ADHD med "trials" with 6 yr old

[Anonymous]

My son just got diagnosed with ADHD-combined type right before his 6th birthday 2 months ago and we are already on the 3rd med

1st Medication: Ritalin 5 mg (no change in attention, increased aggression/defiance, and regressed in some behaviors including pooping on himself at his after-school program, peeing twice in his pants, and defiantly peeing on a tree at afterschool) 10 days on it and it was immediately clear it was not working.

2nd Medication: Vyvanse 10 mg (MUCH more positive and we thought we had a winner. His attention improved a lot in school & home, he followed directions more frequently and seemed to "hear us" better, did NOT run away and hide or run off while we were transitioning between places, followed the directions, less forgetful, and played well in soccer. He did have more difficulty falling asleep initially and seemed somewhat more irritable in the mornings and in the evenings. His teacher reported that when the kindergarteners all come in and are sitting at breakfast together (they all get free breakfast...), he was ALWAYS SUPER chatty, social, and happy. His teacher noticed that he started having "quiet time" in the morning and would eat his breakfast in silence and then just watch the clock until it was time to move on. She checked on him several times and he always said that he was just being "quiet". His teacher also noticed he was much more irritable with small and big things and had a hard time recovering, when before that was never an issue.

After I heard that update, we called his doctor and took him off immediately (Friday). He has been unhinged since then....we saw his doctor today and he was quite literally rolling around the room, bouncing on the chair, interrupting me incessantly and even acted like he was going to write on the wall with the pen I was given. It was awful.

We are going to try Strattera now. I'm slightly terrified to see how he will do with this new med. If it goes badly, he could get in trouble with his after-school program and be kicked out He normally does fine but they are not real forgiving and don't understand medication side effects. His doctor thinks that it's possible the irritation could have been worked out over time with Vyvanse and a higher dose could support him later in the day but wanted to try a different one right now. I know many of you all have been through this but it's hard. Anyone have similar experiences and have positive results with Strattera or another med?

I just hope something works for him. Sincerely, tired mama.

[Anonymous]

Hmmm....your trial is almost the same as ours. But with Vynase really bad stomach pain on top of it and 3 hrs less sleep per night. We tried Adderall ER as #3 in case it would let him sleep, but the crash was awful. We are taking a break before #4, which surely will be a non stimulant. It seems like there's plenty of us who have kids who can't do stimulants and then find peace with a non stimulant. You are not alone, please update us, and good luck!

[Anonymous]

That seems like such a short amount of time for the medications to honestly say it is not working. But then again, I would not medicate a child that young with adhd meds.

[Anonymous]

Anonymous wrote:That seems like such a short amount of time for the medications to honestly say it is not working. But then again, I would not medicate a child that young with adhd meds.

Not OP. Especially in this forum, if you don’t have any thing nice to say, just scroll on.

You haven’t walked a day in her shoes. I would have said the same thing before I had the child I have.

OP. We are also trying to figure out meds, it is a very complicated and frustrating process. I get it. Our doctor said we would know if a stimulant medication is working within 3 days. Good luck!

[Anonymous]

Anonymous wrote:That seems like such a short amount of time for the medications to honestly say it is not working. But then again, I would not medicate a child that young with adhd meds.

Agree. He seems too young for these meds with the strong reactions he's having - but also some of the negative reactions may subside after several weeks if you can make it through the adjustment period. While they say that stimulant meds work instantly, that's only half the story. They work instantly and also over weeks cause changes in receptors and transmitters in the brain, which is why there is a rebound effect and why it takes some time to really return to baseline after stopping the meds.

[Anonymous]

Anonymous wrote:Hmmm....your trial is almost the same as ours. But with Vynase really bad stomach pain on top of it and 3 hrs less sleep per night. We tried Adderall ER as #3 in case it would let him sleep, but the crash was awful. We are taking a break before #4, which surely will be a non stimulant. It seems like there's plenty of us who have kids who can't do stimulants and then find peace with a non stimulant. You are not alone, please update us, and good luck!

Thank you!! I'm hopeful we'll find something that works well for him.

[Anonymous]

Anonymous wrote:

Anonymous wrote:That seems like such a short amount of time for the medications to honestly say it is not working. But then again, I would not medicate a child that young with adhd meds.

Not OP. Especially in this forum, if you don’t have any thing nice to say, just scroll on.

You haven’t walked a day in her shoes. I would have said the same thing before I had the child I have.

OP. We are also trying to figure out meds, it is a very complicated and frustrating process. I get it. Our doctor said we would know if a stimulant medication is working within 3 days. Good luck!

Thanks! I personally struggled as a child with ADHD that was NOT on the correct medication and was NOT empowered or supported. I unnecessarily struggled and carry a good bit of trauma from those experiences. While I think it is important to not just assume everything is ADHD, with my child it is VERY clear. My child has been in several services since he was 15 months old and it became increasingly clear that he had ADHD to his teachers, OT, ST, and our family. I wanted to see how he did in kindergarten before pursuing a diagnosis and I waited until he was nearly 6 but some of his behaviors are dangerous (wandering away, hiding, running off during transitions, not following directions, so he needs the support of medication right now.

[Anonymous]

It took us over a year, working with a psychiatrist, to find the right medicine(s) for our DC diagnosed at age 6.

