Hello,
We have a son, 7, who had originally been diagnosed with Sensory Processing Disorder and later, with ADHD. He also was selectively mute for 3 months at his first PreK. Selective Mutism is an anxiety disorder.
We have been giving Metadate for a little more than a year. Behavior at school improved when we went from 20 mg to 30 mg but there was still a lot of aggressive behavior, mostly in P.E.
We had him on 40 mg at one point, but he began picking his fingers until they bled. So at 30 mg, he picks at his fingers and has some OCD going on.
Because of that side effect, we tried Focalin over the holiday. The doctor wanted to start at a lower dose than the Metadate, so we went with 10 mg. DH and I both thought it didn't help the hyperness, so we increased to 15 mg. which would be as close as equivalent to the Metadate dose as we can get.
Unfortunately, we only were able to observe him at home for three days at this dose. We thought it was lasting an hour longer than the Metadate. But on Thursday of his first week back at school, he seemed to rebound around 1:30, according to his teacher. Then, on Friday, the medicine seemed to wear off around the same time, and he was so hyper that he had to sit out and didn't even make it to P.E. I picked him up early.
On Sat., we didn't notice anything, but on Sunday, the medicine wore off at about 1 p.m. That was a shocker; good thing the teacher had already brought it up, so I was aware of it. Anyway, later Sunday night, our boy had a tantrum like we haven't seen in a year or more. He would calm down and then start back up. He also developed a headache - something that he just never gets. Then, Monday morning, he had such a headache that he put himself back to bed with a book. Again, something he has never done. The doctor had said headaches were possible on Focalin.
Because of the headache and the fact that it wore off so early, on Monday, we started him back on Metadate. Anyway, he had an awful day at school on Tuesday - would get upset, calm down, get upset. Oh, and he wet his pants a little before getting to the bathroom. He never wet his pants even in daycare. So I figure the Metadate is mixing with the Focalin still in his system. Any time we change his meds, he is very sensitive and seems to have a lot of residual going on.
So Tuesday, I picked him up a little early and talked to the asst. principal. It almost seems like he has panic attacks, even when he is on the Metadate. So now I'm questioning if he has primarily anxiety with ADHD or at least ADHD with anxiety.
The school psychologist mentioning putting him on Clonidine (originally for blood pressure)or Risperdal, but the time we tried adding a blood pressure med, his behavior became much more aggressive. And Risperdal may or may not help if the root cause of some of this behavior is anxiety? Does anyone know?
At one point, we also added Zoloft for anxiety to the Metadate and he wasn't able to go to sleep until almost midnight, so we stopped that. He is in bed for stories at 8 a.m., so that's quite a few hours of tossing and turning.
So, now my mind goes back to the original diagnosis. Since we had done tons of paperwork on the SPD diagnosis, our Ped. Neurologist had just said he didn't want to go through all the paperwork again and he recommended we just try a stimulant. He said if we saw improvements - which we did - then it meant that our son was ADHD. Well, according to my b-i-l who is a pharmacist, that isn't quite true. Someone who doesn't have ADHD may also show improvement on stimulants.
What is the right way to be tested for anxiety and ADHD? I'm thinking maybe he has Anxiety as a primary diagnosis and ADHD as a secondary diagnosis. It seems he does fantastic for us on Metadate 30, but still has issues in stimulating environments like school. That's why I'm thinking maybe anxiety is playing a bigger role here.
Thanks for any replies!
The school psychologist mentioning putting him on Clonidine (originally for blood pressure)or Risperdal, but the time we tried adding a blood pressure med, his behavior became much more aggressive. And Risperdal may or may not help if the root cause of some of this behavior is anxiety? Does anyone know?
The school Psychologist has no business practicing medicine.
So, now my mind goes back to the original diagnosis. Since we had done tons of paperwork on the SPD diagnosis, our Ped. Neurologist had just said he didn't want to go through all the paperwork again and he recommended we just try a stimulant. He said if we saw improvements - which we did - then it meant that our son was ADHD. Well, according to my b-i-l who is a pharmacist, that isn't quite true. Someone who doesn't have ADHD may also show improvement on stimulants.
Your BIl is right, this is not how a "test " for ADHD is done, and IMO another Dr is needed, a Psychiatrist.
There are no tests for ADHD, it is diagnosed by many hours of observation, testing to rule out other things( anxiety,LD's etc), and also Bloodwork, ekg's, eeg's etc.
I would find a goof Neuropsychologist and have him re evaluated.
What is the right way to be tested for anxiety and ADHD? I'm thinking maybe he has Anxiety as a primary diagnosis and ADHD as a secondary diagnosis. It seems he does fantastic for us on Metadate 30, but still has issues in stimulating environments like school. That's why I'm thinking maybe anxiety is playing a bigger role here.
It does sound like there are other factors, or may not ADHD at all. SID's can present with anxiety also, especially in stimulating environements.
Thanks again everyone for your insights.
