Best way to do an Adderall XR trial for 6yo with ADHD

[Anonymous]

My 6 yo has bad crashes at the end of the day and our psychiatrist suggested seeing if Adderall XR would be better than Ritalin ER. She suggested transitioning on, 5 mg at a time for a few days, until we reach a dose that we are happy with - then to see if we like Adderall or Ritalin better.

This is all great except that HOLY SH*T this morning has been absolute hell. We started with 5 mg and my husband finally looked at me and was like, give her another pill. He is normally the biggest rule follower ever so I was blown away that he would ever go for that much less suggest it. That gives you some idea of how awful this has been. I did give her another, but we are all still really struggling. I feel like an idiot because I was not mentally prepared for this. I mean it's obvious that this was going to happen, but I didn't really think it through.

Does anyone have tips or best practices for doing this?

[Anonymous]

I don’t understand. What is your daughter doing on the adderall that prompts your husband to want to give her more? Like it’s not working at all?

[Anonymous]

Anonymous wrote:I don’t understand. What is your daughter doing on the adderall that prompts your husband to want to give her more? Like it’s not working at all?

Oh, and my son has these crashes on concerta. We are going to reduce the dose for school. But another option is a very small dose of an immediate release stimulant in the afternoons to prevent the crash.

[Anonymous]

Are you using a generic? Giant recently changes their supplier and I did not think the new generic supplier worked. It’s incredibly frustrating. We just switched to cvs.

[Anonymous]

Was there any improvement after adding the second dose?

[Anonymous]

No great advice except sympathy, as we have been there. I was the OP of the other thread asking about stimulant withdrawal, because we dropped our son's adderall from 15 to 10mg a couple weeks ago, and the first few days without the full dose were *way* worse than he was before starting meds. He settled after a few days (into a hyperactive kid - but not dangerous hyperactive like he was on the first few days). Point being is that your son is probably so bad not just because he's not getting as much stimulant as he needs to thrive, but *also* because his body is going into crash/withdrawal/rebound because it's not getting the stimulant that it's used to. This totally sucks. I'm always surprised that there is not more discussion out there about how to transition from one drug to another. Everyone on this site and other sites is always talking about how they had to try like 6 different meds, at different doses, before they found one that worked. And i'm thinking: every time we try a new med, we effectively can't send our son to school or he would get suspended. How are these people doing it? And i jealously wonder why they are even subjecting their kid to adhd meds at all, to the extent their kid *can* get by at school without. The only reason we started stimulants is because DS literally cannot be in a school setting without them.

[Anonymous]

Anonymous wrote:No great advice except sympathy, as we have been there. I was the OP of the other thread asking about stimulant withdrawal, because we dropped our son's adderall from 15 to 10mg a couple weeks ago, and the first few days without the full dose were *way* worse than he was before starting meds. He settled after a few days (into a hyperactive kid - but not dangerous hyperactive like he was on the first few days). Point being is that your son is probably so bad not just because he's not getting as much stimulant as he needs to thrive, but *also* because his body is going into crash/withdrawal/rebound because it's not getting the stimulant that it's used to. This totally sucks. I'm always surprised that there is not more discussion out there about how to transition from one drug to another. Everyone on this site and other sites is always talking about how they had to try like 6 different meds, at different doses, before they found one that worked. And i'm thinking: every time we try a new med, we effectively can't send our son to school or he would get suspended. How are these people doing it? And i jealously wonder why they are even subjecting their kid to adhd meds at all, to the extent their kid *can* get by at school without. The only reason we started stimulants is because DS literally cannot be in a school setting without them.

It took us a long, difficult year to get the medication right. Fortunately the school worked with us. We started new medications on weekends or breaks so we had a few days to look for side effects. We always told the school when we made the changes so they could monitor for any changes up or down. We asked them to call immediately if there were negative behaviors. Because we were able to work with the school and were upfront with all information, suspensions never came up. Also, having a behavior plan helped. But my kid did spend a lot of time sitting in the office and had to come home early a few times.

[Anonymous]

Anonymous wrote:

Anonymous wrote:No great advice except sympathy, as we have been there. I was the OP of the other thread asking about stimulant withdrawal, because we dropped our son's adderall from 15 to 10mg a couple weeks ago, and the first few days without the full dose were *way* worse than he was before starting meds. He settled after a few days (into a hyperactive kid - but not dangerous hyperactive like he was on the first few days). Point being is that your son is probably so bad not just because he's not getting as much stimulant as he needs to thrive, but *also* because his body is going into crash/withdrawal/rebound because it's not getting the stimulant that it's used to. This totally sucks. I'm always surprised that there is not more discussion out there about how to transition from one drug to another. Everyone on this site and other sites is always talking about how they had to try like 6 different meds, at different doses, before they found one that worked. And i'm thinking: every time we try a new med, we effectively can't send our son to school or he would get suspended. How are these people doing it? And i jealously wonder why they are even subjecting their kid to adhd meds at all, to the extent their kid *can* get by at school without. The only reason we started stimulants is because DS literally cannot be in a school setting without them.

It took us a long, difficult year to get the medication right. Fortunately the school worked with us. We started new medications on weekends or breaks so we had a few days to look for side effects. We always told the school when we made the changes so they could monitor for any changes up or down. We asked them to call immediately if there were negative behaviors. Because we were able to work with the school and were upfront with all information, suspensions never came up. Also, having a behavior plan helped. But my kid did spend a lot of time sitting in the office and had to come home early a few times.

