Really bad long for medication to take affect?

Discussion in 'General Parenting' started by Hanging-On, Jan 10, 2009.

  1. Hanging-On

    Hanging-On New Member

    It's been about a year since I've been here. difficult child is driving me and everyone/thing crazy. He has to be pestering something at all times, or messing something up, breaking something, constantly talking/making noise, etc. He has to be constantly bugging me, CONSTANT COMPLAINING. Today I washed a month's worth of clothes that was tried on and disgarded in 7 DAYS. Once one room is cleaned and I moved to another room, then the first room is trashed. Yes, easy child is also doing this stuff but even his babysitter sees that difficult child flipps him out and he totally changes around him. I have been keeping them separate as much as I can, since easy child gets hurt or follows difficult child's bad behavior.

    I have been in tears all day, getting dizzy, feeling like I'm going to have a heart attack and this is starting to scare me. I can't take this much longer. This week was his medication check, and I told all of this to the psychiatric and he gave us concerta. Started it on Wed on this week. How long does this take affect? We did 1-18mg first and second day. Today and three more days are 2-18mg. Then 3-18mg.

    The psychiatric says this should stop this behavior, but I don't see anything. It even seems worse. He's also on Abilify 22.5 mg/day.

    FYI: difficult child is Pervasive Developmental Disorder (PDD)-not otherwise specified, Severe ADHD, Severe Sensory Integration Disorder (SID), Cognitive Disorder, Dyslexic, and an Apdaptive Functioning of 1.5 yrs old when he was 6 yrs old. He's 9 yrs old now.
  2. MICHL

    MICHL New Member

    My difficult child (13) is also Pervasive Developmental Disorder (PDD)/not otherwise specified. He's on Abilify (30mg/day). Stimulants have never worked for my son, and we've tried several, even straterra. Some kids they don't work for. My difficult child is on Tenex also, which is supposed to help with attention. Good luck.
  3. Marguerite

    Marguerite Active Member

    Sometimes stims work with a Pervasive Developmental Disorder (PDD) kid (if there is an ADHD component) and sometimes they don't. Sometimes it needs a different stimulant. With Concerta, it's basically long-acting ritalin. Did he respond to ritalin at all? It should have been tried, if only to see if it would work and to sort out a dosae. A lot of doctors these days, though, do go straight to Concerta.

    If it's going to work, it takes about an hour at most to show a gradual improvement. By two hours, it's as good as it will get. Depending on the dose, as it wears off (this goes for all stims) you can get rebound, where it's as if you get the accumulted behaviours you would have had (but didn't due tot he stims) ALL AT ONCE at the end of the day. Nasty. Some of them get teary, some get aggressive. Some just bounce off the walls.

    maybe you've not seen any improvement because the dose is still not at full strength yet.

    Keep a diary of what you notice each day, good bad or indifferent. That way you can pinpoint changes due to the medications, more accurately.

    If it's not doing anything or causing problems, you can thank you dexamphetamine. We get a sustained release form privaely compounded, because our kids can't take Concerta due to rebound. A friend of ours takes Concerta but not dex, because he got rebound on dex.

    it's never a cure. I was disappointed when GFG12 started taking stims (ritalin), because although there was slight improvement, the main problems persisted. Turned out it was the wrong stimulant plus the dose was too low.

    Mind you, it was spectacular for difficult child 3 - he was still bouncing off the walls, but finally had a sense of direction and was communicating much better.

    The rule of thumb should be - if it's not making enough difference to justify the expense or the hassle, then it's not worth the trouble. Temple Grandin calls it the "Wow!" factor. It has to have Wow factor or you may as well stop it.

  4. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Pervasive Developmental Disorder (PDD)-not otherwise specified is treated mostly with medications. Interventions are the best way. They are at best a band-aid, but there are other issues.
  5. gcvmom

    gcvmom Here we go again!

