Anonymous wrote:Op here. Ugh so were a few days in and I’m not really noticing any positives. If anything he seems more disregulated and impulsive?? Anyone have similar thoughts?

I’m planning to see a child psychiatrist to help us calibrate the meds but just wondering how long it really takes to know if this is the right medication. Thus far, I’m not feeling great about it and I expected to see more of a difference.

Oh, it takes a while. At least 4 weeks for us with our kid with multiple conditions.

Stimulants work - so if you arent seening a difference, OP, in the early few days, then you are not at the right dose. Titrate up.

Anonymous wrote:Op here. Ugh so were a few days in and I’m not really noticing any positives. If anything he seems more disregulated and impulsive?? Anyone have similar thoughts?

I’m planning to see a child psychiatrist to help us calibrate the meds but just wondering how long it really takes to know if this is the right medication. Thus far, I’m not feeling great about it and I expected to see more of a difference.

Yes, it’s likely interacting difficultly with his epilepsy meds. What is he taking? He will likely need a non stimulant. Try clonidine. And yes, different brains respond in non expected ways to meds. Ask your doctor about amantadine as an epilepsy med which is also sometimes used for adhd.

Op, are you absolutely positive that this is ADHD and not a side effect of one of his other conditions? I'm saying, are all his other conditions managed appropriately and possibly this ADHD is something separate?

Op here. Ugh so were a few days in and I’m not really noticing any positives. If anything he seems more disregulated and impulsive?? Anyone have similar thoughts?

I’m planning to see a child psychiatrist to help us calibrate the meds but just wondering how long it really takes to know if this is the right medication. Thus far, I’m not feeling great about it and I expected to see more of a difference.

Anonymous wrote:We started meds at 4, and just couldn’t get it right. They made him very weepy and rigid. We tried adding a non stimulant and that was far more helpful for impulsivity. But caused sleep issues. That was at 6. He is 11 now and we’ve just had limited success with meds. His issues seem deeper. He also has LDs and a lower IQ. So who knows. A different brain. The kids I know who do super well on meds don’t have those issues. I’d start a post re medicating my child with a lower iq/other issues.

I think op at some point said that her ds didn’t have low iq - that was something people on here were inferring because of her initial comment that he wasn’t gaining new skills appropriately. I think what she meant was that other kids were sitting down learning their abcs while her kid was running around a mile a minute, so he’s not working on the age appropriate skill development. That makes sense to me, and our ds’s hyperactive adhd prevented him from working on social skills development.

That said, I do agree with the overall point in the previous post that kids who present with such severe adhd at age 2/3/4 that they require medication are rarely clear cut cases, and often have other more complicated things going on. In our case, I don’t think the other stuff leads to an official diagnosis or anything. He’s just a really quickly kid with a quirky brain so the adderall solves a lot but leaves lots behind too. Im the pp whose ds is also on non stims and this is also part of my theory on why non stims should be a first line for these severe young kids. They clearly have a totally different adhd subset than your typical kid who starts getting bad grades in 4th grade because they can’t pay attention. So I’d argue that the large studies on adhd kids showing better success on stims than non stims - those studies have little to do with our severe adhd physical toddlers who need help. We tried all the stims and all the Non stims. He never had issues with any of the stims, but did have classic side effects with them all - and some wore off faster than others. That’s how we settled on concerta. And on the no stims, some made him weepy. Kapvay did not.

We started meds at 4, and just couldn’t get it right. They made him very weepy and rigid. We tried adding a non stimulant and that was far more helpful for impulsivity. But caused sleep issues. That was at 6. He is 11 now and we’ve just had limited success with meds. His issues seem deeper. He also has LDs and a lower IQ. So who knows. A different brain. The kids I know who do super well on meds don’t have those issues. I’d start a post re medicating my child with a lower iq/other issues.

Op another positive story (wish I’d seen your post earlier before all the jerks responded…. But we’re traveling for break).

Ds was different from other kids from birth. Extremely sensory and physical. Would literally go up to random kids at the playground when he was two and lush them over, hard, when they were playing totally separate from him - just because he had the need to exert physically. He had zero emotional disregulation. But was constantly putting his hands on other kids. He also ran nonstop and had unending energy. We couldn’t socialize with friends because of the danger to other kids. He was almost kicked out of a preschool, but we were moving cross country so avoided the official boot, second preschool in dc was extremely supportive but it broke my heart to see him being horrible to others. I had other parents say horrible things to us and him. When he was four.

