Medication for J

[Malika]

Glad my musings are helpful, Castle Queen The thing is, Strattera is supposed to be weight dependent with what the manufacturers call a "target dose" of 1.2 to 1.4 mg per kg of body weight (don't know how that translates into American pounds). J weighs about 27 kg, so at 18 mg he is technically under-dosed - but that seems to work for some people so you have to try it.

 

[HMBgal]

I'm following your process. While my grandson is on a different medication, I think the process we all go through is somewhat similar. We've been highly concerned about my grandson's eating and he's a wiry boy, always has been. I do think the medications have slowed his natural growth pattern, but he isn't unduly shorter than his same age peers at this point. We just really try to push high quality calories before the medications are on board and let him eat late snacks as desired. Lately, though, he's been a bottomless pit and is quite hungry. We are hoping that this is signaling a growth spurt. He's been steadily outgrowing his clothes at what seems like a normal rate to us, so I guess the upshot of this is that body will demand food when it really needs it, but we really had to pay attention to having good, nutrient and calorie dense foods in the house and when he's hungry, we let him eat. He doesn't eat much of his lunch at school, so we make sure to have good snacks after school. So, he's not always eating his meals with the rest of us, but we've let it go. He does need to stay at the table and visit for a bit and at least try and have some milk and a "bite to be polite," but we've decided this isn't the hill we want to die on.

And another thing that we've noticed, and it may help you or not, is that it seems to be two steps forward and one step back with behaviors, focus at school etc., but we have noticed a definite steady improvement over time (medications along with maturation, he's 7). It can sure be discouraging to have things going well and then have something happen that we all thought we were done with. It starts us wondering about medication change/vacation/doctor visit, and then poof, he's back on track. It ain't easy!

He has the most amazing teacher this year and we've all learned from her. She is a balm to the soul and watching her interact with our little guy and how she takes the time to honor his reactions, feelings, upsets, and talks him through it and helps him come up with ways to solve the dilemma of the moment (frustration over having to do math and shredding up the paper and creating a distracting disturbance, is one little example) is a beautiful thing to see. I wish he could keep her as a teacher forever. But, I guess he will in a way because we all remember those special teachers and we've carried them with us.

So, onward and upward, with the occasional back slide has been our experience.

 

[InsaneCdn]

I haven't seen appetite suppression effect from Strattera.
Another possibility is that he may be less on "overdrive", so may be burning fewer calories as he adjusts? In that case, just make sure what you serve him is high in both calories and food value, and it will probably work itself out.

 

[Malika]

As I write, J is doing his homework with the boy who comes to help him several times a week. I almost have tears in my eyes because it is frankly pretty well miraculous in terms of change. Whereas he would always start protesting and shouting if you ask him to read anything and then finally stutter a few hesitating syllables if you prompt him continually, he is now reading whole sentences on his own with a little prompting - and doing it eagerly and willingly. It seems extraordinary. Despite the obscene amounts of money amassed by big pharma, for this I am grateful.

As for the eating, it is confusing I know. Despite what you hear about Strattera not affecting appetite, I've read loads of testimonies from people saying it suppresses appetite - doubtless linked to the common side effect of nausea. J is so very picky when it comes to food that, alas, the vast majority of nutritious, high-quality foods he spurns. I've found a kind of little chocolate covered peanut cake in our local bakery that he likes so I'm feeding him lots of those...

Thanks for your words of encouragement, HMBgal. Two steps forwards and one back must feel frustrating but is certainly a movement in the right direction, as you say.

Ah well, life is not so magical, eh? J has now given up, asking to stop because he is tired - but this is after 25 minutes, not the usual 10...

 

[InsaneCdn]

Maybe you need to tackle the nausea separately...
Will he eat things with ginger in it? or take "ginger candy" (sometimes called travellers candy), which helps with nausea?
Nausea isn't the worst of side effects, and if home remedies and OTC remedies don't work, there are medications that help as well.

But... if I remember right, it took more than a few weeks for the nausea to drop for difficult child... so there is still hope.

 

[Malika]

This is not going to be straightforward. Today at lunchtime J was really hungry and ate a substantial, three-course lunch... he was also irritable and hit me several times in anger as well as giving me "the finger" when I said we didn't have time to call at his friend's before returning to school.
So nothing is ever going to be constant, then?

 

[InsaneCdn]

So nothing is ever going to be constant, then?

Yes, Malika. One thing is going to be constant: the inconsistency.
Trouble is... you don't know what impact the medications are having at that moment. Maybe it would have been worse... or not. We never really know.

 

[Malika]

I guess... it's odd, though - I would have thought inconsistency showed over weeks rather than days. Anyway, this evening J was again pleasant and co-operative. He had got so "difficult" in the past couple of months, constant battles at night about him coming in rather than staying out to play with his friends, that I can see it is going to be tough to accept if things go back to the way they were... At least I've read enough about Strattera to know that the effect often seems to peak and then decline.

 

[Liahona]

I am glad J is improving on the medication.

 

[Malika]

Thanks, Liahona. Well, I think J is "improving"... his attention seems better. Playing football this morning, he tried really hard, concentrated when he needed to and scored a goal (I felt absurdly proud). Then he worked well for about half an hour with the boy who comes to help him with his homework - I don't think this would have happened a few weeks ago.

But I begin to see that giving a child these medications is also a process of realising that there is NO magic pill and letting go of that illusion. After this good start, it all went downhill as he got irritable with his friend and then angry, lashing out at us both. Same old, same old, in other words. It all began with him getting upset because he fell down and his friend laughed at him - the sort of thing he has done with other kids. Of course I pointed that out, but the penny doesn't really drop.

