What’s going on here??? | ADHD Information
Hi all,My 8.5 year old daughter started on Concerta last July. She started at 18 mg and then bumped up to 27 mg in November. I never saw the drastic changes that I've read about. I would say that in some areas she did improve (attention, for example), but the improvement was subtle.
Her biggest issues are making careless mistakes in her homework (which is crazy because she was also identified as gifted), keeping track of and losing things (this is a biggie), fidgeting, interrupting and blurting out. In the last few weeks she's also been quicker to anger, but this seems to be only at home with us at the end of the day. She doesn't have any behavior issues at school.
We have a follow-up appointment with the ADHD specialist tomorrow. I am wondering about increasing the Concerta, or switching. I know that this is ultimately something we will have to decide along with the doctor, but I'm wondering if any of you out there have some input/advice, or things I make sure to mention or ask the doctor about.
Is Concerta the first med you have tried? It would be unusual to hit a homerun the first time at bat. Most parents go through at least 2-4 meds before finding the best one for their child. My 9 1/2 yr old began on Strattera, switched to focalin, is currently on 10 mg focalin XR with excellent results. BTW, his meds carry him through the school day. He takes a booster dose of 5 mg focalin if he has after school activities. This dose also minimizes the rebound effect, which your daughter may be experiencing.
Who determined she is gifted? How thorough was the testing? Sometimes this 'label' can create unattainable goals for a young child. My son has a very high IQ, but he is in no way gifted. He struggles with impulsivity, fidgeting, and blurting out during school. The meds help him focus, but they are not a magic bullet which address all adhd symptoms.
Medicating a child with adhd is a long journey with many twists in the road. What works for one child may not work for another. Keep up with the doctor appts, consider a behavior doctor who specializes in adhd kids, and be patient. I hope that her school is supportive. My son has an IEP at his private school, it has made a huge difference. You sound like you are on top of things. As for losing things, welcome to our world. The mistakes my son makes with his writing and spelling are due to his dysgraphia, not his intellect. Good luck figuring out the pieces of the puzzle to place your child on her path to academic success.
We are on concerta. If she is successful with concerta, then I would try upping her dose first before trying a completely new med.
We had tried adderall xr after my son had trouble sleeping with concerta AT FIRST. When he went to adderall xr, he became angry, upset, hysterical, emotional, in your face, etc all at the same time and he was in first grade!!
We went back to concerta with the help of a psychopharm. and find my son's right dose. We also added guanfacine as well.
Yes, Concerta is the first med we have tried. She was only diagnosed less than a year ago, at the end of 2nd grade. She was assessed and diagnosed by a neuropsych. who is with the children's hospital here and is really well regarded. The assessment took a number of visits, each one being a couple of hours, tons of testing, etc.I know it is more typical to have to try a few things before nailing it- still I think we all get nervous as parents any time there is a switch. No one wants it to get worse before it gets better.
She does have some trouble sleeping with Concerta. A mg of melatonin really helps her- she will be out like a light within 20 minutes. Without it, it takes her a good two hours. Last night I fell asleep early. I woke up to go to the bathroom at 10:00 and she was still up because dh had forgotten to give it to her. I wouldn't have known if I didn't check in- when she can't sleep she doesn't make a lot of noise at all, she lies in bed and reads quietly. We gave it to her and she was out within 10 minutes.
Well, wish us luck this morning. I hope we get some good insight from the doc.
I wish you all the best in the world.
I will mention that my son's guanfacine does relax him. He eats with it and sleeps. We haven't had sleep problems since it was introduced to him!
Please let us know how the appointment went and if we can help or listen.!! 
I'll be interested to see what the doc recommends...while sleeping is an issue, her appetite isn't. In fact, her appetite is great, she hasn't lost any weight and I suspect that she may have even gained a bit since her last appointment. I was really concerned initially about appetite, since she's tall and lanky for her age and doesn't have much room to lose.
It's hard for me to assess all of this...on one hand, she's doing very well academically (she's not in a gifted program but does get some enrichment in her area of major strength, language arts), and doesn't act out behaviorally at school at all, socially she has good friends, gets invited to lots of playdates, parties, etc. Still, there are things going on that impact her...the fidgeting, inattentiveness when it comes to detail, constant chatter, losing things (constantly!). And of course, the angry meltdowns at home at the end of the day.
One thing, now that I am thinking of it, I should remember to tell the doctor: Two weekends ago we had a long weekend here with two days off school, and I decided to take the kids out of town to visit my mother. This means 6 hours in the car each way. In the chaos of packing, I forgot her meds. In the 3 days that she was off them, she had *no* angry outbursts. Everything else was pretty much the same. Of course, this wasn't exactly a controlled experiment- there weren't really any demands on her, and she loves being with her granny, so it was an easy environment for her.