    If the stimulant is going to work at all, you will know right away. If it is true ADD/ADHD, the stimulant will make him calm down and be able to focus. If there is a mood disorder involved (which can make a kid look like he has severe ADHD), the stimulant will very likely make the hyperactivity MUCH worse and can send him into mania/hypomania. We experienced this with my difficult child 2, although his mood disorder was not really obvious and he didn't stop responding to stimulants until he was about 10. Now he can tolerate only a very small amount -- otherwise it sends him into hypomania.

    I would suggest you call the psychiatrist today and leave a message about what you are observing. Sounds like the medications may be making things worse for him.
  6. ML

    ML Guest

    Bless your heart! I don't have much to add on the medicine component except that manster is on tenex and from what I understand it's supposed to help with hyperactivity but not attention. That seems to be the case.

    My son was similar to yours when he was younger and I remember just how exhausting it can be. And I didn't have a second child to trigger him. It's true that for kids on the spectrum medications are never "the" answer but they can help with some of the symptoms. Like Marg said, if you don't get the "wow" factor, you might as well drop them because medications almost always have side effects and you want to make sure the cure isn't worse than the "disease". Manster has been on zoloft for 2 months now and while I'm not saying "wow" I am getting there. He has not had a meltdown in weeks. I wouldn't have wanted to try it when he was younger and I have mixed feelings about even trying it at 10. But my goal is the give him a quality of life and to that end I will exhaust all avenues.

    Thinking of you and hoping you get some rest and time for yourself. That is so essential.


  7. Hanging-On

    Hanging-On New Member

    Thanks everyone. I just gave him his medications, and I'm watching the clock and him to see if I notice anything. As I'm writing this, they both just came RUNNING into my room, and running in the house is not allowed. We have raised wood floors and they're starting to creak due to all the running and jumping off the furniture and flying in the air. I just can't get them to stop, and it's damaging the floor. sigh...

    I'll let you know later today what I see.
  8. TerryJ2

    TerryJ2 Well-Known Member

    I can feel your exhaustion, emotionally and physically.
    I would think you would see the effect immediately. I don't think this is the one for him.
    When do you go back to the dr?
    Get something for yourself!
    (My old pediatrician refused to give me anything but told me that wine works just as well!)
  9. DazedandConfused

    DazedandConfused Active Member

    It is my understanding that the effects of Concerta should be seen right away. It didn't help Son either. It only made him more irritable! (and he's pretty irritable in general). I stopped it when I realize it was making him worse.

    I can feel the exhaustion through your words. These kids can zap us dry.
  10. Hanging-On

    Hanging-On New Member

    Lol. If I have wine, I make it 50/50 with water and ice. Just enough wine to flavor the water, and take the edge off my muscles (which are ususally as tight as guitar strings).

    Exhaused, yes. As we all know, being a single working parent being tagged teamed by the kids is truly exhausting. And I've found the winter is worse, cuz there inside all the time with you...

    Oh, we go back to the psychiatric in two weeks.
  11. Hanging-On

    Hanging-On New Member

    Well, this is what's happened so far. Right after he took the medications I asked both of them to pickup the toy room. Of course he was defiant and oppositional as usual. After some stress he finally did it. Then he began taking apart a broken plane and putting it back together with tape. This kept him quiet and focused. A little unusual, but he can hyperfocus on things like leggos and taping things. So I don't know if this was the medications. All the while I'm cleaning the bathrooms and needed the broom. I called out and asked him to bring me the broom, dust pan, and trash can. He was compliant and did it without his normal back talk and defiance which always causes a fight....THIS is NOT NORMAL. So I think the medications kicked in. Then I fell down the stairs and he helped me up and kissed my booboo hands....not normal, cuz this would normally freak him out that mommy got hurt. Then he played outside and when he came in he's not been yelling and causing trouble or complaining and wanting my every attention. So, what do ya'll think? Possibly the concerta is working.

    How long does it last, what happeneds when it starts to wear off? Thanks for all your help.
  12. Marguerite

    Marguerite Active Member

    It does sound like there is some benefit form it.

