New here. My story and questions. | ADHD Information
My son is on the short acting type of Intuniv-Tenex. It took about 4 weeks to see the full effect. Right away he became drowsy but that wore off after a few weeks. We didn't notice any benefit until at least a couple of weeks.OMG!!! Are you sure you're not talking about my son! My son and our situation sound almost EXACTLY like yours. Except for the fact that my son doesn't seem to talk quite as much their situations are very very similar!
1st-The REALLY bad moodiness and defiance that you're describing sounds like "rebound" This is when the meds wear off and the child's symptoms can come back worse for a short period of time as they are coming off the meds. Or (as in my son's case) rebound can make them moody, defiant, sad, & uncontrolably upset. Rebound is NOT something you have to put up with and can be cured pretty quickly by changing the dose, timing, or medication.
2nd -My son started on Adderall and went to XR. It didn't work for him. Adderall makes him rebound badly and the XR NEVER lasted as long as it was supposed to last! I can't remember the exact amount of time but it was HOURS earlier than it was supposed to wear off. We eventually switched to Ritalin and he doesn't have rebound. But we haven't been able to go back to the long acting meds because he metabolizes them sooooooooo fast. Now he takes a dose every 2 1/2 hrs. I know it sounds like a lot but it works WONDERS for him! 
3rd-I would be shocked if his dose didn't need to go up in the beginning. I've never heard of any child that stays on the first dose because the docs ususally start off low and build up.
last-I don't have any experience with bi-polar but what you've described sure sounds like ADHD symptoms to me! I'm not a doctor and you should still have it evaluated but this sounds like ADHD
The good news is that if you saw such good results the first day (as we did with my son until it went bad a few days later) that's a great sign! That usually means that stimulants will work for him. You just need to find the right dose and the right med. I recommend going to a specialist ASAP! The pediatricians just don't have enough experience with these meds to get it right quickly. It can be a long difficult road to finding the right med and dose and A LOT longer if you are with a pediatrician!
I am sitting in the airport and they just called my plane so I'm going to run without proof reading this post. I sure hope it makes sense! 
I wish you the best of luck! I KNOW what you're going through. Trust me...it DOES get better!
him...same experiences you are having...irritable (more
so than normal), "bummed", very difficult to get going,
would just lay on the couch and tell me how tired he was.
It also made his stomach upset from time to time. We are
currently on Concerta (18mg) and we just started adding
Intuniv 1mg today. We also have "rebound" issues in the
afternoon. I'm hoping the Intuniv helps with that. We
will see. Does anyone know how long it takes to see the
effects of the Intuniv? Just wondering.
Your son sounds a lot like mine...a typically kind-
hearted little boy with some impulsiveness and
inattentiveness. My DS also has a hard time with
emotions. He is fine until you make him mad or hurt his
feelings...then he verbally lashes out. It's like Dr.
Jekyll/Mr. Hyde. He goes from 0-60 in seconds. He also
has a hard time controlling inappropriate behaviors even
when directed. You're not alone. Thanks. The doctor upped his Adderall XR to 10 mg. She said they generally like to max out the dose before assuming the med won't work for him. So today is his fourth day at the higher dose. I don't feel like I see much more difference in him than I did before the higher dose. I haven't really seen him much today so far. Got him ready for school and then my husband took him. He just picked him up and is going to the store but he called and said he was on green today (he also was Monday and Tuesday, we had snow days the last two days). The teacher said the last hour he was kind of wound up but still ended up on green.
Let me say, glad to hear that you are having some success. A little warning light went on in my head, though, when I read that part about the teacher talking about the end of the day and "still ending up on green." Please be aware that sometimes when a teacher or other authority figure is aware of ADHD treatment and that there are changes being made and that you are willing to hear what they have to say about your child's behavior, they can become hypervigilant and overly critical of the child. What would be considered normal behavior in another child can suddenly become a sign of hyperactivity or inattention in your child. At the end of the day, many children have had enough of school and get squirrely. While talking in line at 2:50pm might get another child a "Shhh", it could get your child moved to a yellow card...simply because the teacher now knows that your child has these tendencies and the behavior gets added to the aggregate of what went on during the day. I don't want you to get upset about it, I just wanted to give a warning to keep things in perspective.