Due to insurance, we are actually planning to see a child psychiatrist with 18 years experience who will diagnose and manage medication for us.
Wish us luck! Our first visit is Monday.
Val
MY SON ALSO HAS ADHD WITH ANXIETY BAD. WE TREATED WITH FOCALIN FIRST BUT THAT DIDN'T WORK SO WE PUT HIM ON THE ZOLOFT AND THING WERE MUCH BETTER, BUT NOW WE NEED TO DEAL WITH THE ADHD. OUR DIAGNOSIS WAS WITH A CHILD PSYCHOLOGIST(NO CHILD NEUROS HERE) HE SPENT 8 HOURS TOTAL DOING TESTS AND OBSEVATIONS AND THEN CAME UP WITH A 10 PAGE REPORT OUTLINING EVERYTHING. THEN WE WENT TO THE PSYCHIATRIST TO HANDLE MEDS.I would suggest keeping a diary of meds (time, med and dose) and effects (good and bad) to help sort this all out. If the current doc is not a psychiatrist (managing the meds) I would change docs to one. Once you get into meds like risperdal, you need a well experienced doc to help sort out side effects from co-existing disorders. It can be hard to sort out whether anxiety is from the meds or being made worse by the meds.
Prior to adding risperdal, I would ask the doc about trying other methylpheidate forms. Focalin can cause worse rebounds than the mixed isomer methylphenidate meds (metatdate, ritalin, concerta, daytrana). On the focalin you may be seeing the first wave of med wearing off before the second wave is active-causing a roller coaster dose delivery (these ups and downs can be hard on the body). It might be worth trying one of the other methylphenidate forms like concerta or daytrana. These are both very long acting meds and for many have a smoother delivery. They both deliver continuously rather than in 2 timed doses (like both focalin and metadate). You should check out the different forms by searching on the web for the med name and the words "full prescribing information".
My youngest had anxiety due to school failure prior to diagnosis and treatment. This got better with treatment (IEP, behavior mod and meds). Anxiety in her comes out as aggression. Then a series of teasing incidents brought the anxiety and aggression back and she went on risperdal (with guanfacine and focalin). The combination was great for her. We recently tried a bread from the risperdal to see how she did and she no longer needs this med (she has a great teacher this year in school and a lot less stress). In her case we knew the anxiety was not due to meds but to her circumstances and because it came out as aggression, risperdal was a good med to try. She has a doc that explains all of his treatment thoughts to me I know the issues the kids are having, so we work as a team to get the best treatment posible for my kids.
I agree you need a more solid diagnsois. Go to a neuropsychologist and find a psychiatrist to manage your meds. My daughter also has ADHD and mild anxiety. Her anxiety goes up dramatically on most stimulants. We also so a lot of picking behaviors on Concerta and during high stress times. We are now using Strattera and FOR US it is working well, we do not have all that nervousness/anxiety increase nor rebound like on stimulants. WE see a psychopharmocologist for meds and he's GREAT, but gping Strattera and Strattera alone was my idea.Thanks everyone.
We are now considering taking Justin to a developmental and behavioral pediatrician who has "25 years experience dealing with ADHD, learning difficulties, behavioral and emotional problems and experience in the evaluation and management of autistic-spectrum disorders."
Our highly-recommended psychiatrist we saw only once because when he told us to stop the Tenex overnight, Justin had manic episodes. We didn't trust him enough to go back since we had already explained Justin's oversensitivity to meds to him and since every piece of literature I've seen about blood pressure meds say to gradually stop them.
Our ped. neurologist worked with a highly acclaimed neuropsychologist and together, they first diagnosed SPD. This neuro has been selected to take over at All Children's here and has closed his practice.
If we go to this developmental/behavioral ped., at least he is going to do evals and spend time with our son and ourselves as part of the evaluation process. It says the initial eval is 1 1/2 - 2 hours and the second part is 1 - 1 1/2 hours.
The only thing I know is that it seems that none of the doctors so far have really spent much time with Justin - except for our second psychologist, who played with him on the floor and said he wasn't Asperger's. Then, she tested him for processing delays and he couldn't complete the auditory processing part because he got upset. That was when she had him listen to a tape with a lot of background noise and someone talking. I have good hearing; but I couldn't understand what they were saying on that, myself.
If anyone has thoughts on a dev./beh. ped., please let me know...
Thanks!
I think it sounds like a good place to go next. Good luck.Hi everyone,
I am happy to say that I do trust the new doctor. He is a pediatric psychiatrist. He has ordered an EEG, an EKG and labwork, most of which will be done tomorrow.
He spent some time with Justin and reviewed previous reports and questioned myself and my hubby extensively.
He is thinking that Justin may have "mild Asperger's" and may or may not have ADD along with it. It was a surprise to us as parents that this doctor sees him as more inattentive rather than hyperactive.
Anyway, we do have a niece with ADHD/Asperger's so it is in the genes.
Are there any parents out here with children who have comorbid Asperger's?
Thanks again for all the great advice on diagnosis.
Val