unstable moods around here! | ADHD Information

[QUOTE=masd]

I feel so lost. My 6-YO DD has ADHD. She wasn't having any problems at school (Kindergarten), only at home. Once we started her on meds (Focalin) in the spring, we saw some positive changes, which also manifested at school. We couldn't get the dosage on the Focalin high enough to help her with impulse control without it affecting her moods (at 10mg she was a moody, sobbing, defiant mess), so we stopped Focalin and tried Daytrana. That was awful. So we started her on Tenex, then added back in the 5 mg. Focalin XR also. There was a huge difference, almost immediately. Her moods seemed more stable, she wasn't as hyperactive, she was just a lot easier to be around. BUT, the Focalin wears off at 2:30 in the afternoon, so she's a bear in the evenings.

Her psychiatrist prescribed 2.5 mg of short-acting Focalin to tide her over in the evenings. I haven't given it to her every day because it seems to make it harder for her to sleep--she will stay up until after 11 at night, where before she would go to sleep before 8:00. We had seen such a positive difference, but now she's back to being emotionally unstable and unpredictable. I hate this! I just wish we could have one darned week where we didn't have to ride this roller coaster. Tonight we sent her to bed earlier than her 4YO brother because she had been awful in the restaurant where we ate dinner--kicking us under the table, spilling on purpose, etc., etc.) So DH put her to bed, read two books with her, and she seemed okay about going to sleep--we know she was exhausted. Then she figured out that her brother was still awake, so she went nuts. She ended up peeing in her bed on purpose to get us to come up there. This is the first time she has done anything like that, and I am terrified it will become a nightly affair. Ugh.

Her psychiatrist is out of town. I sent him an email, and I don't know if I will hear back from him before next week. I'm wondering if she might need more Focalin? She takes 1 mg. Tenex and 5 mg Focalin XR in the morning, 2.5 mg Focalin short-acting in the afternoon most days, and 1 mg Tenex at night.

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I wouldn't necessarily assume the piddling was an attention getter.

What I noticed is that you said she has been going to bed at 11pm so I am assuming she was peeing just before that.

Then you managed to get her to bed earlier--but she peed. Could be at her age that her bladder simply HAD to go since she was used to being up later?

Also, some meds are urinary weird. Check the side effects for all the meds she is on and see if that's the case.

I would concur with the person here who said to give her the 2.5 [say at 2pm before the other wears off or lunchtime] and see if that helps...

Sorry it's so difficult right now. This could be trial and patience for a while...

We have gone off of all stimulant meds and prescribed meds for the summer and possibly the year. It is so nice to have my happy boy back. We are taking some alternative supplements which seem to be ok for now. I do think that the meds can sure make you crabby when they wear off. What do you think she would act like if you only had the Tenex?

My only suggestion to tide you over until you do talk to him is to maybe give her her Focalin earlier. I'm not sure what time you give it, but if she gets the 2.5 more like noon, maybe she'll be going to bed by 9:00 instead of 11:00. That may involve giving her the XR earlier in the morning, but may be worth it for the peace. There have been times I have literally woken my daughter up an hour or so before her regular time to get up make her take her stim and go back to sleep. This was trying to help with symptoms in th a.m. before school.

All I can offer is support.

Have you considered Bi Polar instead of ADHD? If she only showed symptoms at home then she does not meet DSM IV criteria for an ADHD diagnosis.

ADHD meds, especially stimulants will excacerbate Bi Polar symptoms, making them worse.Unstable moods, and mood swings are often the first sign in young kids.

[QUOTE=edbson]

Have you considered Bi Polar instead of ADHD? If she only showed symptoms at home then she does not meet DSM IV criteria for an ADHD diagnosis.

ADHD meds, especially stimulants will excacerbate Bi Polar symptoms, making them worse.Unstable moods, and mood swings are often the first sign in young kids.

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The attentional symptoms showed up at school somewhat, but did not cause trouble in the classroom, so her teacher never commented to us. Like many of our ADHD kids, DD is very smart, and a centers-based kindergarten allowed her to bop around from activity to activity and pretend like she was doing everything she needed to be doing. Once we started on the Focalin, her teacher noticed some improvements in DD's body control (stopped dropping and spilling everything she touched), her peer and adult interactions (stopped chattering nonstop and seemed to have more purpose to her talk), better able to concentrate on tasks that require it (reading, handwriting improved). We saw MAJOR behavioral ADHD-related behaviors that DD did not exhibit at home.

I just didn't explain it fully in my post because I was too lazy to type it all out!

I am afraid that DD will end up being diagnosed with Bi-polar. My MIL is bi-polar and my grandfather was also. I have chronic depression and anxiety. DD's psychiatrist and psychologist have not diagnosed her, but her psychologist keeps saying that it's a little early to diagnose a mood disorder, and that she hopes this is developmental and ADHD. It's a lot to deal with, but I guess so many of our kids have co-morbid conditions--like everyone else, I'm hoping my DD does not.

[QUOTE=Diane V]My only suggestion to tide you over until you do talk to him is to maybe give her her Focalin earlier. I'm not sure what time you give it, but if she gets the 2.5 more like noon, maybe she'll be going to bed by 9:00 instead of 11:00. That may involve giving her the XR earlier in the morning, but may be worth it for the peace. There have been times I have literally woken my daughter up an hour or so before her regular time to get up make her take her stim and go back to sleep. This was trying to help with symptoms in th a.m. before school. [/QUOTE]

I started doing this on Monday, and it has made a huge difference. When I checked with her psychiatrist, he suggested switching the nighttime dose of Tenex to clonodine, but agreed that trying to give the short-acting Focalin a little earlier might help. If I give her the short-acting Focalin at lunchtime, she is able to go to bed at night.

Thank you all!