Would like opinions please

[chicaroo]

Hello!

Like many let me first say, "I am SO GLAD I found this board!"

I've put a little info about our family in my siggy. Both of my difficult child are on medications Focalin XR for both and Seroquel for my youngest at night time. Their medications were recently increased but they've been acting like they aren't on anything at all! We watch them take their medications, the school supposedly watches them take it. They are not sneaky so I don't think they are hiding their medications somehow. I do think many of the issues are from where we are re-introducing their biological grandparents back into their lives.

I have told the grandparents we need to work on the behavior issues so I've made it clear the boys daily functioning is more of a priority than visits with them.

At home, DS2 is funny, lively (not wired), interacts with his brother, loves spending time with me and husband (loves snuggle time), and has minimal issues. He also engages well with adults in our personal life. At school he shuts down (he is extremely shy) and depending on his mood he may or may not do any schoolwork. He is repeating kindergarten this year because nobdoy taught him the basics (we've been a family since Oct 05). He still can't write all of his letters, hardly any numbers but he loves school and he is a smart kid. He has an IEP and is in behavioral class 1/2 day. We were sent a note today saying he has been digressing the past two weeks (they spent several days with their maternal grandparents a few weeks ago) and they now feel he needs to be in the behavioral class all day. We have an IEP meeting scheduled for 4/23.

I want to do what is best for my son. Do you think all day with the behavioral specialist is best? I know he is the youngest in the her class and there are about 10 other older kids as well. His behavioral teacher is wonderful and she said he is like everyone's baby brother. Which also makes me wonder...is he doing this to get the extra attention from the older students?

Wow...what a great way to introduce myself. :crazy: I'll stop babbling now...

Edited: I mistyped their medications. I put EFFEXOR XR instead of Focalin XR.

 

[timer lady]

Hi & welcome. in my humble opinion, the introduction to new family members is likely contributing to behaviors & emotionality. Do your best to maintain consistency for your difficult children. Help them with their sense of permanency in your home while introducing them to their bio family.

How long has it been since an evaluation has been completed? Is it time for another? Are growth spurts affecting medications?

Again - welcome. You'll find parents here who will offer their wisdom but more importantly their support.

 

[chicaroo]

I agree; I think the visit a few weeks ago was just emotionally and pyschologically sp? too much. We had them here for Christmas Eve; the first time they had seen them in a year. Then supper together one night, an afternoon alone with them, lots of phones calls, emails and on spring break we let them stay 3 nights with them. I KNOW they did not let them see the bio parents (they are not speaking; live in a different area). These are their only grandchildren and love them dearly. So I know they aren't doing anything to negatively impact the boys. I just think it's an adjustment for them.

Their medications were evaluated about a month ago.

 

[BusynMember]

Hi. I have four adopted kids. WEre any exposed to drugs in utero? One of my kids was, and he has high functioning autism. Has your son had a MDE or seen a neuropsychologist? The "very shy" and learning problems could be many things from a form of autistic spectrum disorder to drug related/alcohol related affects. Because adopted kids are complicated, it is harder to get the right diagnosis. My son wasn't diagnosed right until he was 11, but he's doing great now that we know what's going on. His first diagnosis was ADHD/ODD, then bipolar. He has neither. If your kids rage and get violent, remember that bipolar is very hereditary. Attachment issues are also big with kids who are adopted older. Some act out quite badly due to lack of attachment. in my opinion our adopted kids, with psychiatric problems in their background (which are gentic and may require medications) and alcohol/drug exposure issues, and unsure family info need more attention in the diagnostic department. Rarely is a kid diagnosed right the first time, especially ones with complicated backgrounds. I think an intensive evaluation for older adopted kids is always a good plan and I strongly favor NeuroPsychs. When you have a better idea of why they act like they do, then I feel a behaviorists will help more. Right now, you really aren't sure what you're dealing with. I'm glad you're here. Others will come along :smile:

 

[Wiped Out]

Welcome to our corner of the world. I agree with Linda about providing as much consistency as possible.

For some kids being in a room with a behavioral specialist all day is good for others maybe not so good.

Wish I had more to offer but I'm glad you found us-you will find much support here.

 

[chicaroo]

As far as I know there was no drugs, no abuse...just a very neglectful situation. DS2 used to be distructive if he didn't get way, throw temper tantrums. Once in a while he will have an outburst but nothing like he used to be. I don't know type of testing they had but I do know they went thru extensive testing at Vanderbilt in Nashville. They were in counseling while in state's custody and see a Neurologist for their medicine.

I will have to check about the neuropsychologist. I have felt for a while that DS2 displayed Asperger's type symptoms; mentioned it to the counselor and Neurologist but both disagreed with me. Perhaps it's time to get more testing done.

 

[Sara PA]

Now wait, now wait. Are you saying that your 6 and 8 year olds are on EFFEXOR?? How much and who prescribed it? And why?

1. It is an antidepressant, not an ADHD medication.

2. It is not approved for or recommended for people under the age of 18 because of the side effects (most notably suicidality and hostility) and because it is not effective (as an antidepressant but your kids aren't depressed).

