Help with dosage amount | ADHD Information

Explain what you meant about the Adderall XR having "extreme downtime"...I don't understand that one. My son will be 12 next month, and has been diagnosed as ADHD since he was in the 3rd grade. He's taken regular Adderall, but it didn't really have much of an effect, as once it started to wear off, there was too big of a gap in time before the next dose would "kick in", so to speak. He weighs about 66lbs...not a very big kid at all. He takes 30 mg of the Adderall XR and 54 mg of Concerta.

One thing we have started doing for him is we alternate his meds. We used to alternate them every 30 days because what was happening is that toward the end of 30 days, they wouldn't really have as much of an effect as they did at first, but we were "behind the curve" as the Dr put it, so now we switch it up every 15 days. On the first of the month, for example, he'll take the Concerta. On the 15th, we'll switch him over to the Adderall XR, and so on. This keeps his body from "getting used" to one drug, thereby elongating it's effectiveness.

I don't know that weight is the only determining factor when judging dosage amounts.....maybe it has to do with metabolism rates, height, age, level of activity, etc. Ask your Dr why your son is being prescribed the amount he is and ask if a higher dose might help. You might also mention what my Dr is doing as far as the rotation of meds.....it took us a while to find that this is what works for us, a lot of trial and error, and mostly because I was apprehensive about just arbritrarilly increasing his meds every time, ya know?

Hope any or all of this helps, let me know, ok?

Good luck to you, and keep us all posted!

I have been reading and reading and searching and I, like many of you, still have questions, and the doctors seem to lay it on me to decide (by watching behavior). Teachers have been telling me my son has had Add since he was 2 years old. My ex was in total denial (still is) and refuses to help me get help. I finally put him on ritalin (not good for him), strattera (did nothing), Adderall XR(too extreme down time) and now have got him on 15mg of Adderall. My question is that I read if a person weighs 150 then should be taking like 70 mg daily..Can anyone advise about this? My son is 15 and weighs a good 160 or so...does that mean 15mg is hardly enough? I can't see a difference only because we are new to this, by the time he is home, he is out the door, and the teachers are not helpful at all...Any advise or direction would be greatly appreciated...Thanx for your response...I've been busy with dr's, school and meds (imagine that) to get back until just now....I'm just asking but isn't that alot of mg what your son is taking at 66lbs? Here the doc tells 20mg for my son (15 yrs old@ 160lbs.)should be sufficient..?!? I'm totally confused. I don't want to overdo nor do I want to underdo...And I didn't know you can mix both ritalin w/ an aphetemine...Does he get those all at once?
Extreme downtime is my description of when the meds wear off, he was so depressed, sad, emotional, hating school, life, etc..I talked to his dr. today about upping the meds and some of the stuff that I have been reading about and she advised that starting smaller doses and increasing over time gives him the opportunity to increase. If he started at like, example, 40mg, 2 years ago, it would be too much med to up in just a year...(hope I sound clear?!) Better she advised me to get 20mg increase now (from 15mg) and if he needs more then give it twice a day...or break one and make it like 30 .... It's basically hit and miss...She also advised me to not give him anything for the summer..that decreases any side effects or if he is not in school...I tried to tell her that not taking any meds affects social life, so she said "try some here and there.." It's all 'practicing' medicine and the parents are the 'watchers'...It's all too much somedays...and then somedays he doesn't even want to swallow anything anymore...I can't get him to understand that this is a good thing for him, a 'focus med' and not just 'a pill', but he goes so much by his feelings...Finally, I let him read the symptoms of add out of book asking him, Do you think you have this? He looked at me like a light clicked on...sorry, I'm rambling...I'm still just practicing what works...Does your son get headaches or stomach aches? Each time we increase anything mine complains...Please let me know, I need all the help I can get...Thoughts are with you and yours too!Mariann, it sounds like your son is taking an adaquate dose for Adderall XR. It very much has to do with body weight, but also with tollerance and how much assumed defeciency there is in dopamine release in the brain. His extreme shifts in behavior from using to not using might be better helped with counciling in addition to drug treatment. Combining the two (counciling, drug treatment) has shown to be very productive, and has worked well with me. Given that he is so young, he may be having a difficult time understand why he is feeling the way he is, and how the medication he is on is affecting his feelings. Also, a lower dosage might also be beneficial until he gets used to the feelings of being on the drug, and not being on it. I could see how jumping from the feeling of being on Adderall, to having it wear of (and the fatigue is noticeable for about 30 minutes to an hour when it wears off) could cause emotional distress in someone his age. I know he might not want to admit to it, but being 21, I remember all to well how emotionally unstable most people are at that age. Adderall is prescribed in doses starting at 5mg and goes up to capsules of 30 mg at 5mg intervals. I weigh 160 lbs, and take 25 mg's a day, but only on weekdays. On the weekends, sleeping in and some caffeen is usally all I really need, and then when I start back up on monday, the effects are strong enough that it allows me to concentrate and do what I need to do, but isn't overwhelming. Try taking 20-30 mgs one day and try and note the effects it has on your. Around 4 hours is the peak, and you will probably feel very pleasent, a slight tension/tingle in the shoulders and neck, more motivation and less boredom when doing menial or repetitive tasks, and a slight buzz that fluctuates from unnoticeable to something like 4-5 cups of coffee. After using for a period of time, ie a week or so, all of the "stimulating" sensations seem to be less prominent and you feel more normal, but the focus and motivational aspects seem to still remain. For me, if I use every day, this eventually also leads to a loss of the motivational/focus aspects that I depend on. Finding the balance, or how to keep in that zone where its not too strong and not to week, seems to be the key in using such drugs. These drugs ARE neurotoxic, and have very little field data from longterm use. I would not suggest giving him any more than is absolutely necessary. 5-10 years down the road, you don't want his dopamine receptors to be so fried that he is literally dependent upon ever increasing doses of this drug or other analogs. I hope some of this helped, if you need anything clarified, as I am sure I rambled, just ask.

