Can I have your opinions on this please.

I would love to get some opinions on this since we are so new to medication. I realize that no one is a doctor, and I will speak with my child's doctor tomorrow, but I also think the opinion of other moms that have "been there done that" is very valuable.

In short, I have always known that my son had ADHD. At 4-5years old I took him in to get an evaluation, and while his pediatrician agreed that he probably did, he wasn't comfortable making a diagnosis until he was in school and we could get an opinion from people outside of the home. I left that appointment feeling pretty hopeless and deflated. I spent the next 4-5 years going between denial, "oh he's had a great day, and everyone else says "he's just a boy", to knowing what I've always known, that something was just not right.

Anyway, my son has now been diagnosed, at age 9, with ADHD (combined), ODD, mild anxiety and depression, and no one is ready to rule out bipolar, although honestly, while he fits "some" traits of bipolar, he fits almost every trait of ADHD, and ALL the traits of ODD, so I dont' feel like the diagnosis is off at all.

Now that you have a little background, I'll get to my question. My son has been started on Concerta, 36mg. Yesterday was his first day on it. I'm really not sure of what to expect, and what is normal, etc, so I have a few things that concern me. The first half of yesterday was pretty good. He was a bit "slow", and didn't have much energy to do really anything, but he was talkative and said he felt good. Around mid afternoon he started to not do so well. He was starting to get agitated, and his mouth also started to move non stop. Tongue trusts and his lips & jaw moving back and forth. This went on for about 4 hours, and had him, understandably, very irritated. As his meds wore off more and more he got more and more emotional. When he was finally ready to go to sleep, I found him hiding in a cupboard, scared and crying saying he was afraid bad guys would come into his room and steal him if he slept in there. His night time fears aren't really new, but they typically do not affect him to the point that he doesn't want to sleep in his room. Once he finally did go to sleep though, he said he slept great.

I wasn't going to give him his meds today until I talked to his doctor, but he was upset about that, so I decided to try it out another today. Today was better. He was more active, and just seemed more "with it". He has been a bit more argumentative, and aggressive today, but no where near the level he normally is. On a scale of 1 to 10, 10 being the worst, he is normally at an 8 on the aggressive, argumentative, tantrum side of things, and he has been around a 3 today, so really not so bad.

I have noticed, within the past hour, as the meds are wearing off, that he is getting tics again, although they are way more mild then yesterday. Yesterday it didn't seem like a tic, it was non stop movement. Today it seems to be a tic, only occasionally, and I don't believe he is aware of it. He did not previously have tics. As the meds wear out of his system he is fairly agitated, emotional, and argumentative (maybe a 5 on the scale).

He also seems to be hyper focusing a lot, although that might just be because it's the weekend, and he's bored. We'll know more about how his focus is tomorrow during school, and during homework time after school.  

I'm basically just wondering if this all sounds about right for the first few days of medicine, or should I be worried about the reactions he is having as his meds wear off, tics, emotional, aggression, agitation. Also his hyper focusing?

Thanks for any insight you can give me!

Melissa

ladym,

My son was put on Concerta too and he had a really bad reaction. Some of the reactions your son had were similiar to my son's. Particuarlly the fear/anxiety stuff. My son is always worried about "bad guys" (his exact words). His Dr. also tried him on Adderal and had similiar reaction. He hasn't put on another stim. since.

KathyB

Yes, I would be worried.  For several reasons.

First, what kind of doctor diagnosed your son?  What kind of doctor is prescribing his meds?  If your son hasn't been evaluated by both a neuropsychologist and a child psychiatrist, I would strongly recommend you do that as soon as possible.  Without an accurate diagnosis, you can't possibly put the proper interventions into place.

Second, starting at 36 mg Concerta is high.  My son was 9 when he first went on Concerta, and the doc started him at the lowest dose of 18 mg.  After a week, we decided it wasn't enough and moved up to 27 mg where he stayed until he was 11.  It is generally recommended with stimulants to start low and go higher as needed for efficacy.  Otherwise, your child could end up on a dose that is too high for him.  Hyperfocusing and being "slow" are symptoms of too high a dose.

Third, the uncontrollable movements you describe may not be tics but dystonic reactions and are more serious than tics.  My son recently had a dystonic reaction to an atypical antipsychotic (he has suspected bipolar), and had to be taken off of it.  I would definitely look into whether Concerta can cause dystonic reactions.  If it is a tic, however, stimulants are known to exacerbate tics but do not cause them.

Fourth, stimulants can exacerbate co-morbid anxiety and depression.  That's what you saw with your son's nighttime fears.

Fifth, you can't say for sure whether your son has bipolar.  Only time will tell.  ADHD and ODD fall under the umbrella dx of bipolar disorder.  My son has both; in fact, his first dx 3 years ago was ADHD and anxiety.  When we tried to medicate his anxiety with SSRIs and they caused raging, his dx morphed into bipolar disorder.  Stimulants and SSRIs can both make kids with BP much, much worse so be very vigilant with these meds.

HTH.  Feel free to post again with any questions.  And yes, I would give the doc a call tomorrow to talk about your son's reactions to Concerta.

Thanks for all of the help. I will definitely call the doctor tomorrow and talk to him about everything that has gone on. He's gone to sleep tonight without incidence, although late, but that's expected.

To those that asked, he was diagnosed by both his pediatrician and a child psychiatrist, his pediatrician is the one prescribing the medication. Our pediatrician will not diagnose without confirmation from a child psychiatrist. As I said, no one is willing to rule out bipolar, including me, it just doesn't seem to "fit"  at this time, although I realize it could become clear in the future. We have a fairly strong family history of ADHD as well.

The meds have helped immensely with his problem area's. It's been amazing to be able to say the word no, or even make a request, and be met with an "okay" instead of instant arguing, a tantrum, name calling, etc. He says he feels really good, and that things just aren't so hard for him now, which is great to hear. I just worry about his reactions though.

 Just to clarify, he only seemed "slow" that first day, today he didn't seem like that. His energy level was average, not bouncing off the walls, but typical to my other two children, who are kind of my guages right now for that kind of thing since I can't judge my son well, since I've only known him one way for 9 years.

Thanks again for all the help. I'll put a call into his pediatrician first thing in the morning.

Melissa

A reaction like that to stimulants is more likely to be consistent with early onset bipolar, which has a huge ODD factor, than ADHD/ODD. His diagnosis already includes depression. Kids with bipolar are hard to spot because, rather than the moodswings you see in adult bp, they cycle so quickly that it looks a lot like rageful, extreme ADHD. ODD is part of bipolar. In of itself, ODD is more a symptom than a diagnosis. If your child gets violent or rages often for long periods of time, I'd suspect bipolar disorder. Here is a link to childhood bipolar. You need to take him to a Child Psychiatrist, imo. Not treatint it, or treating it with ADHD meds, can make a bipolar child worse. Bipolar tends to be progressive so it's bst to stop the cycling as young as possible. Not saying he has it, but it sounds like it to me. I have bipolar and always did. The ODD is just part of the disorder. The tics could be an early warning sign of Tourette's Syndrome. These aren't things you want to let go.