is it possible? | ADHD Information

Alright everyone, had dr appt today and...
we added intuniv.
Dr still didn't want to increase the concerta so that stays at 36mg for now. My question (for anyone that has an answer)is, what is the difference between increasing the concerta WITHOUT intuniv and leaving the concerta the same and ADDING intuniv? I guess what I'm asking is what benefit does the intuniv have that the concerta doesn't and then why not use ONLY intuniv? Looking forward to your experiences with this. Thanks!

I have experience with Tenex (the short acting form of Intuniv). We've never actually tried Intuniv though. My son takes the Tenex along with his Ritalin. Without the Tenex, my son's aggitation, anxiety, and moodiness would be too bad and he'd have to stop taking stimulants. Stimulants work very well to control his hyperactivity and impulse problems but aggravate his moods etc. The Tenex helps couteract the side effects of stimulants and for my son it really helps smooth out his mood. This has allowed us to raise the dose of Ritalin (which he needed!). This may be what your doc is thinking...to help get rid of the aggression before making any other adjustments.

I've heard others on this board say that Tenex/Intuniv helps their child's impulsivness also. We've never been lucky enough to have that effect but I've heard others rave about the benefits. Also, it can help if there are sleep problems caused by the stimulants. It has an overall calming effect and can actually make the child sleepy. I've rarely heard of Tenex alone being enough for a child that's hyper &/or impulsive. Usually it's taken along with a stimulant.

Overall Tenex has been great for us! I hope it's great for you to!

Corrina-
Yes, we have him in thearapy as well. He doesn't seem to think he needs it and complains when he has to go.

Discipline is a tough one. If he does something wrong, there is a consequence but most of the time he can't deal with the consequence so he lashes out and winds up digging a bigger hole for himself. I've explained time and time again that the first punishment is the easiest, if he escalates the situation then the punishments get more severe. And he gets plenty of warnings before the punishments are even dealt out.
I have also tried the reward system but he loses interest. He'd rather do what HE wants instead of earning a reward.

When we have a 'situation', there is NO REASONING with him. After the waters calm he sometimes agrees that he acted irrationaly and wants to apologize in order to get his punishment removed.

As far as the meds go, I have friends that are teachers and they have told me that you can TELL when adhd kids did not take their meds. This is not the case with my son. That's why I'm questioning the medication.

Thanks for all the info and experiences you share, it is very helpful! There have been times that have run out of my son's dose. You see my adhd husband is the one who is home in the AM while I am at work. My DH "forgets" to tell me or to refill his meds.

So when this last happened, we used what we had to get him through school successful. We actually increased his dose that day. My son said he was fine, and did very well on tests. Thus we realized he needed an increase, so it was done the next prescription.

Why not take a 36 and give him an 18 IN ADDITION to to raise the dose to 54mgs. Ask him how school was etc. You can also do a 27 and 18 but that only would be 45mgs, but it is still higher than 36. I even wondered if both a 36 AND 24 to reach 60 would be better.

All I know is my son is fine in unstructured times as long as he has his meds, the correct dosage. Meds help him keep it together. and he is not zombied out.
[QUOTE=Logan'sMom]Credentials or not, this doc seems to be saying things inconsistant with my son's doc... and it also sounds like Bethann's doc too!

Maybe go back are read what you are referring to and let me know where you have a question.

I see what you're saying...sorry! That's NOT AT ALL what I meant. What I meant (but didn't say very clearly!) was that chihuahua's doc's decisions to not up the meds sounds inconsistant with what my son's doc would say AND inconsistant with what your doc would say. The impression I've gotten from you is that your doc says that you slowly raise the dose until the side effects become too bothersome then back it down. That's what my doc says too but it doesn't sound like that's the way chihuahua's doc feels... That's all I meant. Sorry for the confusion!

Logan'sMom40279.56625Credentials or not, this doc seems to be saying things inconsistant with my son's doc... and it also sounds like Bethann's doc too!

I mean I may be wrong and I am certainly not a doctor but isn't it pretty basic that you raise the dose until you see negative effects then back it down to the last dose before??? I doesn't seem to make sense at all that the doc wouldn't even try to get to the max dose then claim that the medication doesn't work???You guys are great!
Logansmom, my thoughts are the same but maybe since I'm complaining about evening aggressive/irritability that is why the doc doesn't want to increase the dose (higher dose = more aggression).
But like I mentioned before he rebounded earlier in the day on the lower doses. So I would think that an even higher dose would last even longer.
I'm wondering if it's normal practice to change meds and then wind up going back to the original one just to see the different effects and find which works best. I just don't want to be adding more meds to deal with the side effects of the other. Guess I'll have to wait a couple more weeks until our next appt & see what the dr says. But thanks again for all of your input, it REALLY does help! Structure makes a huge difference for my son, whether or not he's on
medication. If he goes off schedule, or something happens he doesn't
expect, forget about it! He's much better than he was before 3+ years of
working with him on dealing with transitions, but it's still tough for him.