Oh. He's in preschool and only goes from 8:45-11:20 every morning so I don't feel that he should be getting that restless in that short amount of time. The "but still ended up on green" was my words, not the teacher's. She said he was on green and that he was a little wound up towards the end but that's all. We've been in close contact with her and we've made a point to make sure she doesn't treat him any differently than the other kids. In other words, if he misbehaves (even if it could be a symptom) he gets the same consequences the other kids would get. But also that he doesn't get further punishment than another kid would get for the same offense simply because he tends to do it more often. I'm very happy with his teacher and how she's worked with us and how she keeps us well updated on his behavior. I'll preface this with a warning. I tend to be wordy in general and when it's a topic that is particularly frustrating or upsetting to me I get even more talkative. This will be long. Probably very long.My five year old son was diagnosed with ADHD combined type last month. I've known it for much longer though.
My husband apparently had pretty much identical issues as a child. In his early 20s he was diagnosed with adult ADHD. Meds seemed to work well for him but he didn't take them regularly. Two or three years later he was diagnosed as bipolar. He's treated for that and doing far better than he did at the time he was diagnosed. He is NOT treated for the ADHD right now but seems to show little to no signs of it now that he is reasonably controlled in the bipolar department so we don't know if the adult ADHD could've been a misdiagnosis or what.
Anyway. When my son was a baby he was pretty much perfect. He only cried when he needed something. He slept through the night probably by about six weeks. He started talking by about six or seven months and his language skills are still way above normal. But his gross motor skills were delayed, the physical therapist he saw believes it was due to his position in the womb. He never really crawled right and he didn't take his first step until 18 months, fully started walking at about 21 months and was completely caught up to his peers by 2.
It was about that age that I started to feel like he wasn't like other kids. At that point it was mostly the non-stop talking. When he was three I was really suspecting he had ADHD but I didn't talk to his doctors about it because I know that most are wary of diagnosing, much less treating a child so young.
By his fourth birthday it was getting really frustrating and I was really starting to notice major inattention problems (so bad that he couldn't maintain eye contact for even a full minute when I'd be trying to tell him something...he'd get distracted and turn his head to look at something else, eventually I started holding his face to me by his chin and even then his eyes would turn to the side to look at something else even when our faces were inches apart). He couldn't play age appropriate games because he wouldn't sit still or pay attention long enough to learn how to play and even if/when he did understand it he'd be too quick to just grab pieces and screw around with them instead of playing right. I could go on but, like I said, this is already going to be long enough.
At his 4 year well child visit I spoke to his pediatrician about it and she didn't make me feel confident that they'd believe he had anything or that they'd treat him. At that point I wanted to try behavioral therapy before meds. Anyway, she gave me questionnaires to fill out but he wasn't in any kind of school or daycare and the only other person he spent any real amount of time with were his grandparents. I did not trust my in-laws to fill out the other form as they have drug and alcohol issues and their opinions seem to change depending on if they've taken any pills, if they're in withdrawal or even what kind of mood they're in at any given moment. (They haven't been allowed to see the kids in about a year.) And my mom is the kind of person that just says "I don't know" when you ask her specific things like the questions on the form so I didn't feel she'd be reliable.
Between that and the feeling I got from the pediatrician I decided to put off pursuing anything about it. Well, he was able to start preschool in the fall. This was about 10 months after talking to the doctor. By this point I was getting more and more frustrated with him. It got to the point that I never really played with him because he was so all over the place and I didn't have the patience for it. I found myself basically wanting to scream "shut up" at him over and over and over because I couldn't handle the non-stop talking (as we speak I have headphones on with instrumental music to drown him out).
I was really stressed about how he'd do in school and by this time I KNEW he had ADHD or some other similar issue. (I know I was basically diagnosing him myself but I am knowledgeable on the subject and have experience through my husband so it wasn't like I was just WebMDing it.)