Here is my experience.

My daughter weighs 72 pounds, is 11 years old.  She's a little on the petite side of average for her age.  She's been taking Adderall XR for 18 months.  We are now at 25mg at 6:30am, and another 10mg at 3:30pm.  We originally started on 10mg, which didn't have a noticable effect, I know what you mean about the problems when the medication wears off, that's why we now take the "booster" dose at 3:30 (just started that 2 months ago.)  The doctor says it's a "rebound" reaction, a lot like when you take a pain med, and when it wears off the pain feels worse.  So of course the first dose of Adderall was wearing off just at the end of the schoolday when she was tired and hungry also, and all hell was breaking loose at the after-school care.  She's very athletic, and practices are always after school - she got kicked off one team for her defiance, and I've had another coach talk to me about her anger.  Since we started the second dose, things have been wonderful.  Though she's still a little wired at bedtime, she seems to actually fall asleep easier now once I can get her to actually GO TO BED! 

We had tried combining Adderall and Strattera, and that did lessen that rebound.  But the second dose of Adderall has been a much more satisfactory solution.

Thanx for sharing...and I understand the purpose of giving them a 'booster', but my doctor has always advised against it because then they are on 'something' all the time...That's what she tells me when I explain to her that the rebound time is awful at home..My doctors aren't really suggesting anything to me, they are leaving it up to me to kinda judge..I have given him 1/2 of normal med (10mg) after school, only because out of desperation we had to do homework! and it does work..but, I also notice that at 4am, he is still up...on the computer no less, wide awake...by morning, if I don't give him his meds an hour before he is suppose to wake up, he's too exhausted to get up..I just don't know if that cycle is good..and then when summer comes I have no idea what I am going to do bcuz his Dad is in PA and refuses to even acknowledge ADD exists, and will not allow him to take any medication for something he doesn't have..which I guess I don't have to worry about because he won't be here...My doctor even told me not to give him meds after school or on weekends not at all unless it has to do with school...I looked at her like she was nuts because I told her how do you expect him to socialize and keep friends without being calmed down?!...I am just overly tired with mood swings and fighting and all...sometimes and I hate to say it, him just walking into the house sets off the whole place with stress..and then he goes into the "I'm the bad one' of the house...I'm not giving up...but it's so draining...

