11 year old DD has OCD/anxiety - where to go from here?

[Anonymous]

Interesting. My anxious/OCD kid had bouts of dysregulation when anxiety was not well controlled but with the onset of puberty, it has gone to a whole new level. We recently added a mood stabilizer and are starting to see some relief.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Two of my kids have ADHD/anxiety. The oldest was diagnosed before K. He started on Prozac in 3rd grade through an NIH study on CBT. We'd done a lot of CBT prior to the study but DS was never able to access the techniques when he was in an anxious state - and he could go from fine to crisis in 0 flat. That part of the brain that regulated fear/anxiety was hyper-reactive and the medication helped rein it in. His anxiety didn't go away completely but medication allowed him to control it rather than it control him.

My younger DS didn't start an SSRI until he was in 6th grade. His anxiety manifested a bit differently than older DSs and it took me longer to recognize how much of an impact it was having on him. Once he got to a therpeutic level, it was so much better.

My only regret with both of them is that I didn't start them sooner. They're now in HS/MS and I can easily imagine the road they'd take if we'd not treated their anxiety with medication. They can utilize their CBT tools but it just isn't enough.

PP, I have a child with the same diagnoses. Are your kids still on an SSRI? And are they medicated for the ADHD? My son was on an SSRI for two years (life-changing) but we stopped when we left stressful public school. I haven't tried a stimulant yet. Or rather we did a quick painful train a few years ago and I am wondering if we should try again.

I'm the PP. Yes, they're both still on an SSRI (year round) as well as ADHD medications (during the school year and as needed). We've tried both stimulant and non-stimulant medications for the ADHD. My oldest first tried a stimulant medication in 2nd grade but didn't do well and we switched to a non-stimulant which seemed to have no benefit so we discontinued until 6th grade when his psychiatrist suggested it to help with the emotional dysregulation exacerbated by puberty. We also had him try a stimulant medication and he did really, really well with it - very different response than in 2nd grade. Glad we gave it another try. My kids go to FCPS schools and I wouldn't call them 'high pressure' at all. The stress they experience is no different than at any other school any where else.

FWIW - we participate in longitudinal ADHD research at NIH. The researchers have been fabulous and we've had some great conversations about medication - they don't push it but are 'fluent' in the research.

Thank you, PP, for the details. When I say "stressful" I really mean for him. He has his own particular sets of personality traits, characteristics, and issues--his miserable experience was not the school's fault at all. But getting him out was a huge positive for him--it was like he stopped holding his breath and was able to be a child again.

Re meds: we have a child psychiatrist who is pretty responsive, but I sometimes feel like I am at a store and she is willing to give us what we ask for. (I don't mean this in a bad way, like she is over-prescribing. My son's challenges are severe and well-documented and it is kind of amazing we have gotten this far with so little medication.) What I mean by that is that she doesn't give as much expert guidance as I would like. She sort of lays out the options and leaves it up to me. I am kind of wondering if we are going through the same puberty emotional dysregulation and questioning whether we should switch to one one of the non-stimulants or, like in your experience, add something different. (And again, of course, I am discussing this at length with the psych but I am looking for experiences.) Thank you!

15:46 again. I know exactly what you mean about having to understand your options and make a choice. IME, which medication to use and at what dose is really dependent upon what's going on in the environments, how your kid metabolizes the medication and, of course, how your kid's symptoms manifest. You've got to learn about medications and not rely only on the doctor's judgment. It can be hard, even for a parent, to know how much of a certain behavior in a particular environment is the result of one disorder over another or a horrible mixture of the two. And, it's not just for medication purposes you have to tease this out but for appropriate discipline/response to those behaviors. It's hard for me as a parent and I can imagine the difficulty a service provider that doesn't know my kid like I do has. I suspect your provider believes you have a good understanding of your DS's challenges and can make an informed choice about medication - so, as frustrating as this can be, it's really a compliment to your capability!