Anyway, when we found out who his teacher would be I contacted her with my concerns. She set up a meeting between my husband and I, herself, the principal and vice principal and the school psychologist. We went in with a list of his symptoms. We explained my husband's history, Noah's behavior and our concerns. The teacher took notes, the school psychologist asked some questions but gave us no hint as to what her impression was, the principal told us we were describing normal four year old behavior. I tried to explain that I know ADHD is so similar to normal toddler and preschooler behavior but that I felt like it was amplified in my son. What I wanted to say was, "this is NOT normal behavior and I'm concerned that you work so closely with young children and don't seem to know that ADHD behavior, on paper, is often identical to normal behavior."
The whole point of that was just to alert the teacher so she could make a point to be more observant of him so that we could move forward. I didn't particularly want the big meeting.
So he started school on August 25th. They have a green/yellow/red light system. Each day they start on green and depending on their behavior they move down to red. Up until he was medicated last month I could count the green lights he had probably on one hand. And they were pretty much all days where something different was going on...a fun assembly, a class party, etc. Events where focusing and sitting still weren't particularly required. Most days were red lights, some were yellow. And he never got in trouble for anything other than getting out of his seat, talking out of turn, being too loud, moving to a station he wasn't supposed to be at, running in the halls, rough play with other kids. (I made a point to clarify that with the teacher because I was given the impression he was hitting other children. I guess technically he was but it wasn't really hitting. He would be hyper and swinging something around. Of course he was never observant enough to notice a nearby kid so the kid would get whacked. Or he just would try to wrestle around with another kid playfully. That kind of thing).
Initially the teacher would tell us that it was normal. Or if he did have a green light day she'd be like "See? It's getting better. He just has to adjust." He'd be on red the next day.
Finally my husband talked to her one day when he picked Noah up. He asked her to compare him to the other kids. Did he get out of his seat more often than them? Did he talk more? Talk louder? Jump from activity to activity more? At that point she realized that yes, he did everything way more often than the other kids.
By then I had decided I wanted to take him to a mental health provider, not his pediatrician. We made that appointment. He had an evaluation with a psychologist that felt he met the criteria for ADHD combined type (7 symptoms of inattentiveness and 8 of hyperactivity/impulsivity). He suggested a combination of therapy and meds. By that point I wanted him on meds. I was too frustrated and I know I wasn't being the kind of mother he needed. I knew meds were far more likely to show results much faster than therapy alone and I just couldn't wait any longer for therapy to show any improvement in him. I felt better when a psychologist told me that kids that need medication but just go to therapy usually get little to nothing out of the therapy because they can't focus enough during the sessions.
Anyway, after bouncing around trying to get him seen by somebody as soon as possible to prescribe meds we ended up back at the pediatrician's office. She really surprised me when she brought up putting him on meds before I even had the chance to request it. He's supposed to start therapy, too (they have some child therapists at the office) but there's a bit of a wait. They're supposed to call me to set up an appointment but I'm probably going to have to call them because it's taking so long.
So he started on Adderall XR just over a week before Christmas. The first day was amazing. He was on a green light in school. I spoke with the aide and she said it was tough to say if it might be the meds or what but he did seem somewhat calmer. When I picked him up he walked out of the building and to the car. I usually have to tell him to slow down. In the car he still talked a lot but it wasn't so loud and it was more...coherent. Usually he ends up with a lot of ums and pauses and restarts because his mouth can't form the words as fast as his brain is putting them out. He didn't do that. I asked him what he did in school and instead of naming one thing or just saying he didn't remember (his typical responses) he started listing off things he did.
I was going to my mom's house and he went in and sat down on the couch to watch TV. Noah has never been able to sit down to watch TV. He rarely paid attention to it for more than a couple minutes at a time anyway and when he did he literally had to be standing RIGHT in front of the TV. But that day he was sitting on the couch quietly watching a show.
While I was there I had to call my husband and Noah wanted to talk to him. I gave him the phone and he went back to the couch and sat down and talked. He does not sit down for anything, not for any length of time. When he does he squirms and fidgets, lays down and rolls around. He wasn't doing any of that.