AWindowPane: Thank you so much for responding..I am at my wits end this week...I'm too tired to think about add/ahdd anymore and doctors and meds..It's like I AM not focusing!...I think alot of it more be 'just me' as I like to be able to have some sort of routine...Take this, expect this...but we all know that is not what happens. What you shared with me is great and I thank you so much for taking the time to offer some help...I try to give him 5-10mg in the afternoons after school only because I want him to be able to socialize....sometimes that backfires tho, because if I can't get them to him on time, his friends suffer through his 'down time' and then all hell breaks loose because he feels like he is a loser...I place the half of pill in a secret place and he calls me after school and I tell him where to go get it to take it..(I can't keep missing work..) I like what you shared about taking the weekends off, so the effect is there on Monday; and thank you for sharing with me what to look for, effect wise...And your right, he is too young to realize the feelings he has are from the meds and not 'real'...But he won't listen to me either...He's either in a great mood, or totally down in the dumps...If you don't mind..I have one more question, if I give him 20 mg at 8am in the morning...when does it hit, peak, and then wear off...? please feel free to email me anytime...thanx so much...

Mariann-

If you are like me, and you see such a dramatic positive effect from the Adderall, and the doctor won't help you keep the child under control by giving you the booster dose, then I think you need to consider a different doctor.  In our case, my daughter could easily hurt herself or someone else when she isn't medicated.  She's so completely without inhibition when she's off the meds, and she exhibits the classic symptom of participating in dangerous activities.  She came within a hair of being kicked out of the aftercare program at school over her anger when they stopped her from doing some of those things, that's the only reason the doctor gave-in and allowed us to have the "booster" dose. 

Initially, our physician was like yours, saying that it was better to be on the minimum medication.  But the booster IS the minimum in my opinion.  How frustrating must it be for these kids to have their brain work fine, be able to do schoolwork and fit-in with normal kids for 8-10 hours, and then crash-and-burn every evening when they come home with us?  It has to be at least as hard on them as it is on us parents.  My daughter was convinced it was her little sister that made her life at home so awful because THAT was the difference she perceived - school was fine, but being home with her little sister was when she was in trouble all the time.  She HATED her sister, which just made life that much more miserable for all of us. Now that we take the booster, she and her sister get along pretty well and she doesn't get into nearly as much trouble at home, and I don't worry about the safety of my younger child.

Regarding the fact that your son is wired when he takes a booster, there are even 5mg Adderall XR's, and I know that the non-extended-release comes in at least as low of dose, and that only lasts about 4 hours.  I've found that even though my daughter is wired at bedtime, playing computer games, etc, if I can actually get her to put her head on the pillow and close her eyes, she will fall asleep easier, and more soundly than without the meds.  It's almost like the meds help her focus on sleeping too.

This kind of attitude by the doctors irritates me - would they keep insulin or thyroid medication away from a child to keep them from being on medication all the time?  If the child can't function within normal ranges without this medication, then by God, give the kid the medication!!!

As I said in the earlier post, we did combine Adderall XR and Strattera.  The initial plan was to get off the Adderall because of this rebound, but she did so well on the combination - the rebounds were much less and the Adderall still had it's positive affects too.  Plus, she ate better when we added the Strattera.  There were clinical trials here for Strattera, and our doctor was in on those - when I told her I liked the combination and was leary of pulling back on the Adderall, she admitted that they'd found that was true in many cases.  So we've stayed on both.  That might be an option your doctor would consider since Strattera isn't a controlled substance.

Honestly, I will admit that with the constant medication, my daughter is not learning any coping mechanisms.  Therefore, when she forgets to take the booster at school, we have a worse hell than  before.  But  before we started on medications, she was spending so much of her energy just trying to not be disruptive in school that she didn't have any energy left to actually do the work.  So if this is what it takes for her to be a part of society, I'm still for it.