3. Antidepressants should not be prescribed for people with a family history of bipolar until bipolar is ruled out. Your children have a family history of bipolar. Mania is often misdiagnosed as ADHD.

4. Antidepressants can cause or contribute to increased mania. Actually, what they really do is cause or contribute to mood swings which include both mania and depression. That is more likely to occur in both children and people with bipolar though it can happen to adults who don't have bipolar.

You might want to read this letter the makers of Effexor sent to all doctors back in 2004: http://www.fda.gov/medwatch/SAFETY/2004/effexor_dear_hcp_june.pdf And you might want to google "Effexor withdrawal".

 

[smallworld]

Sara, actually Effexor is prescribed off-label to treat ADHD. But it is certainly not a first-line ADHD treatment nor one I would expect a doctor to choose for a 6- and 8-year-old.

I, too, would be concerned about prescribing Effexor to children who have a family history of bipolar. My son became manic after taking Effexor for 5 days. Needless to say, we pulled him off of it.

 

[Sara PA]

Not surprising that Effexor would be prescribed off label for ADHD. It's a combo SSRI/SNRI antidepressant; Strattera is an SNRI antidepressant and it's approved for ADHD so, what the hey, just prescribe any SNRI for ADHD. Of course, that overlooks that few kids with bipolar family histories have any success with Strattera (mood swings, aggression, etc) or that Effexor has real withdrawal issues. And it totally overlooks that the suicidality and hostility issues with Effexor have resulted in the letter I linked. But I guess nothing should surprise me anymore.

Effexor was my son's first medication. If I knew then what I know now, it wouldn't have been.

 

[timer lady]

chicaroo,

It's a good idea to explore further evaluations & to verify that medications are not contributing to or making matters worse.

I'd like to offer that my tweedles went through many diagnosis's & evaluations on an annual basis. We didn't get a true picture (therefore a clear treatment plan) until ages 10 & over.

The evaluations addressed concerns; those same concerns dropped off the map while others were added the following year.

It's difficult,at best, to find a clear diagnosis for our difficult children. Add into the picture a complex hx in the bio home - presenting symptoms, behaviors, diagnosis's & such become more blurred. This is going to take time, patience & lots of respite (if you can get it!).

Medications are always a crap shoot. If the medications works for your difficult child use it - if it doesn't let psychiatrist know. There can be concerns over the use of certain medications for children - it comes down to what works for your child.

As to the all day behaviorial room - I'd go for it, if difficult child needs it to be successful/functional in the academic setting. There are many children here who can handle the mainstream setting with supports & interventions - there are others who need the small contained setting to succeed.

 

[chicaroo]

DS1 - 8 yrs old: AM Effexor XR 15 mg, Noon Effexor XR 10 mg, PM Impramine 25 mg (for bed wetting and initially for depression issues when in DCS care). He also takes Zyrtec for allergies.

DS2 - 6 yr old (almost 7): Both AM and Noon: Effexor XR 30 mg, PM Seroquel 100 mg. He also takes Zantac for stomach issues.

I'm going to call on Monday and try and get them in this week with their Neurologist. I want to get updated testing on them.

Oh, DS1 was on Adderall and then state health care stopped paying for it (pre adoption). He was put put on Effexor XR, I think 10 mg and 5 mg. I was told DS2 was initially put on Ritalin but he built an immunity to it. Again, I wonder if he is doing the same thing with Effexor.

The neurologist has their biological family history.

I thought about spending the day with DS2 at school so I can observe him. Plus if he acts better with me there they can see he doesn't act like that all of the time.

 

[smallworld]

Are sure it's Effexor XR? The lowest dose it comes in is 37.5 mg.

And substituting Effexor XR for Adderall? Very strange choice.

 

[chicaroo]

Yep...we've gotten it in 5 mg, 10 mg, 15 mg, and 20 mg

 

[smallworld]

From Wikipedia:

Available forms
Effexor is distributed in pentagon-shaped peach-colored tablets of 25 mg, 37.5 mg, 50 mg, 75 mg, and 100 mg. There is also an extended-release version distributed in capsules of 37.5 mg (gray/peach), 75 mg (peach), and 150 mg (brownish red).

Check the bottle. Your description sounds more like Focalin XR than Effexor XR. Big difference if that's the case.

 

[Sara PA]

And the Effexor is being given twice in 4-6 hours? Then none for 18-20 hours? That's the way stims are prescribed, not antidepressants. And Effexor doesn't come in 5 or 10 mg, 37.5 is the lowest dose available according to the prescribing information. Are you sure it isn't Adderall XR?

 

[chicaroo]

Y'all I think I'm losing it! YES, it's Focalin XR not Effexor XR! The dr had ME on Effexor XR (I have PCOS and had Endometriosis; body went haywire was put on it in July, had hysterectomy in November and now being weaned off of it). Sorry for all of the confusion. No wonder y'all are questioning their medications! :smile: