"Double" medication or not?

[Anonymous]

My DS is in 5th grade and is being treated by a psychiatrist for anxiety with a low-dose of generic Prozac. He has had anxiety ever since kindergarten, but it was beginning to be debilitating the higher the grade and there is a family history, so we started medicating in November. He is thankfully improving.

Complicating matters is that we, and the psych, are fairly certain he has ADD-inattentive as well. Psych wanted to tease out the anxiety problem first, as it seems to be the largest problem at the moment, and treating for ADD can make anxiety worse. We are slowly and incrementally increasing the Prozac until he seems to reach the sweet spot. It looks like a fairly low dose will do the job.

In the meantime, his public school, which has always been very supportive, is giving us a lot of nudging that his focus issues need something more now – despite the fact that he gets A's and B's and is never getting in trouble at school. I had been told by friends that have gone through this that medication for ADD can be a long and difficult road and to only go after it if his was not able to function in school well. He is struggling a little with all the academic expectations, but he is still fairly organized and is playing in band and doing some other things he wants to do and still managing it all. He has a social life as well. Yes, I would love for him to be able to focus more (he daydreams a lot), but I'm also worried about muddying the waters as we get a hold on the anxiety problem. I feel like the teachers want to make it easier for them to teach him, not necessarily that he needs it. He already has an IEP with supports.

Do we really want to attempt medicating for BOTH anxiety and ADD if it's really mostly the anxiety that is debilitating right now?

[Anonymous]

Take the minimal medication route. His brain is still developing.

[Anonymous]

My child takes both an ssri for anxiety and ADHD meds, so it's certainly possible. But I agree that you only want to add a medication if it's necessary. Have you asked the school in what ways his lack of focus is causing problems?

[Anonymous]

My kiddo definitely needs medication for both ADHD and anxiety/depression--and even then, the classroom is the site of a lot of struggles with attention and emotion.

I will report that getting the right combo took an awfully long time--and there were stretches when the (wrong) ADHD meds exacerbated anxiety and depression.

My suggestion would be to file the teachers' suggestions for now, but explore the issue with your prescriber (a psychiatrist?). And I would also have ongoing discussions with your child. How does he feel about his classroom performance? If HE feels like he's falling behind, or troubled by the way school demands for focus and attention seem to outpace what he can give, that's when meds should come under serious consideration. That may well happen later in middle school--when the academic demands typically ramp up.

[Anonymous]

The psychiatrist is correct. Mood stabilization comes first. Manage the anxiety--that's often a big part of ADHD.

You can't prevent a kid from day dreaming. It doesn't sound like you, the psychiatrist, or the teachers have a handle on what symptoms of ADHD he needs to manage. ADHD meds do not automatically mean higher grades. It may mean behavioral, organizational, or social supports.

You're hyper-focused on grades and "doing better" but you don't even know what that would look like.

[Anonymous]

OP. Sometimes my DS will comment on his lack of focus and issues it may have caused during the day, but it sounds to me like he might be parroting a lot of what his teachers are telling him, as opposed to him being troubled by it.

I have directly talked to his teachers many times about the attention issues. I have a positive relationship with our IEP team. We have adjusted his accommodations, I help him write lists to stay organized, he has a buddy he can call at home if he forgot the homework, I have his resource spec ed teacher check his assignment book before he comes home to make sure he wrote down important info, etc.

He is in the advanced math group and his teacher for that (who happens to be his homeroom teacher) has fewer complaints. It's his reading/social studies teacher, because he has weakness in reading and writing, and so he is less inclined to pay attention in her class. I get the feeling she is tired of constantly redirecting him to pay attention – most of the students will start up doing something and he will still be sitting there staring out the window. She is really pushing the "he needs to be doing a lot more independently before middle school," but when I pushed, I found out through multiple sources that a lot of the kids in 5th – and in that class – are struggling to adapt to all the new expectations.

I really want to stay the course on the SSRI for now just to see how much of the anxiety we can get rid of and then see what the results are. My oldest was screened for ADHD two years ago in middle school because she could not focus during lectures. Turned out all the tests for ADHD were negative, but her anxiety was off-the-charts. She's doing a million times better now with an SSRI herself, very low-dose.

[Anonymous]

My son's psychiatrist felt as though it was important to treat both and even though anxiety was the greater problem, the ADHD had to be addressed first. However, the doctor avoided stimulant medication for the ADHD. I'm not convinced I agree but he's been medicated for both for a year and doing well, so I guess it's a good plan for my son.

[Anonymous]

I would go with the doctor's recommendation. Every case is different. My DC's ADHD was the priority over anxiety and OCD leanings, but his medication for ADHD also helps the others too. He is on a non-stimulant ADHD medication.

[Anonymous]

I'm just going down this road myself. It seems my son's anxiety is caused by ADD. He feels he can never do what he needs to do, and therefore gets anxious about it. We are starting mess for ADHD first. But I know every situation is different.

Trying a drug doesn't mean it's a permanent part of your kid's life. Perhaps go with the doctors recommendation and see what happens for six months? Then reevaluate.

[Anonymous]

Anonymous wrote:I would go with the doctor's recommendation. Every case is different. My DC's ADHD was the priority over anxiety and OCD leanings, but his medication for ADHD also helps the others too. He is on a non-stimulant ADHD medication.

I agree ^. I have one kid whose ADHD is greatly exacerbated by anxiety and when that is under control, it is much easier to manage his ADHD (with meds still). I have another kid whose anxiety is mostly caused by ADHD effects. In both kids, we treated the primary problem first and once we found an effective dose we looked at the symptoms that were still interfering with daily life and then treated the other.

[Anonymous]

One more thought...how about if you get a tutor for reading? If he did better at it there may be more focus and less daydreaming...

[Anonymous]

It's a cautious crowd here today, but here's a counterargument. Why not give it a try and see? Unlike the SSRI, the stimulant ADHD medications don't need to build up in your body over a long period. They work (or not) almost immediately, and then are gone from the body by the end of the day. It's a pretty low-investment experiment. A lot of people find these drugs life-changing. For some the side effects (including increased anxiety) outweigh the benefits. But you can just stop taking it at any time.

[Anonymous]

OP - Better to follow the advice of our son's psychiatrist with whom you have an on-going relationship rather than the input from an anonymous board. Also, as you describe things, your son is doing well in school with As and Bs. Even if he slipped to a C, it would be better to follow the advice of the doctor and keep as you have been in close touch with the teachers. It seems to be that the reading/social studies teacher could work with you and DS to have an accommodation that when there is a transition activity perhaps "a buddy" could give DS a quick cue to get onto the next task if she is so busy or bothered by perhaps having to redirect him.

[Anonymous]

If your kid had diabetes AND strep, would you only medicate for one?