My oldest currently takes a stimulant and SSRI in the morning and a non-stimulant (guanfacine) in the afternoon. Other than making sure he eats something before taking the stimulant medication, we've seen no negative side effects. The guanfacine's impact was most noticeable in middle school when the emotional dysregulation was notable. It didn't get rid of it but it sure brought it down. HTH

[Anonymous]

I have two boys with anxiety. One also has OCD features. For the OCD one, Lexapro is really effective. For the other (who also has ADHD) Zoloft and not overdoing stimulant medication works. Lexapro activated him and caused him to self harm. Both are SSRIs.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Two of my kids have ADHD/anxiety. The oldest was diagnosed before K. He started on Prozac in 3rd grade through an NIH study on CBT. We'd done a lot of CBT prior to the study but DS was never able to access the techniques when he was in an anxious state - and he could go from fine to crisis in 0 flat. That part of the brain that regulated fear/anxiety was hyper-reactive and the medication helped rein it in. His anxiety didn't go away completely but medication allowed him to control it rather than it control him.

My younger DS didn't start an SSRI until he was in 6th grade. His anxiety manifested a bit differently than older DSs and it took me longer to recognize how much of an impact it was having on him. Once he got to a therpeutic level, it was so much better.

My only regret with both of them is that I didn't start them sooner. They're now in HS/MS and I can easily imagine the road they'd take if we'd not treated their anxiety with medication. They can utilize their CBT tools but it just isn't enough.

PP, I have a child with the same diagnoses. Are your kids still on an SSRI? And are they medicated for the ADHD? My son was on an SSRI for two years (life-changing) but we stopped when we left stressful public school. I haven't tried a stimulant yet. Or rather we did a quick painful train a few years ago and I am wondering if we should try again.

I'm the PP. Yes, they're both still on an SSRI (year round) as well as ADHD medications (during the school year and as needed). We've tried both stimulant and non-stimulant medications for the ADHD. My oldest first tried a stimulant medication in 2nd grade but didn't do well and we switched to a non-stimulant which seemed to have no benefit so we discontinued until 6th grade when his psychiatrist suggested it to help with the emotional dysregulation exacerbated by puberty. We also had him try a stimulant medication and he did really, really well with it - very different response than in 2nd grade. Glad we gave it another try. My kids go to FCPS schools and I wouldn't call them 'high pressure' at all. The stress they experience is no different than at any other school any where else.

FWIW - we participate in longitudinal ADHD research at NIH. The researchers have been fabulous and we've had some great conversations about medication - they don't push it but are 'fluent' in the research.

Thank you, PP, for the details. When I say "stressful" I really mean for him. He has his own particular sets of personality traits, characteristics, and issues--his miserable experience was not the school's fault at all. But getting him out was a huge positive for him--it was like he stopped holding his breath and was able to be a child again.

Re meds: we have a child psychiatrist who is pretty responsive, but I sometimes feel like I am at a store and she is willing to give us what we ask for. (I don't mean this in a bad way, like she is over-prescribing. My son's challenges are severe and well-documented and it is kind of amazing we have gotten this far with so little medication.) What I mean by that is that she doesn't give as much expert guidance as I would like. She sort of lays out the options and leaves it up to me. I am kind of wondering if we are going through the same puberty emotional dysregulation and questioning whether we should switch to one one of the non-stimulants or, like in your experience, add something different. (And again, of course, I am discussing this at length with the psych but I am looking for experiences.) Thank you!

15:46 again. I know exactly what you mean about having to understand your options and make a choice. IME, which medication to use and at what dose is really dependent upon what's going on in the environments, how your kid metabolizes the medication and, of course, how your kid's symptoms manifest. You've got to learn about medications and not rely only on the doctor's judgment. It can be hard, even for a parent, to know how much of a certain behavior in a particular environment is the result of one disorder over another or a horrible mixture of the two. And, it's not just for medication purposes you have to tease this out but for appropriate discipline/response to those behaviors. It's hard for me as a parent and I can imagine the difficulty a service provider that doesn't know my kid like I do has. I suspect your provider believes you have a good understanding of your DS's challenges and can make an informed choice about medication - so, as frustrating as this can be, it's really a compliment to your capability!

My oldest currently takes a stimulant and SSRI in the morning and a non-stimulant (guanfacine) in the afternoon. Other than making sure he eats something before taking the stimulant medication, we've seen no negative side effects. The guanfacine's impact was most noticeable in middle school when the emotional dysregulation was notable. It didn't get rid of it but it sure brought it down. HTH

Thanks for all your thoughts!