One other thing- she didn't have her Nintendo with her. The Nintendo has been an issue. Originally, she wanted one and planned to save her allowance to get it. Slowly and surely she did, and bought one with her own money. I actually thought this would be a good exercise for her, to learn more about saving, delayed gratification, and appreciating the value in things that you have earned in a sense. She got it finally in November. Well, she likes this thing- A LOT- to the point that if she had her way she'd do nothing but. Of course, this isn't a good thing- everything in moderation, right? We set some concrete limits- never before school, never when there is homework to be done, never after supper, never when she has friends over, and never to take it over to a friend's. Originally I thought this would be a great thing for when we have to do those 6 hour drives, which in our family are pretty regular.
Anyhow, both dh and I agree that the Nintendo somehow makes her more easily frustrated, unhappy when she doesn't "win." I have said to her on more than one occasion when she's angry while playing that if it doesn't make her feel good, she shouldn't be on it.
She has lost her playing privileges because of this sort of behavior a few times. She didn't have it with her went we went to my mum's, and she did just fine without it, even though she protested big time at first.
My guess is that video games do this sort of thing to lots of kids, but esp. kids with ADHD? My son, who's very different from dd, has zero interest. He might play for 10 minutes or so, then go back to his Lego or a book or whatever.
Oh well, time to round up the girl and get her to the doctor...
I'll let you all know what happens...thanks so much for you support everyone.
I hope things go well at your appointment. A few comments.
1. We had more anger issues when my daughter's Concerta dosage was too low. Increasing from 18 to 27 made a huge difference. Maybe she needs to go up a little.
2. Like Bethann, we use tenex as well. It helps my daughter be a little more even keel and our evenings are generally better.
3. My take on video games / TV (and it may be different than others) is that if effects their behavior in a negative way, they should stay away from them. I know that my daughter behaves better when all screen time is limited. Maybe you could chart her behavior vs. game playing and she could see how it effects her.
Good luck.
HorseMom39869.5690046296 Back from the doctor. We had a good visit. First off, she'd gained weight finally- almost 10 pounds. Up until now she'd been holding steady, not gaining or losing, since she started on meds. He looked over the teacher's questionnaire and listened to our concerns. He attributed the anger to late day rebound, since it's not happening at school at all. He also said that because she was off of it for 3 days at one point, that it probably took a few days for the Concerta to stabilize in her system again, which is why he doesn't recommend med breaks on weekends or vacation. He's very conservative with meds in general, and said that because she's doing well over all he's hesitant to up it at this point. He did give us the option of adding in a bit of Ritalin around 3:30, prn on days that she has extra homework or something else demanding.
I have to admit, when he suggested the extra bit of Ritalin late-day, I was concerned and said so. I wondered how that might affect her sleep, especially given that we already have to give her melatonin on a pretty regular basis. He said that current studies are showing that in many kids, the opposite actually occurs- that it gives them enough focus to be able to wind down and fall asleep easier.
He's also big on implementing classroom accomodations (which are already there for her) and routine, routine, routine at home. Plus a good amount of physical activity. I really like the fact that he has a very holistic view, and doesn't just push the meds.
And a funny thing about video games- he asked if we had a Wii at home (we don't). Because the Wii is a lot more physical than a Nintendo DS, he actually recommended getting one, and using that as an option for her downtime rather than the Nintendo.
So, we shall see how it goes. The anger business has gotten better now that she's been back on the Concerta for the last week, so that's a good sign I hope.
HorseMom- I think it's a great suggestion to track her behavior wrt Nintendo. I'm going to do that for sure.
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Glad to hear that!! We had rebound at first. As his dose was increased, it got better. What also helped, and I mean it, was that my son wasn't eating. When he got home, and it started, I gave him a hershey bar, and the sugar helped him, It would stop. Their blood sugar falls.
Once he started eating the chocolate, he would realize that he was starving and would then have some "real" food!!
Have you checked her sugar? Is she eating while on the meds??
Yes, she is definitely eating, she's gained 10 lb in the last 4 months, after not gaining anything for almost a year.I do think she sometimes ends up eating too late, once her blood sugar has dropped. She's on a balanced day school schedule, and they end up having two mini-lunches, one at around ten, the other at noon. School here is EARLY- from 8:00 to 2:30. We're home by 3:00. Usually she has snack 4-4:30ish, but I think she really needs it right when she gets home from school. Supper is not until 6:00, so I will definitely boost up her snack after school.
Is there an easy way btw to actually check her sugar at home? I'm thinking of the strips I used to use when I was preggers...not sure how agreeable she'd be though to peeing on demand, LOL.
I am glad I found this Forum. My daughter never wants to go to sleep. Her bedroom is right above mine and I stay awake every night hearing her. No matter what time I put her to bed she is up until 10 - 11 pm. I think I will try the Melatonin that someone mentioned here. I have tried taking her TV out, sitting with her, reading with her, praying with her. She is very active and you would think after 2 hours of hard soccer practice she would sleep, she doesn't.
Concerta has worked the best for my son 10. We started on FocalinXR, then Vyvanse both with serious problems. We are now 3 months on Concerta just bumped to 27 today and I can see a subtle change for the better. You are still at a low dose. I would consider going higher before changing meds.