But about 2:00 or 3:00 that afternoon my mom and I took him to the mall and he seemed like he was back to his old self. I'm not sure if an XR med could wear off that quickly or if the mall was just sensory overload that it trumped the med or what.
The next few days I was still seeing a noticeable difference in him. He'd sit and play with one toy for a longer period of time, he'd color pictures and stay reasonably inside the lines and use lots of colors (usually he'd use one or two colors for the whole picture and just scribble, making no attempt to do it neatly), he still talked a lot but it did decrease a little. He was getting all green lights in school.
But I still felt like he would start to worsen again in the afternoon. Still not like he used to be but not as good as he seemed to be doing, especially in school.
The night of the 21st I forget what happened but he ended up not going to bed until late, probably 1.5-2 hours past his bedtime. This happens from time to time and usually he still wakes up at or only slightly after his normal time and is the same during the day as he is any other. Well, the next day he didn't do well. I had to go get him up for school (he's usually up before the alarm goes off). He seemed normal before going to school but when he came home he was horribly cranky.
We had some errands to run and were getting ready but he went in and got in bed. When I went to see what he was doing he complained of being tired. He never complains of being tired except for when it's getting close to bedtime (this is a boy who, if I'm letting him stay up late for some reason, will tell me he's tired and wants me to tuck him into bed). He seemed a little upset and I thought maybe he wasn't feeling good be he insisted he just felt tired. Then he told me that he had really missed me while he was at school (a kid who didn't even miss me the first day of school). He said that they had a Christmas concert there and he was sad and I guess started crying (had never cried in school before). He said his teacher let him sit on her lap during the concert.
I was a little concerned because he's never like that but I just chalked it up to not getting enough sleep the night before (and maybe that it was a combination of the new meds too, since he never acts that way). He went to bed at his normal time that night and the next day the aide told us he was really "bummed" in school. They had their Christmas party that day and apparently he just didn't even seem excited for that. Then I was starting to worry that it was just the meds causing it.
That was his last day of school before Christmas break. That whole time he seemed fine, if anything more hyper/inattentive than he had been the previous week plus. He went back to school on Monday and had two green lights in a row. No reports of being down or crying or anything of the sort. So now I'm thinking again that it was just some fluke thing.
But the last two days he's been on red lights. The first day was typical stuff that he would get in trouble for before. But yesterday it seemed more than that. He was being kind of defiant. Take away the talking and not sitting still and moving around, etc and Noah is a VERY good kid. I might venture to say better behaved than most kids his age. But yesterday he just kept telling the teacher no. He ate breakfast at school and instead of dumping his tray and sitting it down where he's supposed to he threw it onto the counter. That is EXTREMELY out of the ordinary for him. They also did an art project and after it was over he said, "This wasn't fun" and threw it in the garbage.
I'm hoping it just happened to be that he was just being a brat that day, like kids do sometimes. But with the two red lights in a row and the fact that I feel like the meds aren't doing as much now as they were at first...and then the couple of "bummed" days before Christmas I'm a little worried that maybe it's some medication issue.
My questions...
Do you find that XR meds wear off and if so usually about how long after they're taken?
Have meds made your child sad/cranky and if so was it a regular thing or did it only happen from time to time? Is it something that went away after a little while or did you have to find a different medication?
Did your child need a higher dosage shortly after starting a medication? I know the pediatrician said it usually takes about a month to get the right dosage (he goes back on Monday so it'll be a day shy of a month) but I didn't think to question her further on why that is. I'm thinking (hoping) maybe the child will often build up a bit of a tolerance to the med quickly and will need more before he gets really balanced on it.
Also, if anybody has any specific info on bipolar disorder and ADHD as it may pertain to me, I'd appreciate it. Given my husband's history sometimes I worry that either this is ADHD that could turn into bipolar disorder or that it is just early bipolar or something. I know a lot about both disorders but I'm afraid I haven't been able to find much, if any info on how one can lead into another or anything of that sort.
That's all I can think of at the moment. If you have any other advice or information or even have a similar situation and want to commiserate, please share.
Thanks. And again, I'm sorry this was so long.