Actually, weight isn't the only determining factor when it comes to dosaging medications.....it can also be determined by your age, as your metabolism is faster (generally) when your'e younger versus as an adult.....also, by your actual size in relation to your weight. It's also important to note that just because you weigh more does not mean you can automatically tolerate a higher dosage, as everybody's body is different and can/will process different meds at different rates. (Here's a good example for ya: I'm 5'0, weigh 107lbs, and can take Sudafed all day and all night and not have it take the first effect on me, even at the highest reccommended dose....now....my husband on the other hand, is 5'9, weighs 160lbs, and can take the bare minimum dosage and be knocked out cold for hours....see?) I am 22 years old and weight 240 lbs and i am taking 20 mg XR adderrall each dayso 70 mg is way to much cause 20 is good for me and i wieight over 100 lbs more than your sonBefore I get to your post, I'd just like to point out that I said Milk worked as an alkalizing agent, and that isn't true. I forgot that it become an acid when digested. Just thought I would clear that up.

The strength of the dose, with Adderall XR at least, should not strongly affect it's duration. It is meant to be absorbed at a certain pace so that it lasts 12 hours. Of course, how fast those little plastic laced pellets dissolve depends a lot on the person. However, 10 mg should dissolve at the same rate as 20 mg and 30 mg, at whatever that pesons rate is. Giving a higher dose shouldn't make it last significantly longer, unless you dramatically increase the dosage.

The homework thing is tricky. Giving him a dose too late in the day will make it hard to fall asleep. I don't know how much help I can be here, because I myself do not abide by any sleep pattern that any sensible person would consider normal. I usually end up in bed around 2 (regardless of the day of the week, sometimes I stay up even later) and then get up at whatever time I have to. Sometimes 6:30 (class days), sometimes 11 or 12 (non-school days). But I only had school 4 days a week. Sometimes, I would actually find myself tired and going to bed at a reasonable time because of this. But once I am up, I am up and fine, until the adderall wears off. When it wears off I have about a 30-45 minute lag time where I could easily fall asleep. But pushing through that usually leads way to a second wind of sorts, and then I am fine until my stupidly late bed time.

I do my homework in the morning. A college schedual allows for me to do this, and it is the only time I really feel motivated to get started on anything new. The hardest part is getting started. If an assignment isn't due the day after it is assigned, try having him work on it in the morning before he has to go to school sometime. Maybe having gotten it started will make it easier to finish later. I would ask the doctor before uping the dose at all. Maybe she can give you something that does not last as long for the afternoon.

I totally forgot if your son was on Adderall, or Adderall XR. Most of what I know is about XR, because that is what I am on. Oh, and eating is important. If his body doesn't get enough calories, then he will be noticeably more tired and his body will canabalize muscle, not fat. He may be losing weight and feeling good about it, but its not good weight to lose. Eating foods that are rich in complex carbohydrates like pasta and staying away from overly fatty foods along with a gym class should be a lot healthier than not eating enough. Eating too much is bad, but so is eating too little. If he drinks pop, I use a coke when I start feeling tired to get through that spot. As for doing chorse, I would set a time for him to have something done by. And then tell him if it isn't done by then, that you are going to nag every 5 minutes until it gets done. Avoiding nagging is reason enough for me to get something done, as long as I can do it around my own schedual.

Because parents of ADHD children have many concerns and questions about medication, rightfully so, I have provided a very informative link that can answer many of the questions that parents are concerned about. Also, I urge all parents who have children that have formally been diagnosed as having ADHD to seek out a doctor who is a specialist in ADHD disorder. For all those who have aol, you can easily access this link and will find it to be very informative.

 

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Luvmykids0238114.3384837963Adderall peaks at around four hours, but the jump from baseline to peak is steep, and at around 1 hour (depends on a lot of things) is when the effects become noticeable for me. I tend to get really bad dry mouth shortly after this period. Adderall XR is then SUPPOSED to have a steady, gentle slope down from peak, but this seems to very greatly from day to day. There are many compounds which he may or may not take that can have synergestic effects with adderall as well. Acidic fruit juices will lower the aborbtion of amphetimines. Adversly, gastrointestinal alkalizing agents will increase abosorbtion. Baking Soda for example. If his diet that day is heavy in acidic foods, the medication will not have as strong of an effect, and if his diet is higly alkaline, the effects will be increased. As a sidenote, if your son has allergies, amphetimines interfer with antihistamines, and render them basically useless.

