Guanfacine ER and Lamictal are helping my 9 year old child. It’s an alternate form of Matthew’s protocol. Stimulants and SSRIs were activating and made things worse.

Anonymous wrote:

Anonymous wrote:I have a similar child. Something that jas worked out for us is a high intensity sport. Since DC started intense training his outbursts have practically dissappeared.
I am starting to notice them again with the summer schedule (less practice).
Is she into any sport?

Sports are not the answer this is absurd.

Sports and heavy exercise are one way to burn off the rage and anxiety. It's not a cure, but it might help along with everything else.

Anonymous wrote:We saw no improvement from talk therapy for our kid of similar age with tantrums. Kid could recite all the techniques when calm but couldn’t access them when upset. For us, it was a waste of time - parent training was way more effective.

Feel free to just drop the therapy until she is older or until meds are squared away.

I'm the therapist from above and I agree. I've had people reach out and after an intake I suggest they focus on OT or other therapies. Talk therapy is less effective for this profile than parent coaching or behavioral therapy. One more book I want to recommend if you haven't read it is this:

https://www.amazon.com/Breaking-Free-Child-Anxiety-Scientifically/dp/B08WHGHBLT/ref=sr_1_1?dib=eyJ2IjoiMSJ9.onbqeqjqAS4KHaKM7I6fBapXkUq-H2bKkgnTteKT-ZY66AKazW2XzHJfoBBmtzWbny_etUDo5RcZYzZBEb--WS1j8_SwW__vl7O6B5aJh_iysAeZL_YdNJMO8cFc_czT0qH_U7FfiF68_CkIJO2FUHLgwTTN_Jf_gStalZpWA54oTM-pkSm7cNyWLJhGqyGbV6TzEFrmDaoQunjbr4GrkSAT9_dNLEeyjWGtqn4CE8k.MnExJeUQLZoVbP1L74Kb-bA7NrkY9AuzwVIOydrpNJc&dib_tag=se&hvadid=694736298437&hvdev=c&hvexpln=67&hvlocphy=9033314&hvnetw=g&hvocijid=4474808236004241029--&hvqmt=b&hvrand=4474808236004241029&hvtargid=kwd-2272203907606&hydadcr=3711_13508536&keywords=breaking+free+child+anxiety+ocd&mcid=45d1b0f84c253545bee51d4974d3038f&qid=1750447257&sr=8-1

We saw no improvement from talk therapy for our kid of similar age with tantrums. Kid could recite all the techniques when calm but couldn’t access them when upset. For us, it was a waste of time - parent training was way more effective.

Feel free to just drop the therapy until she is older or until meds are squared away.

I'm a child therapist. The first thing I would suggest if I saw you was an OT eval. It sounds like she's in fight or flight all the time. She needs help regulating her nervous system. I actually agree with the PP who said sports. How does she react to loud noises?

I love these books, I would buy them and start here:

https://www.amazon.com/Understanding-Your-Childs-Sensory-Signals-ebook/dp/B015YEHU7M/ref=sr_1_1?crid=1VGRTYHUJR63F&dib=eyJ2IjoiMSJ9.9Nd7YU2CEOZqTjMaYSK8QBwm4PB3aOH_IO3dxnLLnOholT6JJKcc-23-G5PZaFI_Foq7_b3xs7yaCUZ925jzPzxPWaHIFn-rcWZg9r6_O1B0gf11duq9dtdn5SPJ7sXUgJJtDQAgv5riTJ2tEOowIJSGs9Y1_HgsRZSGiuBWG9G6nqdkMEo65_AdN8PyRZkyUDXhab4wS6d0ZCzxX26wM4SVVFMSL2go7TN5T7GcFmY.UeEzWoqTKa5z-zxTVPWvVJHpzhgnJT-xtqiDLAVWC4w&dib_tag=se&keywords=understanding+your+childs+sensory+signals&qid=1750446339&sprefix=understanding+your+child%2Caps%2C178&sr=8-1

https://www.amazon.com/Why-Kid-Doing-That-Understanding-ebook/dp/B0859MCXWB/ref=sr_1_1?crid=DTC2H6UXDDIJ&dib=eyJ2IjoiMSJ9.wVuLeC-1IlRLuF0ExFct7-B7rANcBmP7MRp3Llahj9k9eVi69u-T_G9VMUOzMRtKSlI7T-_lr6YwJkwQv3KShgLA4FDuVgpWpXsD6wEBq0tJpOeBrKYKkrY1UWjdpHrxZeIwSL2SDZUaYpKy5C9_xVfrVQ7o7a3ntK0gVDPVLUxa9uWXaKH71aGYj3oawiB6Zamw14N8wcRd5oHz6dhFIrP5UF0zZi_od692HscdsMg.7xJRySDZAPHj652RP8EysS9Qm1nHFGqRfx3neC2_FsE&dib_tag=se&keywords=why+is+my+child+doing+that&qid=1750446360&sprefix=why+is+my+child+doing+that%2Caps%2C186&sr=8-1

I believe you should ask for genetic blood testing to see which meds are likely to work best.