I suspect that for both of these meds he was on way too low of a dose. I would not at all stop stimulant trials, especially while you have teachers at school who are communicating with you and who know your kid. Once the school year ends you are going to be without teacher feedback.

For the ritalin you observed no change because 5 mg of what sounds like immediate release ritalin is the lowest dose, I believe. That is why there was no change in attention. Immediate release works for four hours which is not enough to last the school day. Anyway the regression of the behaviors was probably a good enough reason to go off it.

For the Vyvanse 10 mg, also the lowest dose, it is longer acting but the less meds in the system the quicker they wear off. When on too low of a dose you have the med wear off to suddenly. When you are on too low of a dose this could have been happening at school rather than later on. Youd need to ask if the irritability was happening all day every day or what. I also think you need to be on a new med for a least 2 weeks if there are no extreme side effects to let it settle in.

There are a myriad of other stimulants - including ones in liquid form with precise dosing that can work better for younger kids. i don't get the switch to a nonstimulant so quickly.

Good luck and keep us posted.

[Anonymous]

Straterra was worthless for my son. No difference at all. What I don’t understand is what about your son’s reaction/behavior led to the decision to discontinue. It all sounds like a pretty normal adjustment. I mean, the quiet is the reaction you’re looking for and the irritability takes some time to work through. I agree that it sounds like you didn’t give the Vyvanse a chance.

[Anonymous]

Anonymous wrote:

Anonymous wrote:That seems like such a short amount of time for the medications to honestly say it is not working. But then again, I would not medicate a child that young with adhd meds.

Agree. He seems too young for these meds with the strong reactions he's having - but also some of the negative reactions may subside after several weeks if you can make it through the adjustment period. While they say that stimulant meds work instantly, that's only half the story. They work instantly and also over weeks cause changes in receptors and transmitters in the brain, which is why there is a rebound effect and why it takes some time to really return to baseline after stopping the meds.

Do you have a citation for the claim that they "over weeks can cause changes in receptors in the brain?" Thanks.

[Anonymous]

This is so hard. I was so hesitant to medicate our young son but all the same reasons did. Please ignore the not helpful comments.

Have you looked at quillivant? It worked well for our son when he was young. Its a long lasting liquid med. I will say he was definitely a little but less of himself on, which wasn't ideal, but it was the only drug that seemed to not have the terrible side effects. He did rebound at night coming off.

We have since moved on the Azstayrs. Its a new drug and we've been really happy with it. Less rebound and less big reactions to small things.

[Anonymous]

Stimulants make a minority of ADHD kids more emotionally dysregulated like your son. I think discontinuing makes sense in that case. Strattera is a different class and takes longer to see an effect (weeks to a month). If that doesn't work, guanfacine ER is another non stimulant for ADHD. Hang in there.

[Anonymous]

Why are you medicating in the first place? If he “does fine” in aftercare unmedicated maybe he doesn’t need medication. Not all kids are easy - that doesn’t mean there’s a medication to change them. I get it, I had a kid with behavioral issues too. At the end of the day there actually is no magic pill.

[Anonymous]

Anonymous wrote:It took us over a year, working with a psychiatrist, to find the right medicine(s) for our DC diagnosed at age 6.

I suspect that for both of these meds he was on way too low of a dose. I would not at all stop stimulant trials, especially while you have teachers at school who are communicating with you and who know your kid. Once the school year ends you are going to be without teacher feedback.

For the ritalin you observed no change because 5 mg of what sounds like immediate release ritalin is the lowest dose, I believe. That is why there was no change in attention. Immediate release works for four hours which is not enough to last the school day. Anyway the regression of the behaviors was probably a good enough reason to go off it.

For the Vyvanse 10 mg, also the lowest dose, it is longer acting but the less meds in the system the quicker they wear off. When on too low of a dose you have the med wear off to suddenly. When you are on too low of a dose this could have been happening at school rather than later on. Youd need to ask if the irritability was happening all day every day or what. I also think you need to be on a new med for a least 2 weeks if there are no extreme side effects to let it settle in.

There are a myriad of other stimulants - including ones in liquid form with precise dosing that can work better for younger kids. i don't get the switch to a nonstimulant so quickly.

Good luck and keep us posted.

OP here- thank you for this feedback! That's a good question about the timing of his irritability. I honestly wasn't sure if we should go ahead and continue the Vyvanse but with some adjustments (timing, dosage, ect). The few weekends that we observed him with the Vyvanse were special weekends (bday/family visit, another one had some special activities which required me to be out of the house and my husband didn't give him meds until like 10/11 am and the last weekend we went camping and he got the stomach bug). I will follow up with his teacher to ask about WHEN she noticed his irritability and also follow up with his after-school staff to see if they had any specific observations about his behavior. He didn't get in any trouble over the past few weeks at all.

My older DS also has ADHD but is VERY different and ASD is strongly suspected (and being evaluated). He tried Guanfacine ER (did not help, increased aggression), and Vyvanse (on it for about 2.5 months and was much more aggressive and agitated), and then was put on Concerta ER and it's been really helpful (probably still needs to be adjusted).

[Anonymous]

Liquid Quillivant worked for our son at that age. He's 8 now with a super high metabolism so the combo that seems to work best for him is liquid Quillivant, Guanfacine and an afternoon booster of Ritalin. I will note it took about four weeks for the initial Guanfacine side effects (dizziness, sleepiness) to go away but we had been warned to give it about that amount of time for his body to adjust.