We had a full dev ped review which diagnosed clear cut adhd sever hyperactivity. They recommended therapy and reading up on it. We read the books, but were already implementing everything we could at home (where he was actually manageable despite the hyperactivity). I called every therapist in dc, all of whom told me there was nothing to be done at this age but wait it out. Or medicate.

After one particularly horrible event at preschool, we asked his ped to start meds. He said four was young, but not when you had such clear cut adhd as shown by our top notch KKI diagnosis. We started and never looked back.

Ds has borderline asd too (but doesn’t qualify for a diagnosis) so while I’d like to say we’ve never had problems since, I can’t because he struggles majorly with social interactions even when heavily medicated. But we haven’t had any issues that threaten him being at school or anything. And nothing physical.

Our only regret looking back is that I think the dose of adderall he needs to function in school comes with a lot of side effects - standard ones like no appetite, trouble sleeping and dull personality - but they really suck. We would try reducing the dose, and immediately get calls from the teacher. In second grade we tried adding a non stimulant (kapvay) and that allowed us to reduce his stimulant and get rid of most of the side effects. I wish we’d tried the non stimulant from the beginning, because he went through three years of being a bit of a walking zombie before we got there. Unfortunately stimulants are the first line approach, and non stims are second line - but I have a long theory about why I think kids with severe early struggles with adhd are a different subset than what the studies are based on and that non stims should be first line (mostly because non stims don’t work on inattentive, and do make you sleepy - which is why it’s not a good option for most adhd kids, but is basically perfect for a behavioral four year old).

In any event, ds is 12, still on meds, and if we skipped meds a single day I guarantee we would get a call from school that he’d had a serious behavior issue. So whether we started at four or six, or twelve, ds needs meds to function around other people and could not participate in society without them. I suspect 200 years ago he would have been a kid kept home to work on a farm and just get in a ton of trouble. He’s extremely high iq, and struggles socially, so we would have been closing a lot of doors to him if we home schooled him (since he needs to practice social interactions and he needs the rigor of his gifted school).

So in short, yes, don’t pause - just do this and it will improve all of your lives so much. Mostly your ds. But do look into non stims and look out for over medication, and/or don’t take your doctors word that the side effects are standard and required.

Anonymous wrote:We started mine on Ritalin at 4, also a very very low does. A year later, he's finishing Kindergarten strong, and this year went better than we ever hoped - although DS does have and will continue to have challenges.

We have had some issues from the medicine - reduced appetite and some jaw pain. We don't medicate on the weekend or school holidays unless he has to go somewhere and we need him to be able to comply. We feed him anything and everything he'll eat from 4-8:30 pm every day to get the calories in. We also give magnesium and omega 3 - the Magnesium to help with the jaw cramps that come on after the dose in the morning. The omega-3 just helps with mood in general.

Our son is growing, happy, proud of himself, learning in school, and working on friendships.

I hope this helps your son!

For us - it was life changing, and I am glad we have a great doctor (psychiatrist) to help us. She sees him frequently and we pay out of pocket - no insurance - but it's worth it.

I have a friend who had the exact same experience. But he was a bright, on track academically and much more NT kid than mine. My son attends a SN school and he and most of his peers were medicated very early on and it makes a small but helpful difference for most of them. The thing is, if your kid has a low IQ, as noted upthread, or has LD or ASD, the meds don't work as well generally, and there is just less improvement because the baseline is so bad. That's just how it is.

Here:

https://pubmed.ncbi.nlm.nih.gov/32329315/

https://pubmed.ncbi.nlm.nih.gov/34657003/

https://link.springer.com/article/10.1007/s00431-011-1546-y

https://journals.lww.com/psychopharmacology/fulltext/2014/08000/bilateral_gynecomastia_in_a_preadolescent_boy.31.aspx

https://www.sciencedirect.com/science/article/abs/pii/S0924933817304248

good luck

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I'd be watchful for breast growth in boys (gynecomastia). A cousin has this who has been on ADHD meds since early elementary.

https://www.researchgate.net/publication/277654926_Methylphenidate_induced_gynecomastia_in_a_prepubertal_boy_A_case_report

Thanks. I wasn’t aware but after reading the article, sounds like only 2 cases ever on the medical literature, with many millions on this medication for a long period of time. We will watch closely but I can live with this risk.

My cousin is #3? Come on. This is not a 2 or 3 in a billion phenomenon. Psych meds and stimulants can cause gynnecomastia. This is well documented in medical literature.

The case number of 2 literally came from the article you posted.