    As for ow long it lasts, that depends on the child and the dosage. Our pediatrician showed us by drawing a graph of an upside down parabola with a horizontal line cutting through it above the X-axis (if that helps). The horizontal line is the medication blood level needed to produce a benefit, when the parabola isbelow that line, you can't see any change. As the parabola goesabove the horizontal line, you see them quieter, calmer, better able to focus. The height of the parabola is the blood level of the drug. The width of the parabola is how long-lasting it is. But you can also see, with something that is sustained-release like Concerta, the parabola has to be fairly wide. But if the dose is still too low, or the child's horizontal line (varies for everybody) happens to be set higher than average, the wide parabola will dip below the line too quickly even so.

    The outcome is - the Concerta could well be working, but wearing off too soon because the dose is low (for him). There are several ways of dealing with tis, and it still involves thinking about the paraola, plus observing your son to try to develop his own graph.
    What you do, is observe. How is his ability to focus? When do you notice him beginning to have difficulty? When you DO notice this, is there any hint of rebound? Or is it just a return to normal? (I hope for your sake there is no rebound, because it sounds like the Concerta IS working).

    If it's wearing off way too soon, say midday, then eiter the dose needs to be increased at the begining of the day, or he can have a second dose at, say, 11 am, or he could get a top-off dose of ritalin (short-acting) after lunch. You have to be careful to let the blood levels drop to below the horizontal line by bedtime (usually earlier) so he can get plenty of sleep. Also, these medications tend to suppress appetite so if the levels drop low by dinner time, then he is more likely to eat a good-sized meal and this helps counteract the appetite suppressant effect.

    The aim is to keep the parabola with a shallow curve above the line for the time of day he most needs it (during school hours, at least) but below the line first thing in the morning and last thing at night. Of course, this means we cop the worst behaviour at home, and often at the end of the day when they're also dealing with the accumulated stresses and fatigues of the day (and so are we). We need a bucketload more patience at the end of the day to deal with this, we also had to learn (in our house) to go easy on punishing then because the kids were just not able to keep it together at the end of the day. That's when I learned to shove food at them when they got home from school (medications worn off by then, but they were also exhausted and would soon be too tired to eat) and put tem to bed early, until they got used to it all.

    Homework is usually a huge issue, because they really concentrate hard all day at school, then they come home, with medications wearing off/worn off and are expected to do more! Frankly, if it's a problem you need to talk to the school about lightening up on him, or perhaps setting work than can be done one day on a weekend, during the day when he's medicated. It's not fair to the child or the family, to expect a severely ADHD kid to do homework midweek. Also, increasingly the research is coming in saying that doing homework doesn't increase the academic standard long-term. Coaching is different, it does raise the academic level to a certain extent. But homework - no.

    With the oppositional problems, you have several issues here and you need to do your utmost to nip this in the bud. And you DON'T stop it by getting just as oppositional yourself. Firmness doesn't stop it, it makes it worse. Read "The Explosive Child" by Ross Greene, it really helps a great deal.

    For tidying up, a tip of mine - ask them to pick up ten items and put tem away. Also be aware, a Pervasive Developmental Disorder (PDD) kid generally has trouble with transition. So if he's putting that model together, and you call him to wash his hands for lunch, he will either ignore you or loudly refuse. But if you say to him, "Lunch will be ready in fifteen minutes. Get yourself to a point where you can put that down, then go wash your hands for lunch," you are more likely to get cooperation. Standing there tapping your feet wouldonly heighten his stress and make him more argumentative about it, you need to lead him from task to task.

    With the tidying up, I found that if I got him to work alongside me, we got a lot done. We then did something HE wanted together, as a reward. Or I use bribes (freely). For example yesterday, "difficult child 3 - I need you to empty the dishwasher and then put a loaf of brad on to cook. When you've done that, I will take you to the beach. We can go as soon as those tasks are done."
    I sometimes add, "While you're doing that, I will be doing the washing." That way he knows he's part of a unit, and not feeling like he's the only one working.

