? re 6-YO and Focalin/meds | ADHD Information

My 6-year old was diagnosed with ADHD (the impulsive kind) in March after one year with one psychologist and a year with another.  She is in a centers-based kindergarten and is not having problems in school, but her IQ testing shows a 15-20 percentile differential between her verbal IQ (which is in the high superior range) and the processing and performance parts of the test (high average/average range).  We think she is able to keep up because she is so bright, but reading is a problem because she can't sit still and focus, she trips and falls a lot or drops things because of her inattention, and her impulse control is poor, among other issues.  These are just examples, there are loads of other things she has going on, but she wasn't what you would think of as a "typical" ADHD kid--if there is such a thing. 

My daughter's psychologist recommended a psychiatrist who does not have available appointments until October.  We are on a waiting list for cancellations, but the psychologist suggested we see my daughter's pediatrician and try a medication to see if it would help.  She is very familiar with the pediatrician, they have worked together before. 

We started her on 5 mg of Focalin in March.  We could see immediate changes--she was able to play hide and seek, for example, where she didn't have the patience to hide for long--she would get frustrated and come out or hide in obvious places so she didn't have to "compete" and "lose" (be found).  She was more flexible and less apt to burst into tears or hit her 4 1/2 yo brother.  She still had fits, they were just reduced in intensity and frequency.

At our 2-week med check w/ her pediatrician, he agreed with the psychologist that she should go up to 10 mg.  We did that.  It has been a month or so since we went up to 10 mg.  Things have been fine and relatively uneventful.  She is still very inconsistent in her moods, but I could definitely see a difference in her moodiness.  She was able to read to me for 10 or 15 minutes at a time without falling on the floor crying, her handwriting improved, she started sitting for 20 minutes at a time drawing and writing stories. 

In the last two weeks, she has reverted back to being absolutely uncontrolled every few days.  I swear she is like an animal.  She hits her brother, dissolves into tears if there is a sound that she doesn't like, freaks out about wearing the uniform she's worn every day for three years, has hit my housekeeper several times and thrown her shoe at her dad.  I never know which child is going to wake up in the morning--the sweet and happy one, or the devil's spawn we sometimes get.  She is still doing fine at school, her teacher has no complaints whatsoever, and it's a small private school where I can get feedback from my daughter's two teachers or the head of lower school anytime by email, in person or by phone, so I would know if they were having trouble.

I don't know what to do.  Does she need more Focalin?  Does she need to stop the Focalin altogether?  Is there something to add to the mix to help her?  I was so encouraged when the Focalin seemed to make such a difference, but these crazy mood swings are unbelievable.  Last night we were in the car on the way to Dave & Busters to play games and reward the kids for getting dressed and being ready for school 5 days in a row, and she cried the whole way in the car because my son was talking.  TALKING, not screaming, not teasing or taunting, just having normal conversation with me and asking questions of my daughter.  I even turned on the car DVD player, thinking it might distract her from her frustration/irritation, but it didn't work.  She threw fits in Dave & Busters when it would be my son's turn to pick a game, cried when we stopped to eat dinner, and so on. 

It helps just to type this out, but I would love to get some input from some of you more experienced parents. 

Thanks for reading this long post! 

 

masd39207.3063657407

Thanks, Vickie.  We had some relatively mild rebound initially--the meds wore off at about 2:30-3:30, and she gets out of school at 2:30.  It was fairly simple to change our schedule and leave her alone for about an hour when the meds were wearing off--she could snack, watch tv, and recover.  She actually recovered from the rebound and was back to seeming like the medication was still taking effect by abotu 4:00-4:30.  So we handled the rebound--her age makes that pretty simple at this point because she has after-school activities that are more flexible than school-related sports or other school-related activities might be.

The latest changes are different.  She takes her meds at 7:30 in the morning, and she has been throwing fits by 11:00--ONLY AT HOME.  She is fine at school.  There must be some structure there that I cannot duplicate (or have not duplicated) at home.  She seems to react more to her brother than to friends, and there is such a unique, tried-and-true set of stressors at home--brother, mom, dad off at work or traveling, etc.  We drive her crazy.  She drives me to take Ativan and dream of running away . . . .

Initially, we noticed that her behavior was much more consistent than it had been.  She would have the hour or so of irritability, then would act like we had given her another dose.  Her evenings were smooth as could be.  That isn't the case any longer. 

Anyway, this isn't all rebound because it's happening when the medicine should be in full effect.  It's also happening at night, which could be a factor of the medication wearing off, it's just different from what we were experiencing two or three weeks ago.

Thanks for the Tenex info--I will print it off and look at it.  Like everyone else, I'm sure, I wish this were a simple process. 

Also, do all of these stimulant meds make their stomachs hurt, or does it vary med to med? 

Welcom masd,

Your child and mine could be twins (except mine has a mild dyslexia). We did not get a diagnosis until things fell apart in the 4th grade and we were in crisis with a child that wanted to die. You are lucky to have started the treatment journey earlier in your child's life.

Are the problems when the med is in her system or when it is wearing off? Rebound can cause some of these issues and there are ways to mange it.

