After a comprehensive neuropsych eval, my son (currently 7 1/2) was diagnosed with ADHD at age 5. Many signs were there very early on, especially the hyperfocus. He was first tested at age 3 due to his disregulated behavior. He has received numerous behaviorial, social, sensory and coping therapies, both in and out of school and has also received some alternative treatments (acupunture and traditional chinese medicine for one).
Despite all of our and HIS efforts, his impulsivity and lack of attentitivenss and hyperfocus continues to interfere with his socialization. He has made some progress off-meds, but not enough, so we just started medication.
We saw a bit of improvement from 2.5 mg of generic Ritalin short-acting. We increased it to 5 mg and saw a marked difference--he was energetic and happy and his edginess and rigidity gone (however, he suffered severe emotional devastation at the day). We are now taking 20 mg of Ritalin LA (around 8 a.m.). His ability to self-manage was somewhat improved, like 2.5 mg of the short-acting, with a bit of a let down at the end of the day, but not as severe. Now he took 30 mg of Ritalin LA and it was as if he was not on medication at all, angry, rigid, inattentive to others
As a side note, the short-acting lasted 3 hours--so he was taking 5mg of generic Ritalin 3x/day.
I am trying to determine if 20 Ritalin LA too much, too little, not the right medication?
Any words of wisdom? I would like to better understand the delivery system of the long-acting meds. Can anyone guide me to a thorough explanation of how, when these meds release throughout the day and how they metabolize differently than the short acting.
A thought could be to try the 20 (Ritalin LA) in the am and add a 10 (Ritalin LA) at lunch time. It could ease the rebound you were seeing when the 20 was wearing off, plus give you coverage later in the day.
I just got a book out of the library by C. Keith Connors, MD (the Connors ADHD Rating Scale guy) titled "Attention Deficit Hyperactivity Disorder which on page 39 describes dosage response curves. Describes three.. 1) linear response: This is the most common response: an increasing dose causes increasing improvement (for a specified symptom); 2) Threshold REsponse: In this response, nothing happens at lower doses, then a resp;onse kicks in at a higher dose; 3) Quadratic Resp;onse: With this dose response, behaviour first improves with increasing doses, then worsens as doses are raised further.
Sounds like #3 may be occuring with your son.
The ritalin la has a short acting med and a delayed acting med. It is supposed to be like 2 sequential doses of fast acting med. If the dose is wrong or he is a fast metabolizer, the first one can peak and drop before the second kicks in causing a roller coaster. Concerta has a different mechanism where the fast release med starts and the rest is slowly released for a total time of 10-12 hours.
This is all very individual and takes trial to find the best med for the individual. Do not give up, it will be worth it.