Worried and confused! | ADHD Information

First Thank you for taking the time to respond to me.  I have been up all hours of the night reading this forum and it is wonderful that this exist for worried parents and in my case grandparent. Bipolar disorder has been brought up with all 3 doctors she has been going to.  The standard response has been that there is no way to test her at her age and that ADHD and bipolar are so similar in how they affect children.  I guess I am in denial somewhat as it upsets me to no end that a 6 year children has to take 1 drug for one condition, then another drug to help with the drop off and then another to sleep.  I am sure that there is not another parent on here that does not feel that way.  Yesterday she spent the entire day one on one with her mother without the patch - and was perfect.  Listening and no meltdowns and fell asleep by 8:30 without any problems whats so ever.  This is the child we have always known until school problems and meds.  But she has always had a hard time going to sleep at night.  She has gone from 95% being great to being uncontrolable at home 45% of the time. 
All the doctors she goes to are highly recommended in dealing with children and even specializes in ADHD and even bipolar.  I don't know what to do right at this point.  Her mother is going to see her pediatrican tomorrow and discuss all again with him and hopefully get her on the right track.  This sure is a heartbreak to watch when a baby is losing it.  I will keep you posted on what happens this week.  I have read about Concerta and she hasn't tried that yet because in the beginning she had issues about swallowing pills.  She is over that now and maybe that will open up some options.
Thank you again!  
To me, it sounds like the she needs a different medication.  It shouldn't be making things worse.

For us, the combination of Concerta and guanfacine.   When her concerta dosage was too low,  her behavior in the afternoon/evenings went down hill.  With the correct dosage,  she's great and experiences little to no rebound.   (We had behavior issues before we started the med's, so we knew they weren't a side effect from the meds)

kaykenneth wrote:
The standard response has been that there is no way to test her at her age and that ADHD and bipolar are so similar in how they affect children.

Its highly alarming to read that trained professionals are making such inaccurate statements. Pediatric bipolar disorder, while difficult to diagnose can be diagnosed by an astute clinician. While symptoms of the two disorders overlap, the disorders are not similar and any clinician who states that they are needs to go back to medical school because there are vast distinctions.  While it can be difficult to diagnose pediatric bipolar disorder, an astute specialist is able to make a differential diagnosis.

You are a very loving and caring grandparent with vast knowledge and I commend you for reaching out for help for your precious grandchild. I'm not suggesting that the child has bipolar disorder but before giving more medication, it is critical to ascertain the reason that the behaviors are escalating. Below please read more about bipolar disorder in children:

 

Bipolar disorder and AD/HD

As any parent of a child with AD/HD has probably already noted, there is a significant overlap in the symptoms of mania, and to a lesser extent depression, and the symptoms of AD/HD. AD/HD, mania and depression may all involve inability to concentrate and problems with distractibility. Mania and AD/HD may both involve hyperactivity and impulsivity. Though the symptom overlap is significant there are several factors that can help to distinguish these disorders.

AD/HD in children usually does not involve mood symptoms such as depression and euphoria to the extent seen in bipolar disorder. AD/HD symptoms usually first appear early in childhood while the onset of bipolar disorder appears to occur later in childhood or adolescence (4). AD/HD also usually involves normal sleep, at least once a child has settled down in bed and is ready for sleep.  Mania, in contrast, involves decreased need for sleep with the individual still "raring to go" the next day despite little sleep. The family history can be helpful, as both disorders appear to run in families. 

BPD in children with ADHD is a chronic and disabling disorder, so every child with significant mood lability, irritability, and uncontrolled anger/aggression should be carefully assessed for the possibility of BPD.

If a child has comorbid ADHD/BPD, the recommendation is to treat the bipolar symptoms first, and then, if the ADHD symptoms persist and impair the child's functioning, treat the ADHD. Stimulants should be considered the first line for treating ADHD symptoms in comorbid ADHD/BPD after stabilization of bipolar symptoms with mood stabilizers. However, clinicians should be alert to the possibility that stimulant treatment may aggravate manic symptoms in some patients.