Also, read the thread on Tenex and print off some of the articles you find in the links. Take these to the pediatrician for discussion:

http://www.adhdnews.com/forum/forum_posts.asp?TID=24770& PN=1

masd,

as far as the f xr goes... have you tried giving it to your dd with other foods?  My son takes his in scrambled eggs, peanut butter (not so much anymore since the recall), jelly toast,apple sauce, oatmeal, etc.   These are just a few that we have tried and my ds doesn't have much problem taking it. 

I'm starting to teach him to swallow it now and it is of course going to be easier, I'm sure.  We still however go back to the not wanting to swallow it amd so we have to give it to him sprinkled in his foods.

I would ask for the doctors to do a glucose tolerance test... my son's was 6 hours long.  They drew blood every hour for 6 hours.  I recommend this because my son was much the same as far as impulsive issues.  He was put on F xr 5mg and they discovered that he also had what the doctor called reactive hypoglycemia.  This doctor by the way is a psychiatrist that did all the screening, testing, etc...   The doctor described to me that my son having reactive hypoglycemia can contribute towards the impulsive issues he was having.  Since then we have met with a nutritionist and we make sure our son has plenty of protein and we watch our carb intake. 
We've never had to increase the meds and I feel strongly this is because the doctor discovered the hypoglycemia issue. 

Another thought if you haven't done so already... my son goes to play therapy. In the beginning he went weekly.  Now we go monthly.  We found this to be very helpful for him and us.  It gave us some ways to deal with him during the impulsive moments. 

I have to say for the most part our son is doing very well. 

Goodluck finding what is best for your child.

Every side effect varies from med to med.  Try to keep track of everything you do not think is "right" so you can discuss with your doctor. There are SO many options out there and no 2 children seem to function well on the same. I have a 12 year old combined ADHD, LD, anxiety. It is quite the roller coaster, but so great when things just fall into place.

As Diane said, the side effects vary from med to med and even from the same active ingredient in different formulations.

Focalin has 2 types of beads in it- one for immediate release and the other for delayed release. It may be that the immediate release is wearing off before the late release is in her system. This can cause more ups and downs than she should have. (kind of like a rebound in the middle of 2 doses)

The problems may be worse at home becasue she is comfortable "letting it all out" in the safety of those who love her no matter what. The stress of holding it in at school may be increasing anxiety for her as well.

It might be worth looking into daytrana patch. It provides a smoother med release during the day and may (or may not) avoid some of the stomache issues. I would look at this posibility before adding a second med.

Keep the tenex info in mind in case it is needed.

I know this can be tough watching your child have problems, but you will get her effective treatment.

vickie39207.6559027778

You should know that guanfacine in a long acting form should be out for ADHD later this year. Shire completed their studies and have submitted to the FDA for approval to market for ADHD. They are now in trials for ADHD plus ODD. Keep this in mind in case you need the info later.

I can't tell you how glad I am to have found this board and have experienced people to give me advice.  In my life, no one except the professionals we pay and my husband seems to think medication is a good idea.  I have a cousin whose child has ADHD, and it's like a dirty secret that they give him Concerta--so it's not like I can poll my friends and family for advice.  People who haven't been through this seem to have the idea that all parents of children with behavioral issues just want to turn to meds as a first line, when that hasn't been my experience at all. 

Anyway, back on topic--I will ask about the hypoglycemia.  I am going to call DD's psychologist on Monday and ask her to give the psychiatrist another call, and I will call myself to see if we can get bumped up on the waiting list.  October seems like a long way away!  Both DD's psych and her ped loved this one child psychiatrist, so it might pay to wait.  Ugh. 

We initially decided to try the Focalin because DH was unhappy with the idea of the patch.  I would prefer it, myself, because it's simpler than pouring all those beads into yogurt every morning and forcing my child to eat the yogurt.  I plan to call the psychologist on Monday about the psychiatrist and also to get her thoughts on a med change.  I will mention Tenex to her--not sure that she and the pediatrician will feel good about going off-label with that one, but it doesn't hurt to ask.  I'll probably be begging for it by October if it takes that long to get to the psychiatrist. 

Vickie, I agree on the school-to-home stuff.  I think it's both that she feels more free to let go at home and also that there is some peer enforcement of the rules at school.  Everyone on the playground has the same rules, and they police each other to some extent--at home, there's just me saying, "We don't hit.  You are a girl who can use her self-control to keep from hitting" or whatever the mantra of the day is.

My husband is on board with the medication, but he's not actively participating in making these decisions.  I think there is a part of him that thinks this is all going to go away and that we will figure out that she doesn't actually have ADHD.  

Forgot to mention that DD did play therapy for a year.  We finally decided that it wasn't helping--she doesn't have many issues with peers, just her brother and ME, and then with learning-related tasks (basically learning things that require persistence to master--like reading).  So the play therapy was fine, but not getting closer to the root of the problem.  Maybe once we get the meds settled she would benefit more from play therapy?? 

What I wouldn't give for a 10-step program detailing exactly what I should be doing to help this child!  I would do it all, do anything, if I knew what would help!