I used to have 8am classes on Tuesday, Wednesday, and Thursday. I would need to leave at roughly 7:30 for these classes. Getting into a pattern or routine is ESSENTIAL in my opinion for anyone with adhd. I would, on any day when I needed to go to class, make sure that I set my alarm for 30 minutes before I needed to get up, which was 6:45. When the alarm went off, I would hit snooze once, and wait for it to go off five minutes later. That time, I would take my adderall with a glass of milk or water.

[I would suggest staying away from pop. Caffiene does help quite a bit, but my stance on its use is still rather ambivalent. It is known to be addictive. Chocolate contains smaller amounts of it, as well as dopamine, and is not as highly acidic as pop. Amphetimines target the dopamine receptors in the brain and I believe either help to produce more of the nuerotransmitters (more transmitters, stronger the effect) or they help to prevent "re-uptake". Re-uptake occurs after neurotransmitter release. Basically, the bulb releasing the transmitters sucks some of them back up like a straw after it spits them out. Chocolate makes people feel happy. This is why it is an aphrodesiac and why men give women chocolates.]

I then continue to hit snooze until it is my time to get up. Usually, you get annoyed and are wide enough awake a couple snoozes before it's time to get up. I don't know if he has trouble waking up early, but I do, and this helps a lot. Waking up slowly allows you the chance to get up closer to the peak of an electrical activity cycle. Sleeping is characterized by dropping below a certain level of brain electrical activity. The cycle has peaks and lows. These peaks and lows are not constant, and get progressivly higher the longer you have slept. Waking up at the top of one of these cycles is a bijjilion times easier than waking up at a low. Esepcially since the lowest low is characterized by an amount of electrical activity so low that you are technically almost braindead.

So I would get a dose at around 7 am, and at around 10 or 11 am, I would be really in the zone, have really bad dry mouth, and be dramatically more talkative. About 5 or 6 hours after the peak, most of the effects are incredibly more sublte, but I don't usually get the hour long tired crash until about 4-6 pm. Metabolism plays a huge part in how long it stays effective. Since he is at the age in his life when metabolic rate is probably the highest it will ever be, it would not surprise me if he drops sooner than I do. I have a pretty high metabolic rate, but I am also not growing much, if any. I would probably skew the normal graph to include that factor. He probably feels it at as early as 30 minutes, and peaks over a period of time between 2 and 3 hours. From then on out, just ask him when he usually gets tired, and assume a pretty constant decrease from peak to plunk. Double dosing can be good or bad. I really find it to be situation specific. Giving him another 10 mg in the afternoon does not sound like it would be a bad idea, as long as he gets some down time during the weekend. This drug IS basically controlled speed, and tollerance can be developed fairly quickly. What I know about drugs leads me to believe that even 1 or 2 days off each week could add substantial longevity on the effectiveness of a certain dose. Some doctors will carelessly move children up and up, trying to keep the same level of effectiveness by adding more and more. Imagine, if you even move up ten mg every year, where you will be by age 30, 40, etc. This also greatly increases physical dependancy on the drug. Adderall is not a cure all, and may not last as a solution for ever. It might be safest to think of it as a teaching tool on how your brain can also operate. Even one weekends, I find myself able to put myself in the frame of mind that adderall brings about.

I would also ask your doctor if his diet should be more closely watched since he is on adderall. It can be an appetite surpressent, and a lack of calories could help contribute to the fatigue. By watching his diet, I am mostly saying to make sure he gets enough calories. When I was that age, I used to consume like 6000 calories a day easy, and I am very skinny. If he is burning through his calorie intake and not noticing that he should be eating because of the appetite surpressing factor (which is not experianced by all) it could be bad. Many people think this may help lose weight...and it will, but not weight from fatty tissue. Your body cannabalizes muscle when it has a lack of calories.

I am an extremely non-linear thinker, the creative type, intelligent and weird. At that age, those characteristic can feel like a curse. Adderall almost acts like the post office for my brain. It catches streams of thoughts shooting into my brain, sorts them relivently, and lets me know where everything is so its not just all over the place. Previous to using adderall, I had to type or write things down in order to have an organizing space other than my brain. After starting adderall, it was like I had the messy room, and then the sorted room. I'm struggling with metaphores here, because it's really hard to describe how one processes thoughts. It could be this doesn't apply to your son at all, if his brain doesn't operate like mine. But the clean room really knows how to chew the fat, and since it seems to have the seem outcome with your son, I get the feeling he may have a similiar experiance.