Medication is not going to stop a child's impulsivity. It can give them
time to think, but they have to be trained how to make a decision.

From the time children are born they learn how to make decisions - they
just pick it up. But if they have ADHD, a whole lot of their brain power is
used up by buzzing or trying to deal with the chaos in their minds. So a
lot of them are delayed socially, sometime by years. And that does
include impulsive control.

So you can't just give them a medication and make it all better. You have
to teach them all the things they didn't pick up.

So - what else are you doing beside the medical route? How about
therapy? What's your discipline plan? Have you tried modeling, or
deconstructing events after the fact to highlight what worked and what
didn't? Also, my son is obsessed with knowing "why" - he knows that
he'll go along with anything - might help with your son.

Good luck!The dosage for stimulants is not weight dependent, so there would be no reason not to increase the dosage if he's not getting good results. My son and his uncle both take focalin xr, but my son takes almost twice as much because that's the most effective dose for him.

As for trying other meds- and you very well may need to as most people have to try a few before finding one that works for them- all stimulants are effective for both hyperactivity and inattentive ADHD. For example, I take adderall for my inattention and my friends' soon to be adopted little girl takes it for extreme hyperactivity.

As for rebound- I know many of us have used a "booster" dose in the afternoon to ease rebound as our kids adjusted to their meds. My son's doc gave him a short acting pill at half his regular dosage- it worked very well. It's a common side effect that just happens to really suck, but it typically goes away after a while.
Hey Bethann, It amazes me your boy is that large lol. My son is small and now emaciated from having some sort of eating thing where he only eats certain fast food meals, he really doesnt eat he has lost even more weight with the tenex. You are lucky to have found what works for you and your son and family. hugs.I agree with Bethann. It sounds odd to me that the doc doesn't want to go above 36 mg. That sounds really low...It sounds like the doc isn't comfortable with the meds. I'd try a specialist and if your current doc is already a specialist, change docs!

Thanks everyone!
We do see a specialist for the meds.
It was explained that the higher the dose of Concerta the worse the aggression becomes when the med wears off. To neutralize the aggression they sometimes prescribe respirdal (sp?) or clonopin (sp?) and this sounds scarey to me. I think maybe instead the dr wants to try a different med altogether. But it appears that increased aggression is a possibility with all adhd meds. So I'm confused. I really don't want to put him on an array of different meds just to counteract each ones effects. Also dr said the higher the dose of Concerta the harder it is to sleep and they have loss of appetite (I did notice my son lost a little bit of weight). Being as inexperienced as I am, I still think 36 seems low for a 13yo boy.My son was on a higher dose than 36mgs when he was in 2nd/3rd grades.

When we first started concerta my son couldn't sleep on it either, but when we "increased" his dose AND added guanfacine, it got better.

The higher the dose I found never changed how my son was when the meds wear off, BUT if the dose is wrong, it does.

Rebound affects everyone different. My son got thin, but still was growing. He wore slims for a year and then everything changed. His body adjusted and we made sure he was always at the right dosage. I remember changing a dose days apart. Also guanfacine really helps him as well. He takes both.

I wouldn't give up on concerta just yet, I still believe he needs an increase.

than is my opinion.
Thanks Bethann.
I agree, I'd like to try an increase before we change meds. But when I mention it to the dr (because we cycled through 18-27-36) she seems reluctant, almost like 'well if your not getting the desired results then why keep trying that med'. I've thought of switching dr's but she has many credentials with regards to adhd. I even thought, maybe my expectations are too high and the meds are working, he did improve on his report card. But... his impulsivity control is definately not where it should be. These are the 'think before I act' instances. After witnessing his behavior all day over spring break I was convinced the meds weren't working AT ALL. When I called the dr. she didn't seem surprised and said that he wasn't in a structured environment (school). So why would the meds only help in a structured environment? Ughhh... I'm so confused!

Still no difference for my 13 yo son on the 36mg of Concerta. It seems like there is some sort of improvement for the first couple of days after the increases but then NOTHING and I was able to witness the effects ALL DAY during spring break. I did notice that the rebound effect happened much earlier when on the lower dosages but he still gets aggressive in the evenings. Dr. seems reluctant to increase past 36, suggests we try something else at next appt. Not sure what else we can try that doesn't cause aggression. Other meds seem to address hyperactivity and he's not hyperactive, it's more of the frustration of things that throws him off kilter. I've noticed alot of parents on the board that have their kids on 54-108mg of concerta, not sure why our dr. wants to stop at 36... but what do I know, right?

