's a dope. This is the teacher that told me she had a "very immature class this year". Idiot, you have 26 8 year olds in your room. I guess they would be immature. They're EIGHT!

I think there are alot of problems with alot of kids because alot of teachers are dopes (and this is no offense to teachers here). These teachers expect our kids to sit at a desk for oodles of hours per day and bust a*s working on NCLB. NCLB is ridiculous as it is. Sorry. The school district we just left was removing all specials (gym, art, music) to add more cirriculum. ELEMENTARY SCHOOL! They wanted all kids to know trig by 5th grade. WHAT? They were even cutting recess when I left. No way. So, no wonder these kids are the way they are? I'm sorry, but I can't sit at my desk at my office for 8 hours without taking a break. Why should my child be expected to? Her expectations are unrealistic. Yes, easy child is hyper. Yes, easy child can be loud. Yes, he needs something, I'm not saying he doesn't. But geez - be glad to see improvement and stop trying to make him a perfect little angel child that is going to bow to you. Ain't happenin.

Wellbutrin is not an option, but thanks for the info, Sara. I'm just trying to treat the ADHD with an ADHD medication here. I don't want to get into all kinda funky stuff that isn't really necessary. I'll keep the Focalin in mind, SW, thanks.


Janna

 

[smallworld]

Janna, Adderall is a stimulant. It's just not in the same medication family as Concerta.

 

[Wiped Out]

Janna,
I hope the Adderall works-trialing medications is such a pain! We did get lucky with easy child-she has only tried the Adderall (she only has ADD not the Hyper) and it has worked great for her!

 

[Sara PA]

Chris, he's on Captopril for his blood pressure. It decreases certain chemicals that tighten blood vessels so the heart pumps the blood more efficiently. It is used for high blood pressure. And it's used to help control heart failure. I think it may be in the same line as Tenex/Clonodine.

Captopril is an ACE inhibitor; Tenex and Clonodine aren't. All three are antihypertensives.

He liked Adderall and Strattera because they are non stimulating (this is right?)

Adderall is amphetamine -- pure speed. Ritalin/Concerta/Metedate are all methylphenidate with different delivery formulas. All are stimulants.