As to him not listening to what you have to say, may I suggest possibly a different approach? I'm not sure how you currently try and give him information you know is helpful, so if you do it this way, then I think you are doing it the best way possible.

Don't "tell" him anything. Instead, ask questions. Not too many at once, and don't drill them as if you are Socrates. Wait for a moment when asking a certain question seems relivent, and try and relate it to something other than his personal life. Politics, religion, the educational system, or something else big. Something he is bound to have strong opinions on. Being able to have a debate with him, either with you agreeing or disagreeing, is a good thing. If he thinks you are wrong, don't get frustrated. Don't raise your voice or let your emotions get the best of you. If he notices that you can calmly and rationally explain why you think what you do, and he can't do so in return, it might turn him on to the possibilty that some of his assumptions are unfounded. In some cases, it might show you this instead. At the very least it will make him explain to himself why he thinks what he does, and you can be at least confident that he has given it a decent looking over. Accepting having any ignorance is something a lot of people, myself included, have trouble doing. But the truth is a lot of things that I "know" are based on information which I just assume to be true. My dad will not change his opinion on anything, period, and it kills me every time I point out a flaw in his belief and he just deflects it with a comment like "if you spent as much time doing yard work..." Emotions are hard things to get kids to want to talk about. Even asking questions. Are you feeling ok? will almost always get a "yeah", regardless. The trick is to find something he is interested in. Then make a general statement, not as if you are telling him it as fact, but just stating your opinion on something because it interested you and caught your attention. Pick things that relate to an idea you support that he might has seemed against. Lyrics to music he likes could help.

I guess the hardest but also best thing you can do is to remember how you interacted with your friends back then. And how you interact with them now. You are his mother, and gave him life, but playing the part of Mom and Son too strongly will just alienate you from each other. You have to learn to geniuinely find common grounds and interests. This will probably require both of you to try new things. Things you may think you don't like at all. Wine is not the only aquired taste though. It's hard. I am still struggling to establish a relationship with my parents that puts me above the "you don't talk to us that way, we're your parents" crap. I talk politely but I also am going to say what I think. And being debased on such irrelevent points is very frustrating. I am not going to respect every single thing they ever say, and it is rediculous for them to expect it. But I guess I get in fights with my friends too. It's all too complicated sometimes.
     AWP...Thanx so much for the input! It's been awhile since I was able to check back..I am thrilled with your information to help, thank you! I may jump around here but this is what I am seeing these days...For the down time, when he seems irritable, depressed, I am giving him 5-HTP and fish oil tablets with L-Tyrosine for nerves. Seems to work okay (tho he hates taking all these pills...I give him his 20 mg at like 8 am and by the time he has to get up at 9 he is already up and showered and ready to go...then in the afternoon I leave him 1/2 on the 20 to find and take when he calls me..He has not much of an appetite and he likes that cuz he is dropping a few pounds which matters to him...once that afternoon wears off (how soon does 10mg, I have no clue)..He's pretty irritable..I still can't get him to sit still and focus on homework...He's behaving okay, but just ready to run with the pack...and I find myself wanting him to have the right amount of dose to be able to get along with everyone instead, but i notice he does talk alot...But my concern is that he won't sleep...He doesn't now..and the only thing that gets him going is the next dose...
I like the idea of not 'telling' him something, rather asking..Cuz believe me, he's tired of hearing me...I went at him the other day because I just walked into the house and he was like 'take me here, now. gotta go.."...So, later that evening when I asked him to pick up his clothes, I did the same approach and said "do you see how it feels now?" Cuz he'll say 'later" all the day long!!...Let me ask you...He is leaving for a month to be with his Dad in PA..think it's okay to not supply any meds? Of course, his Dad doesn't believe it or even want him on meds..so I guess that's that...I see in adderall that he does feel better, but as far as 'doing things', not...like picking up, doing homework...taking the garbage out...I guess it just depends...Would it hurt to give another 20 in the middle of the day?? THe nurse won't give without it being on the script bottle, so that means I have to run out there, which I will, but is the dose too much? Thanx for your help...and all the advice and insight...Thank you so much!...