 Luvmykids0239943.9230671296I also believe that the ADHD behaviors are magnetized once meds wear off. I'm not sure if it's rebound or not; I have not asked what rebound looks like. I never saw this behavior before meds, and it started two weeks after I began the meds. My boy becomes unbelievably hyper and silly. I give him a homeopathic remedy, and the five times that I have stopped, I've seen this super-ADHD behavior once the meds wear off. I give him melatonin to sleep, and the psychiatrist said that was fine. On the weekends when I don't medicate him, he falls asleep with no problems. My daughter becomes crabby, and easily frustrated when her meds wear off. She tends to become upset easily, and she's more likely to hit. She is the fiesty type in general. In her case, the meds ruin her appetite and she eats nothing all day. When I insist that she eat a hearty meal as soon as she gets home, she is much better. She takes melatonin to sleep. On the weekends when I don't medicate her, she falls asleep with no problems.I don't know about the out of control behavior...but your granddaughter is only 6, is exhausted, and has ADHD. Jessica N39943.8899305556Welcome kaykenneth You have come to the right place for support. Relax and take a deep breath.  You mention that the father has bipolar disorder. Bipolar disorder is highly genetic. Perhaps you should have your granddaughter retested by another psychiatrist or a neurologist to see if she might also have bipolar disorder. If the child has ADHD and bipolar disorder as well, if they are given ADHD med's it can throw the patient into a mania which would account for some of the behaviors you are describing. ADHD meds can exacerbate the symptoms of bipolar disorder.  When a person has both disorders the bipolar has to be managed first before ADHD med's are given.  The above medications you mention are very good medications and have been very effective for children who experience rebound or sleep problems. However,  I suggest that you speak to the parents about getting another opinion to rule bipolar disorder in or out as these disorders can co exist.. The child's behaviors suggest that she is crying out for help and perhaps if another opinion is sought out you will get more definitive answers. I'm not a doctor and I'm not suggesting that your grandaughter has a co existing disorder but its worth checking out if her behaviors are getting worse despite getting her effective treatment for ADHD. Please feel free to post any time and know that we are here for you.My 6 year old granddaughter has always been very active.  Her mother was ADD and uncle was ADHD when he was younger.  Her father is bipolar.  This year when she entered 1st grade her being active caused major problems.  Everyone knows the rest of the story on here.  By the way - I am so happy to have found the blog.  To make a long story short - as everyone knows these stories are long and often mind boggling.  She was given several different meds to try and the one finally settled on was the patch 15mg of Daytrana.  This is my concern and I will try to keep it short an to the point.  She has always been very very busy.  I raise two children so I am familiar with all that goes with that but that has been over 25 years.  When taking the patch and coming from school after the meds seem to have worn off she became what I was say hyper.  Took a long time to get her settle down to sleep at night.  The hyper brothered me - as this type of behavior was far more intense than before she was ever on meds.  In the last month her behavior has gone from hyper to totally out of control times.  Which makes me wonder if using drugs can make ADDH worst on drugs.  Her grades have impoved since at school with her attention and testing has gone from 32% to now being 98% which of course proves it has worked in a class room situation.  Now her behavior has become what she describes "her body being out of control"  During these times she has a different look in her eyes and even her voice will change.  She has become physical with her parents especially and with me on occassion.  But at night when it is way past the time she needs to be asleep - she will screamed out of control, pull hair, hit, kick, ect.  I took her myself to her Psychiatrics that specializes in ADHD for children and Adolescence and then went to her pedatrican to see what is going on.  The psychiatrics added TWO more medications for her.  One was to take after school to help with the rebound and one to take to help her get to sleep at night.  Guanfacine for after school and clonidine at night to help her sleep.  I have raised children with ADHD on Ritilan and I myself is taking Adderall XR for the same thing - so I understand this nasty beast.  What blows my mind today is the fact that this doctor see no problem with drugging a 6 year with 3 different drugs to conteract the other.  It makes no sense to me.  She is also seeing a counsler for behavior modification on a weekly basis.    I beleive in my heart of hearts that in the beginning - other than her school work - that this medication has caused the meltdowns, horrible uncontrollable behavior and intense hyper activity.  Please if anyone else has experienced this -- I need help with advise as I am frantic and so are her parents.  My email is par8hd2@verizon.net if someone has the time to and wants to contact me personally.  Any help will be so appreciated.


clonidine