We have tried every ingredient in the alphabet soup called adhd. Concerta works best for us. 18mg. is a very low dose.
We do use focalin for rebound issues but usually only when we are going to be away from home for an extened period in the evening.
We also use guanfacine and melantonin for sleep issues. And, with puberty [ok, age 14 now and 5'9"] those issues are beginning to diminish.
My 10.5 year old daughter has been on Concerta 18 mg for the past 7 weeks. We switched from Ritalin LA (10 mg) to get more coverage. It seems to last about 9 hours.
A few of things I have noticed:
1. The immediate release dose seems too low - seems OK for school but on the weekends, she's bouncing off the walls. She's not bad if she has a soccer or basketball game in the morning.
2. The rebound seems worse than with the LA. I have a very agitated, sometimes angry kid around 5 PM for an hour or two. If she has soccer/basketball practice, that usually put her in a better mood. She's almost always perfect after practice.
3. She also seems more volatile at bed time. Lots more yelling. For example, it took 20 minutes to get her teeth brushed tonight.
I don't remember this level of agitation with the Ritalin LA - though we still had some behavioral issues. We have been working with a behavioral therapist for the past 6 weeks to address many of these. We have had lots of ups and down during this time but the general trend is a positive one. (We had tons of issues prior to the ADHD diagnosis and starting meds. She was great for about a year and many of our old problems reared their heads again at the start of the school year.)
She is doing outstanding in school and has A's in her classes. She had issues with eye tics prior to switching to Concerta and they decreased considerably. (I think they are anxiety induced.) She has no behavior issues at school. She is also doing well in her after school sports. I'm just not liking the kid I have between 5-7 pm and at bedtime. (She can also be a bear on the weekends at times.)
I am thinking about asking for a change in med's. Does anyone have any experience with both Concerta and Medadate CD? I am thinking the initial coverage with the Medadate would be better, but then I have read the afternoon/evening coverage isn't as good as Concerta. I am also considering Daytrana but am a little hesitant to deal with the hassle. We have tried Focalin XR in the past and we didn't like it.
Since she is doing well at school and with her sports, I am tempted to not want to mess with it but dealing with a grouchy agitated kid ever night isn't fun. Thankfully, her 5th grade teacher doesn't believe in tons of homework and if she gets upset doesn't do it, it's not a huge issues. Would a small does of short acting after school help with rebound?
Comments or other suggestions?
My son has had great success with concerta. I wonder if you asked the doctor to increase the dose, if it might be better for your daughter.
We had rebound at first, but no more. I believe my son knows how to handle it. But at first it was tough.
He has not tried metadate. He did try the patch, it never activated. It was as if he had nothing in his system. He tried adderall way at the beginning, but that hated my son, real bad rebound for him.
Yes a small dose of short acting will help her after school.
We also use guanfacine along with the concerta, both only in the morning.
And my son is 10.5 also.
BETHANN39405.0785185185We also liked the Ritalin LA over Concerta, but same thing didnt last long enough. I also think a small does of something after school may help with the rebound. I like Daytrana the best of the three, but it IS a hassle. Takes a very long time to take effect, we were about to add a morning short acting. It's not really something she could do herself (like on a sleepover). You daughter maybe could do this, mine couldnt. Side effects were less, but still had the horrible appeteite suppresion. We recently switched to Strattera and if need be will add back the Daytrana at a the smallest dose for school. We've never used Metadate. I think I'd try the afternoon booster for starters if you like the rest of the day, you will know pretty quickly if it's going to work. Diane V39405.1340277778Thanks everyone. I am still struggling with what to do. I'm not sure if it's the med or another phase she is going through. We had another very wild evening. When it was time to pick up some toys and she totally blew a gasket. Lots of yelling, chasing the dog and she smashed up the k'nex roller coaster that she spent hours building a couple of weeks ago. It was crazy. We ignored most of it and she eventually calmed down. This type of behavior has become more frequent the last two weeks. I haven't quite put my finger on what's causing it. At least she is maintaining better self control and not hitting. Could this be rebound? It usually happens in the evening.
Exercise does seem to help. On nights when she has had basketball practice, we usually have much better evenings. She plays 3 nights a week. This week one of her teams has the week off, so we are down to just one practice tomorrow night.
Bethann - How long did it take for the rebound to stop? Did you start the guanfacine at the same time as the Concerta or do you add it later?
Thanks!
The rebound depends on the person and how quickly they get through the medications leaving their system. Rebound is like being dropped on the floor unexpectedly, it is very uncomfortable.
Maybe the exercises relaxes her.
My son liked chocolate bars. He would eat one when it began, then he realized just how hungry he was from not eating and would have something to eat, like real food. But the sugar helped his "falling" off the rebound.
And YES, we did add guanfacine when we started the concerta with the psychopharmacologist - the doctor who prescribes my son's meds. It is what really makes the concerta a success. I describe it as the "frosting on the cake" so to speak!
My very best to your daughter and you!!
My child's dr. started guanfacine (tenex) in the evenings to help reduce the rebound. It didn't make things perfect, but it helped a lot.
As for concerta vs. metadate cd, my child currently is having good success on metadate cd. He's getting good adhd control and fewer side effects than he got on focalin xr (less appetite suppression, no period of a couple of hours where the drug wipes out his personality and makes him detached from the world). He's been on it since July, so my fingers still are crossed that it'll work over the long haul.
My child took concerta for only one day (only day he was able to get the pill down), but in hindsight that one day was an indicator that it wasn't the right med. for him. He was way too mellow all day, though the coverage throughout the day was much longer than metadate cd or focalin xr.
As you probably know, everybody responds differently to the different meds. If your gut tells you that concerta is not the right med. for your child, I'd discuss it with the dr.
WOW, When I was reading the post from MOM2ADHDboy I had to doubleThanks again for the information and suggestions. We saw her psychiatric nurse practitioner today. We discussed many different possible options.
She wanted to try a short acting dose at 4pm to see if that helped with the rebound before increasing the dosage. Her concern was that if we increased the dose, it might make the agitation worse.
She also gave us a prescription for trial of Daytrana. We are going to give it a try and see if we like it. We will give it a try over Thanksgiving break.
Clonidine after school can help with rebound.