Thanks for reading!Frustration of things that throw him off kilter - sounds like a kid who could
use help learning how to work through the unexpected. I know I sound like
a broken record, but give The Explosive Child a whirl - might be just what
you need.Thanks Corrina.
I have mixed feelings about that book.
It sounds great but I've heard that it's kinda just letting these kids have THEIR way. Meaning we have to walk on eggshells around them. People argue the fact that they have to learn to cope in order to survive the REAL world. The world doesn't revolve around THEM. What are your experiences/thoughts on that? I appreciate your insight. I noticed another book about the explosive child written by Riley. The one you're talking about is by Greene, right?

I think the Explosive Child is a good book.

It really talks about being the reasoning part of the child's brain and not just letting the child get THEIR way. Many kids, not just ones with ADHD, need help in making better choices and seeing all the options there are.

When a child is impulsive, they are not able to see all the options, only the one which they are doing. The idea of the book is that even after they made an impulsive choice, you can discuss better options for next time.

It takes time for this to develop but I really think the book offers a lot of great information and helps you better to understand your child.

It honestly sounds like the dose is too low.

Are you seeing a doctor who specialiazes in these meds and disorders?

I would call your pediatrician for a referral to see a psychopharmacologist. Are you using your ped for meds?

We went to 54mgs by using a 36 + 18. My almost 13. yr old son is taking 104mgs, that is 2 52mg pills.

36 isn't that high of a dose at all. AND if you aren't seeing any results, then it isn't really worth it. Why medicate if it isn't helping.

You need to find the right med AND the right dose!

The Explosive Child teaches kids not to have knee jerk reactions, but to
think about why they are doing what they're doing, and make decisions
instead of having tantrums.[QUOTE=Logan'sMom]

[/QUOTE]

I believe that you must have me and my family confused with someone else. My son's doctor is the complete opposite of what you said above.

He will change the prescription from one day to the next allowing my son to reach his maximum dosage to help him have a successful day. And I have posted that many times here on the boards, as well as recently. So I don't know why you think these things?

I just don't want any new members who are lurking or those still struggling to find the right dose to be confused with what I say. I still don't know what you read to ever think that?

My son is doing awesome. He has been on concerta and guanfacine for 6 years. When I first arrived at these boards, no one was using guanfacine. But that is no longer the case. I hope I helped with that. We continue to increase his concerta when necessary, 104mgs right now, but the guanfacine is still at 1mg.

Our son's doctor has the belief that you never know until you try. Process of elimination. Unfortunately that is all we can do with these meds. And he is absolutely right. He lets me even tell him what I think my son needs and we do that and we have been successful. It is any one's guess where anyone should be on whatever med. But if you aren't allowed to increase it to see if that is a better dose or too high, then you will never know. And by changing meds BEFORE increasing the dose, is also a mistake.

I just want to clarify for anyone who is confused just what I meant.

I do think Chihuahua got it. Her replies all made sense.

How quick are you to discipline? I can't discipline my son immediately
after an infraction - I have to let him calm down first. I'll tell him we'll
revisit it, and then talk through what happened, including coming up with
consequences.

I suggest you try the plan in The Explosive Child. But you have to trust
your child to put it in action.

Trust your gut. You're his mother - if you think the drugs aren't working,
talk to the doctor.

If punishments aren't working, give him goals. If giving him warnings
aren't working, then stop giving warnings - tell him for X and Y there will
be 0 chances, and the consequence is Z. And don't let him slide.

You sound like you just want to give up and wash your hands of him.
(We've all been there! It passes.) You can't force something to work. You
have to get radical, and make adjustments along the way to find what
works for your son. Try a different therapist. Ask him what he needs.
Ask him what worked best. He's old enough to get involved in his plan -
include him and he'll be more likely to work it.

Best of luck to you!

I'm sorry but I'm very confused! I've obviously done a horrible job of trying to say that I think your doc has it RIGHT! I was trying to say that my doc has it right and I think your doc has it right also. When I said "increase the dose slowly" I meant that in relative terms. Meaning if it needs to be done every other day then so be it. I just used "slowly" to indicate that my doc doesn't just start with the max dose.

[/QUOTE]

But if you aren't allowed to increase it to see if that is a better dose or too high, then you will never know. And by changing meds BEFORE increasing the dose, is also a mistake.

[/QUOTE]

This quote above is EXACTLY what I was trying so say. Sorry for the confusion...it won't happen again.