Have you had a thorough behavioral eval in the home? I’d start there.

Agree you could ask about Clonidine. My child takes that for AdHD with added benefit of helping some with sleep. Guanificine was not good for my child

You can ask for a consultation with other psychiatrists. Even though we stay with our current psychiatrist, we've seen a few other psychiatrists for second opinions which usually consist of 2-3 hours of parent session, child session, and another parent session.
Also, 12.5mg of Zoloft seems to be very very low to make any impact.

Guanfacine XR had a fast onset of improvement for us. I think for all of these meds any with bearable side effects need to be used for 2+ weeks to a month in order to see if they subside.

I believe any child psychiatrist would be willing to serve as a 2nd opinion. Unfortunately, there are often a lot of these threads so I would do a deep search on DCUM. Use different search words such as ODD or PDA or autism.

I was on Prozac and found it difficult to sleep - this is very common. I was given a sleep medicine for a month or two to help the adjustment. Eventually, my body adjusted and I could sleep without the sleep med (It may have been a benzo which I understand why a doctor might not prescribe that to a minor.) But I wonder why they didn’t try Clonidine in your DD’s case. My AuADHD child (with no behavior problems) but anxiety and sleeplessness was on it for a bit and found it helpful.

This sounds difficult for all of you. I hope you can find help soon.

I see my post was not clear. did not mean it as a replacement to medication, PP. Just as a complement once OP gets the medication right.

Anonymous wrote:I have a similar child. Something that jas worked out for us is a high intensity sport. Since DC started intense training his outbursts have practically dissappeared.
I am starting to notice them again with the summer schedule (less practice).
Is she into any sport?

Sports are not the answer this is absurd.

I have a similar child. Something that jas worked out for us is a high intensity sport. Since DC started intense training his outbursts have practically dissappeared.
I am starting to notice them again with the summer schedule (less practice).
Is she into any sport?

She's diagnosed with anxiety and has characteristics of adhd and autism per neuropsych but no diagnosis for those. She has dramatic rages that result in property destruction and make me worry for the safety of her siblings (since at least age 3). I could see an ODD diagnosis in her future. She's in therapy, and we've done several varieties of parent training. I think getting the meds right is the most critical issue right now. We're on our second psychiatrist -- and this one objected strongly to the medication the first had her on, saying it's not appropriate for children. Neither regime is working perfectly, though both options have worked better than nothing. Would another psychiatrist be willing to talk things through with me without her becoming a new patient?

I'll also crowd source in case any of you have thoughts. Here's what we've tried (over the course of 1.5 year):
1. very low dose Prozac -- made her extremely fidgety and unable to sleep
2. 12.5mg Zoloft -- also extremely fidgety and unable to sleep
3. low dose Remeron (mirtazapine) -- no side effects at all. symptoms improved but not resolved.
--swapped psychiatrists because we moved, new psychiatrist was absolutely opposed to mirtazapine use in children--
4. guanfacine 1mg --> 2mg -->1mg ER -->2mg ER over 2 months -- absolutely no improvement in symptoms. psychiatrist was adamant it takes time
5. guanfacine 2mg ER + 12.5 Zoloft -- immediate improvement with the addition of Zoloft, but child complained of nausea and dizziness with sports (guanfacine lowers blood pressure)
6. guanfacine 1mg ER + 12.5mg Zoloft + 10mg Hydroxyzine -- reduced guanfacine which resulted in a return of the Zoloft related fidgeting and insomnia. Added hydroxyzine to deal with insomnia.

So now we're at 3 medications, which child really resents and I don't love either, and while symptoms are better than before, they're not resolved and we can't increase the dosage. And I have to administer them at *exactly* the right time or sleep is impossible.

I'm looking for
-Do psychiatrist 2nd opinions exist?
-Any psychiatrist recommendations for this profile (for 2nd opinion or just general treatment)? Willing to go anywhere in the DMV area.
-Other medications that have worked for your child with a similar profile?
-Any exceptional therapists for similar children? The one she goes to is convenient but doesn't seem very experienced with kids at this level.