I'm the person you were responding to. Of course we also work with the school. I have always had amazing relationships with my son's teachers. I consistently get the feedback that they wonder why all parents can't be as proactive and involved and caring as me. That said, if we have to change to a different med type, there is zero chance my son can go to school the next week. Of course we start on weekends. It's not about side effects. It's about the requirement that you start slow and work up -- PLUS, as i said above, your kid is going to have major withdrawal symptoms from not having the full dose of another stimulant in their body. In our experience, for the first 5 days following starting a new stimulant, DS's behavior will be TWICE as bad as it was before ever starting meds. It is literally impossible to send him to school on a starting dose of, say, ritalin, when 3 days ago he was on a full dose of Concerta. Ask me how i know this? Because every time we've tried, he has to come home within an hour or so. The times we tried on a non-starter dose of the med (so, converted over from, say, full dose concerta to starting ritalin at a comparable dose), we ended up with scary side effects that also made school a non-starter. So don't act like OP should just "work with the school" and start on the weekend, and this solves the problem.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:No great advice except sympathy, as we have been there. I was the OP of the other thread asking about stimulant withdrawal, because we dropped our son's adderall from 15 to 10mg a couple weeks ago, and the first few days without the full dose were *way* worse than he was before starting meds. He settled after a few days (into a hyperactive kid - but not dangerous hyperactive like he was on the first few days). Point being is that your son is probably so bad not just because he's not getting as much stimulant as he needs to thrive, but *also* because his body is going into crash/withdrawal/rebound because it's not getting the stimulant that it's used to. This totally sucks. I'm always surprised that there is not more discussion out there about how to transition from one drug to another. Everyone on this site and other sites is always talking about how they had to try like 6 different meds, at different doses, before they found one that worked. And i'm thinking: every time we try a new med, we effectively can't send our son to school or he would get suspended. How are these people doing it? And i jealously wonder why they are even subjecting their kid to adhd meds at all, to the extent their kid *can* get by at school without. The only reason we started stimulants is because DS literally cannot be in a school setting without them.

It took us a long, difficult year to get the medication right. Fortunately the school worked with us. We started new medications on weekends or breaks so we had a few days to look for side effects. We always told the school when we made the changes so they could monitor for any changes up or down. We asked them to call immediately if there were negative behaviors. Because we were able to work with the school and were upfront with all information, suspensions never came up. Also, having a behavior plan helped. But my kid did spend a lot of time sitting in the office and had to come home early a few times.

I'm the person you were responding to. Of course we also work with the school. I have always had amazing relationships with my son's teachers. I consistently get the feedback that they wonder why all parents can't be as proactive and involved and caring as me. That said, if we have to change to a different med type, there is zero chance my son can go to school the next week. Of course we start on weekends. It's not about side effects. It's about the requirement that you start slow and work up -- PLUS, as i said above, your kid is going to have major withdrawal symptoms from not having the full dose of another stimulant in their body. In our experience, for the first 5 days following starting a new stimulant, DS's behavior will be TWICE as bad as it was before ever starting meds. It is literally impossible to send him to school on a starting dose of, say, ritalin, when 3 days ago he was on a full dose of Concerta. Ask me how i know this? Because every time we've tried, he has to come home within an hour or so. The times we tried on a non-starter dose of the med (so, converted over from, say, full dose concerta to starting ritalin at a comparable dose), we ended up with scary side effects that also made school a non-starter. So don't act like OP should just "work with the school" and start on the weekend, and this solves the problem.

Get off your high horse. Our kids are not so different. I never said it was easy. I just said that's how we did it. YMMV.

[Anonymous]

We started medication with Adderall XR 5mg, and...nothing. No observable positive change. 10mg was the sweet spot for us. It gets DC through the day, but starts to wear off around dinner time and then we see a loss of focus. We only have major crashes in the late evenings when DC is over-tired.

[Anonymous]

Has anyone tried piratall instead of adderall for their child?

[Anonymous]

Follow up here from OP. So that first day that I posted, we increased to 10 after my husband told me to give her the additional 5 mg pill. She was better on 10 than on 5 but not as good as she was on 20 mg ritalin XR.

So the next day, we decided to give her 15. I feel horrible and like a bad mother even typing this. Liek some of the PP's above said, it was just so horrible for our whole family to not have her properly medicated.

We did notice that there was not much of a rebound effect at the end of the day on 10, but I didn't know if that was just because she wasn't medicated enough to even have a rebound.

So yesterday we gave her 15 and omg. She was a different kid. Better than she had ever been on the ritalin. All day long, we literally could not believe how good she was being. It wasn't like a drugged "zero personality" state either, she was just a much better version of herself. I was hearing the angels sing and thinking about how this was going to be life changing, and then something happened at bed time.

I put her to bed at 8 and I am not clear as to whether she fell asleep or not (or was maybe half asleep)? but it any case she was silent until about 11 or 12. She ended up complainign that she could not sleep and wanted one of us to go in there, and proceeded to flip out for over an hour until I finally agreed to leave her light on at 1 am so that she could read, because I had to go to sleep for work today. She was up at 6:30 and refused to stay quiet or in her room, when she is not normally allowed out of her room until 7:30.

So I feel like we are robbing Peter to pay Paul, she was great yesterday but god only knows what is going to happen today when she got half the amount of sleep she normally does. And my husband and I are zombies.

Any thoughts on this? DOes this mean the 15 mg is too high? Or is it our irresponsible parenting with not being slow enough to build to that?

[Anonymous]

OP, ask your dr about giving her melatonin to help her settle down in the evenings, at least while you all work through the dose changes.

[Anonymous]

Anonymous wrote:OP, ask your dr about giving her melatonin to help her settle down in the evenings, at least while you all work through the dose changes.

+1