babygonz,
At a max dose of methylphenidate of 2mg/kg/day (I mistyped the amount in my earlier post), and 48lb (22kg) child would have a max dose of 44mg/day. There are other limits on the meds based on clinical trials (like 30mg max for daytrana). An individual doctor will also add his/hers experience to the treatment decisions made.
You don't need advice, you have the best course of action layed out already. Taking him to the doctor. I would only add that you write down as much as comes to mind between now and Thursday. Stressfull situations like this make it hard to remember all the details. I used to get angry when I would leave the doctor's office that my problem was not dealt with, and later as the stress subsided, I would remember I forgot to tell him something. So I write it all down when it happens so I have all the facts he'll need to do his work.
Also have the teacher write out her observations and concerns as well. It never hurts to have as many viewpoints as possible. Bring in all communications that have come from the school, and have the teacher write out a note/letter outlining all of the behaviors that she has witnessed. My ped has forms that she gives me at each visit to bring completed to the following visit for all of Chase's teachers to complete.
My 4 1/2 yr. old son has been on Concerta 27 mg. for about 6 months and is also on Clonidine at bedtime. He has been doing so good at school and I have been so proud of him. But for the last week and half he has come home from school with sad faces everyday. At night he also has been so hyper and just not listening. At school the teacher says that he is having a very hard time with not being picked first to answer a question and is getting mad and yelling. He is also having to be asked several times to do something which is very frustrating. It is like the problems that we were having before meds is starting all over again.
We are going to his phy. next Thursday and I was just looking for some advice that may help me. I don't know if this is normal or if I need to suggest something new to the doctor.
Please help!!! I really do not want to go back down that terrible road again. He is also only 31 lbs. so I am not sure if the doctor will up the dose to 36mg. or not.
Ds took concerta too, it was the first one we tried. He started on 18mg, after a few mos we went up to 36 and then to 54. When his teacher said that it was like he wasn't on meds at all, we took him back for an eval. His pdoc wouldn't put it up to 72 (I didn't want to either) so she started him on Adderal XR. We had good results with that and later with regular Adderall with a lunchtime dose. A lot of other parents I have talked to here have had the same experiences. I think that you begin to build up a tolerance to it.
Also another thing, size in itself is not a deciding factor on the amount of medication. Above all, try not to let it stress you as these feelings only intensify the difficulty you experience and the frustration will manifest in everyone else, Your son included. Be patient and remember, it may be a bit before they get the med requirements right. Look up and stay positive, that, like frustration also rubs off on those around you. The best is always yet to come. keep in touch.
Thank you all for your comments. One question though if size itself is not a deciding factor then why have the doctors been so reluncant to increase his dose? They just keep saying well he is so little maybe if we add something in addition in the afternoon it might help. Now granted this was the pediatrician saying this not the psychiatrist. I have not asked the psy. about uping the dosage but I guess I will discuss it with him on Thursday.
Well, theres also the possability that particular drug may not be the right drug. It's a tough call when the same drug does different things to different people. Asprin works wonders in one person, but could harm someone else.
I hadn't considered this yet either, maybe he's getting to much and it just took awhile to build up in his system. Or maybe it could be 1001 other different things, I will be interested in hearing what they find, I hope all goes well for him, he has a good concerned mom in his corner, I think he'll pull through just fine.
Although size does not determine what dose will work, concerta has a maximum suggested dose of 2mg/kg of body weight. Doctors can prescribe outside of the suggested ranges but many don't untli they have lots of experience managing a particular med (psychiatrists usually have more experience with these meds then pediatricians). Adding some thing to extend the effective time is also different than increasing the amount in the body at any one time.
You may need to try another med or augment with something like guanfacine (Tenex).
I accidently posted 1mg/kg/day (it is really 2mg/kg/day).
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