    The floors - I'm not sure what you can do there. Are you sure that the floors can't take too much? A dance floor (sprung floor) certainly couldn't take much, but I would have thought a standard timber floor with joists and bearers at the correct distances could take it. However, timbers do get a bit loose at times. If you're at all handy, you cna strengthen them yourself and deal with the squeaks and possible loose spots by getting under the house and putting in small wedges, or even checking the bearers to make sure they're in good order. Sometimes a new floor will develop new squeaks because it wasn't fully seasoned to begin with. We get squeaks etc in Australia, because we get either heavy rain, or months of dry weather. The floorboards either swell in the damp, or dry out and shrink. Very annoying.

    If you opt for the "let's check it out" route, try to involve the boys to turn them into potential handemen. Even if all they do is find the squeaky spot and stand there, while you crawl underneath.

    On the dyslexia front, have you investigated coloured glasses? I'm not sure what the view is these days but it was big in Australia back in the 70s. I think my optometrist still uses this, so I figure it's still believed to help. It needn't cost a fortune, so be wary of people who want to charge you an arm and a leg.

    I hope this helps.

  13. Hanging-On

    Hanging-On New Member

    Ok, it's now 5pm (9hrs after taking his medications this morning) and I just asked him to do his nightly chore of feeding the dogs and filling the water bowl. His response was "crying", then defiance/oppitional/crying etc. I told him to do it, and walked away. He's now in my room asking something as if nothing happened. Totally calm. So what's this, because this is some what normal for him. He does cry alot when I ask him to do something. So I wondering if we're going into rebound, or not.
    Last edited: Jan 11, 2009
  14. Hanging-On

    Hanging-On New Member

    Thanks Marg. You are full of info. Thanks.
  15. Marguerite

    Marguerite Active Member

    Hmm. Possible rebound, or it could be simple exhaustion from being able to concentrate better all day. You need time to observe and see how you go.

    Rebound itself isn't necessarily all bad. If the net benefit is amazing, you put up with a bit of mild rebound. But if it IS rebound, then it will get worse as the dose increases. He may learn to cope with it, especially as he gets older. Also, teary rebound is much easier to live with, than aggressive rebound (speaking from experience). difficult child 1 is gentle, loving, considerate. But when affected by rebound when younger, he attacked easy child with a screwdriver. Off his medications he would get aggressive (still does). On his medications, he's a darling.

    Telling him to do something and then walking away - it is likely to trigger the oppositionality. He is going to be far less capable at the end of the day and when unmedicated. You do need to read tat book. For a fast preview, check out the link in Early CHildhood (it's a sticky). But I'm currently re-reading the 3rd editino of the book, it's the New Improved version and is even better, I think. It refers to Plans instead of Baskets. You take from it what you feel will help and leave the rest.

    I found it made my life much easier, I could throw out a lot of the charts and stickers and just go back to my own eits, guided by this book telling me this was OK to do. And then quickly reinforced by the improvement in how we all got on.


  16. gcvmom

    gcvmom Here we go again!

    Nine hours is probably about the most you'll get out of Concerta. It's been a while since we used it, but I think 8 to 10 hours is typical for it to last.

    It does sound like it's working pretty well. The crying could be from the medication wearing off -- sometimes some people can become irritable as it wears off.

    I think the best thing you can do is document his behavior for a few days and then follow up with a call to his psychiatrist to let him know what you are seeing. He can help address the emotional issues that you are seeing as well.
  17. smallworld

    smallworld Moderator

    Concerta can last 10 to 12 hours, but it depends on the dose and how the person metabolizes the medication.

    I agree with gcvmom about documenting behavior and reporting it back to the psychiatrist. It's the only way you both will know whether it's working or not.
  18. Hanging-On

    Hanging-On New Member

    Thank you all of you. Even after a long hitatus away you still come back to my rescue. Just talking with you guys help calm the nerves. It's now 8:30pm, and he's still calm. Even having a conversation with me and easy child while I cooked dinner. I mentioned taking a bath (which usually flips him out), and he smiled and said ok. Now, that's a WOW affect, but let's see if he actually takes a bath. I just pray that it keeps getting better and we don't lose it, like we have so many times.

    Thank you all for being there for me. God bless you all. Good night.