starting sdhd meds

[Anonymous]

DS was diagnosed last year (at age 12) with adhd, primarily inattentive with impulsivity and severe executive dysfunction. We just started his on medication - 20mg of generic methylphenidate. He has only taken it a couple of days but we have seen no positive changes, and on the other hand ds has had a lot of trouble falling asleep and staying asleep (he slept from 1am - 7am last night). He also seems a bit wired during the day, but I admit that is subtle. DS’s doctor had asked that we check in by phone after a couple of weeks, in person check in after one month, and if severe side effects are experienced to stop immediately. That all sounded logical in his office but now we are wondering what constitutes “severe” side effects. I’m not comfortable with how little sleep ds is getting and that can only hurt his focus. I also suspect that if there is to be a positive effect from the medicine, we would see it immediately since the medicine does not need to accumulate in the system to be effective.

I would appreciate any thoughts/advice on whether to stop the medicine or give it at least a week or two. Thank you!

[Anonymous]

Often it’s with school that you will see the positive effects. It takes a week or so to get used to the sleep issues. I would suggest that you work on a good sleep protocol.

[Anonymous]

How is his appetite? 20 mg is a relatively low dose. Wondering if it's a high enough dose to see an impact.

Kids on stims typically need a little less sleep to function. Your son will adjust somewhat. Make sure he is practicing good sleep hygiene, no screens 90 min before bed, good routine, etc. Melatonin can help.

These aren't severe side effects. Those include more aggression, intense emotions, stomach pains, etc.

This also may not be the right stimulant for your son. It a stinks, but there's a lot of trial and error when first starting meds. One piece of advice, keep really good notes so that you can compare/contrast down the road. Good luck!

[Anonymous]

Thank you from op (and apologies for all of my typos including in the title). This is very helpful feedback. DS has always practiced good sleep hygiene (a regular routine, no screens about 90 minutes before bed which, based on how much his phone “pings” from friends once it is docked in the kitchen at night, is very unusual for a 13year old!) but has always had trouble falling asleep. I am the same so I relate. Not falling asleep until 1am, even after taking melatonin, is extremely unusual for him, though - and waking up so early despite the late bedtime was unheard of for him. I will give this a little longer, at least a week or two, before checking in with the doctor. Thank you for the reassurance! I feel so uncertain about this whole process and I keep doubting myself with very decision.

[Anonymous]

Op again - his appetite seems basically unchanged so far but it has only been a few days and he has never been a big eater. I know that 20mg is on the low side but his doctor wanted to start low and work up, if needed, which made sense to us. Given the low dose, that is why the big negative sleep effect was so concerning to me because I can’t imagine increasing the dose and presumably making the sleep negative effect even worse.

[Anonymous]

If he continues to have trouble falling asleep, try giving more melatonin. Ask your doctor. We need 12 mg, which is more than recommended on most bottles, but our doctor said it was safe.

[Anonymous]

Anonymous wrote:Op again - his appetite seems basically unchanged so far but it has only been a few days and he has never been a big eater. I know that 20mg is on the low side but his doctor wanted to start low and work up, if needed, which made sense to us. Given the low dose, that is why the big negative sleep effect was so concerning to me because I can’t imagine increasing the dose and presumably making the sleep negative effect even worse.

My son is 13 and has been taking meds since he was 8. He is also tiny and he started out at 20mg. 20mg is very low. If his appetite isn't impacted, it is probably too low of a dose. My son's doctor said once his appetite goes away, you are probably at the right dosage. Make sure he takes it early in the morning so it won't affect his sleep as much. My son has never been able to fall asleep because of the ADHD. He would always talk (and sing when he was little) to himself for an hour or more before quieting down. Ask the doctor if he can take a dose of melatonin to help with sleep. Once schools starts, my son is tired out by school and sports so falling asleep isn't as big of a deal.