Extreme irritability

[Anonymous]

Our 11-year-old son with ASD/ADHD is very agitated all the time. Although I am aware that some of it may be the result of hormones changing, this has been happening for more than two to three years. I'm starting to wonder if the stimulant/non-stimulant combination he's on is to blame. He has been on the same medication since he was 7, and it seems that the anger and hostility (which is more verbal in nature and includes statements like "I hate you," "I hope you die," and other similar expressions) get worse every year. He goes from 0 to 60 over the smallest things (like a sibling just talking). He is competent and intelligent but gets impatient so easily when he doesn't comprehend something and won't accept assistance. It also seems like things that use to come easier and he enjoyed are no longer enjoyable. For instance, he used to love going on bike rides, now he is paranoid someone is going to run into him and screams the whole time that we are getting to close or complains of being tired. The only thing he wants to do is screens (which we limit). I'm not sure what I expect to get out of this post. Its just exhausting to be around and makes me sad that we've lost our happy go lucky guy...and really sad for him that he seems so unhappy. Seems everything irritates him and nothing brings him enjoyment anymore. I have brought this up to our doctor who keeps saying lets wait and see (for context, we moved our son to a specialty private school this year and I think our doctor's thoughts are maybe a new environment with right supports will ease some of this). We've also on school breaks/holidays taken a "vacation" from the meds, but our son is so impulsive and hyper that I'm not sure what is worse.

[Anonymous]

We have a similar situation. Our kid can't get any schoolwork done without a stimulant. But he's an irritable beast with it. We were so bummed to restart the stimulant at the end of the summer because we felt like we were losing our sweet kid.

[Anonymous]

This was a very bad period for us too. We saw what you did at the beginning of adolescence. I hope I give you hope OP by telling you it did pass for DC after a couple of years. Still sometimes irritable and the verbal abuse isn't totally gone but usually happy to just okay most times. Night and day from those two years.

[Anonymous]

That was a difficult time for us for the same reason. Abilify was a magic fix. Several years later, he's in a much better place and we're weaning off the abilify.

[Anonymous]

Could be increasing anxiety as well. I would discuss with the psychiatrist. If you don’t get parent only time, schedule a separate parent appointment. We also did parent training to learn how to respond to irritable angry behavior in a way that didn’t reinforce it. I was tripping over myself trying to appease because otherwise it would escalate which was totally the wrong thing to do. (One we identified that is was mostly due to anxiety and were treating that with meds and therapy of course.)

[Anonymous]

This is random and anecdotal, so take it for what it's worth, but my friend's son is 13 with ASD/ADHD, and has struggled with mood/irritabilty/depression for many years. She started him a probiotic this summer and says that he is a different kid! YMMV but so much of what is happening in our brains are connected to our guts. Either way, it's a low-risk proposition! Good luck--we struggle with this with our DS with ADHD. I dread the return to stimulants.

[Anonymous]

Op here. Thank you for the replies and support. I do think some could be anxiety. I will try and ask for a parent appointment. Our nueropysch doctor noted she thought it was anxiety or depression. We did try abilify and the side effects (serious weight gain) made us have to stop...and I can't say I noticed enough of a difference for it to be worth it.

We actually have seen a functional medicine doctor and a GI doctor to help with this gut issues. I do think it helps and we notice a difference in his behavior when he is constipated, but hasn't move the needle that much. We even tried GF, etc diets but those only made him angier that he wasn't able to have the foods he wanted. ugh!

[Anonymous]

Op it definitely sounds like your non stimulant isn’t working. It should be taking the edge off.

Have you tried stopping the non stimulant for a few days to see what happens? Our doctor says that sometimes you learn more about the effect a medication has by taking a break from it.

[Anonymous]

Anonymous wrote:Op here. Thank you for the replies and support. I do think some could be anxiety. I will try and ask for a parent appointment. Our nueropysch doctor noted she thought it was anxiety or depression. We did try abilify and the side effects (serious weight gain) made us have to stop...and I can't say I noticed enough of a difference for it to be worth it.

We actually have seen a functional medicine doctor and a GI doctor to help with this gut issues. I do think it helps and we notice a difference in his behavior when he is constipated, but hasn't move the needle that much. We even tried GF, etc diets but those only made him angier that he wasn't able to have the foods he wanted. ugh!

Recs for a functional med doctor?

[Anonymous]

Irritability in kids is often depression.

[Anonymous]

Not to take over this thread, but have others noticed this level of irritability in kids who are unmedicated as well? My 10 year old daughter with ADHD has been coming home since the start of the school year very irritated. She was diagnosed about a year ago, and we’ve decided not to medicate her yet as we’ve been able to control her behavior through other methods (exercise, diet, sleep). She’s not yet entered puberty (very small and skinny), but moody as heck. It’s becoming an issue in our home as she’s extremely rude to us and quite frankly mean to her younger siblings. I am at a loss and was coming here to post about this.

[Anonymous]

Sorry that your family is going through this right now. I wish I had some good suggestions, but our family is going through exactly the same thing and struggling to find the right interventions too. Hang in there!

[Anonymous]

Op again... thank you for the support. I definitely have considered depression and probably should have him evaluated further. Also, thinking maybe anxiety? Our pysch really wants to wait and see how school plays out (we moved our son to a small speciality school).

We did take a break from the non-stim and I can't say it was any better/worse then when he was one the non-stim. I also keep pressing our pysch to try something new...beginning to think I need to find a new doctor who will really listen

[Anonymous]

Sounds exactly like my 10 yo.
Taking him off the non stim and making sports happen every single day has helped a ton.

[Anonymous]

Our ADHD/ASD DD, almost 10, has very similar behavior that ends ups escalating to aggression when it gets bad. Anxiety and intrusive thoughts/ocd are the root for her, and she is helped by a very low dose of abilify on top of ABA and OT for now. She gets stuck on the most innocuous (to us!) things and ends up in a hypervigilant state where she lashes out when we interrupt her or ask anything of her.

As parents, the Unstuck and On Target online version was helpful in providing some insight and support we can use day-to-day. It's still a struggle though. I would press for a further evaluation for your DS to try to get to the root cause of the behavior. It could be as simple as tweaking his meds, but it's so hard to get into their heads sometimes!