Anonymous wrote:

Anonymous wrote:I'd be watchful for breast growth in boys (gynecomastia). A cousin has this who has been on ADHD meds since early elementary.

https://www.researchgate.net/publication/277654926_Methylphenidate_induced_gynecomastia_in_a_prepubertal_boy_A_case_report

Thanks. I wasn’t aware but after reading the article, sounds like only 2 cases ever on the medical literature, with many millions on this medication for a long period of time. We will watch closely but I can live with this risk.

My cousin is #3? Come on. This is not a 2 or 3 in a billion phenomenon. Psych meds and stimulants can cause gynnecomastia. This is well documented in medical literature.

Anonymous wrote:I'd be watchful for breast growth in boys (gynecomastia). A cousin has this who has been on ADHD meds since early elementary.

https://www.researchgate.net/publication/277654926_Methylphenidate_induced_gynecomastia_in_a_prepubertal_boy_A_case_report

Thanks. I wasn’t aware but after reading the article, sounds like only 2 cases ever on the medical literature, with many millions on this medication for a long period of time. We will watch closely but I can live with this risk.

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Anonymous wrote:OK, I can't read all of these responses because too many of them clearly just don't get the point you have reached. OP, I don't have experience with ritalin at 4, but I did medicate DS with an SSRI at 6. I totally get it. It made a massive difference. His tic disorder and anxiety were so severe that he couldn't function anymore. It made a world of difference. If it doesn't help significantly, the benefit of Ritalin is you can always pull him back off without too much trouble. People who's never received nonstop calls from schools and don't have this level of kid have trouble understanding how bad it can be.

FWIW, DS is 21, still on Zoloft, HFA with anxiety, panic, tics (though manageable with the meds), but is in college and basically takes care of his needs and is on track to have a job and maybe even some sort of social life!

Op here. Thank you! I love hearing stories with this kind of long term perspective. It is so reassuring to hear that stories like this do happen at least some of the time!

OP, that poster is talking about a 6 year old who is in school, in kindergarten or 1st grade. She has no experience with medicating a 4 year old who is not in school yet.

In two years, you and your DC will be in a totally different place. While your DC will still be immature for their age, they will have had 2 years of maturity and growth.

Op here. Ok. It’s still nice to hear about kids doing well in young adulthood after having challenges when younger. The fact that PP’s story doesn’t map perfectly to mine doesn’t change that it is still nice to hear.

Again, there’s tons of medical/school/home context I could provide on my situation but this isn’t really a thread where I’m looking to do a deep dive on my child’s full history. In part, because I’ve already had that conversation on this page before so I just don’t feel the need to revisit it. We have also already made the decision to try Ritalin, the medication is on the way, and so I’m not in the process of deciding. I came here to hear about other experiences with Ritalin at 4. It does seem relatively uncommon so I haven’t gotten a ton of replies that are responsive to my actual question, but a few of them have been helpful.

Op, it’s not worth anyones time to comment or share or advise when you keep insisting you are only revealing a sliver of information because that’s all we need to know to weigh in. That’s not how any of this works. The child is viewed and treated holistically. You are doing yourself a major disservice by thinking of treatment in these discrete chunks and you’d get much more helpful insights if you shared relevant information. There’s no way to know based on the lack of what you provided. It’s silly.

Op here. No one has to comment if they don’t feel it’s worth their time.

I agree that it’s important to understand my child holistically, which is why we just flew across the country to take DC to a super specialized clinic, where we spent multiple days with multiple providers. We saw 18 providers over the course of 4 days and every provider spent a lot of time with DC, and the unanimous recommendation of the team was to try stimulants. DC has a lot going on medically and multiple diagnoses. I think for kids who have less going on, it makes sense to get into all the details but for my DC it has never been helpful on this board because our experiences are just kind of unusual.

All I asked is if anyone had experience doing this, not whether posters recommend that I try it.

Anyway, first dose starts tomorrow, I’m excited to see how it goes.

I

You flew across the country for docs to prescribe a 4 year old methylphenidate (Ritalin) stimulants?

Many clinicians suggested our DC has ADHD. But we opted for a private school and tutor instead of stimulants. After doing years of OT, BT, ST, and PT. DC is doing pretty well. But it was work.

Op here. No, we didn’t fly across the country for docs to prescribe Ritalin. As explained, DC has multiple diagnoses and a lot going on medically.

We are also doing all the therapies. Thanks.

I'd be watchful for breast growth in boys (gynecomastia). A cousin has this who has been on ADHD meds since early elementary.

https://www.researchgate.net/publication/277654926_Methylphenidate_induced_gynecomastia_in_a_prepubertal_boy_A_case_report