 

[HMBgal]

I totally get what you're saying. But what we've seen is the longer attention span allows more time to learn the tools for self-regulation: that little bit of time to explain something, that moment in time when he uses those tools he's gained to have a situation turn out better than it usually does. It builds confidence in the child's feelings of self-mastery. At least that's what we've seen, but it has taken a while. But it feels good for us and the kiddos when we can catch that moment when they didn't revert to a problematic behavior and you can point it out and talk about how proud we all are, and then try to have them access how they feel. Such a journey!

 

[Liahona]

At least with my kids, with medications they take agonizingly small baby steps forwards. It takes a frustratingly long time for them to be taught social skills. Without medications they are going backwards. No magic pill.

 

[Malika]

Thanks, HMBgal and Liahona. I think J's problem is not with social skills per se but with self-regulation - this obviously has an impact on social relationships. For three days last week J was sweet, co-operative, helpful and a delight to be with. Then that all seemed to wear off and yesterday was pretty hellish - irritable, argumentative, gratutiously rude and offensive. And that was just me! No, I'm joking - it was J, but his extreme unpleasantness failed, as ever, to bring out the best in me.

Of course one part of me simply hates the idea, and reality, of putting these substances into a child's body. But I realise now how much more complex it is when a child grows up with ADHD (or whatever). If they are unmedicated, they could harm themselves seriously (not to mention others) anyway - I fear for J's impulsiveness around knives and lighters, for example... without the ability to focus and attend properly, life cannot really be lived properly.

 

[InsaneCdn]

J's problem is more executive function skills... rather than social skills. Skills that still need to be learned somehow, at least to a "socially acceptable level". Maturity is a factor, but only one factor. medications don't teach skills... but medications (when they work as intended) create an environment where skills can be (slowly) acquired.

 

[Malika]

Well, we are now four and a half weeks into the medication and the effects, such as they are, are subtle. J seemed to focus better at football (and revealed himself not a bad player), he remarked yesterday on the way from school to tae kwando: "I'm going to take my school overall off and leave it in the car so that I don't lose it at tae kwando." Such evidence of forward planning is very unusual for him. He kind of "crashed" last night around 7 pm and had a totally manic and high-speeed, high-volume game of cops and robbers with his friend in the house - obviously needed to run and run. He is now eating better, doesn't seem so tired in the day and is sleeping soundly all night long. So all that is good, but he is still very oppositional at times and the magical concentration powers of last week seem to have worn off. He is still not at what they call "target" dose - between 1.2 and 1.4 mg per kg of body weight - so I am sure the psychiatrist will up the dosage to 25mg when we see him next week.

 

[BusynMember]

No medication will solve his problems alone. They can do a lot of good or a little good, depending on the person, and help that person learn, usually in therapy, how to cope better and these skills that he is now able to focus on enough to learn can be invaluable. But anyone who expects medication alone to totally cure a learning/behavioral problem (not saying you do) will be disappointed. And, honestly, if somebody is overly agitated on a certain day due to life's normal stresses or just the moon not aligning right with the stars, you can be right back where you used to be and forget your coping skills and the medications can be less helpful when your body is amped up because of stress. Stress can interfere with how well the medication works.

medications saved my life. I know they did. I have been able to live a good, fulfilling life in spite of my neurological problems because of one anti-depressant and one tranquilizer. But I still need to remember coping skills and social skills more than other people (ok, well, MUCH more) and that requires ongoing therapy to give me a tune up. I think medications are great when they work, but I don't think they provide anybody who tends to have moodswings with a totally stable emotional constitution. Ya just have to sort of learn skills to bring you back when you get off kilter. And J., of course, is still very young for that. But that may be why he has a good half day then a worse half a day and a good few days then a bad day, etc. When he is older he will be able to learn lots of cool stressbusting tricks, emotional dysregulation tricks, and ways to calm his energy and anger.

Just food for thought. I'm glad the medication seems to be helping him somewhat.

 

[Malika]

I think what I fear about medications is their potential to add to the child's emotional chaos and distress. This is often one of the ironic side effects, isn't it?
So tonight J had a horrible rage that went on for about half an hour (much longer than usual). He was screaming hysterically, slamming doors, shouting abuse at me, etc. It is not totally manic because I still see that he exerts some self-control - he doesn't smash things or really hurt anyone. I find the anger so difficult, so difficult to keep feeling connected and loving towards him during it... I didn't do badly, managed to stay mostly calm until he dropped asleep on his bed, exhausted.
He was hungry and tired, the two big triggers. He had tae kwando and I tried to get him to eat afterwards but he was already all ramped up and refused. He is definitely less hyperactive in the day now and it seems to be leading to a big "crash" (just like with stimulants) when he becomes extra hyper and emotional, needing to run, etc, frantically.
I will of course speak to the psychiatrist about it, but this anger scares me. He's six but it's real rage and soon he will not be so sweet and innocent... I have also found a woman here who does cognitive behavioural therapy and has had some experience with ADHD kids. It may be an avenue.
I am scared at times like this. For him, for me.

 

[InsaneCdn]

Sometimes when we deal with one layer of issues, another layer is revealed.
The rage etc. may be any number of things, and medications reaction is only one option.
It's not easy parenting complex kids.

 

[Malika]

Oh, sure. I think that's absolutely right. The rage is there in J - the medications wearing off is just a catalyst for it.

 

[BusynMember]

I think your little guy has a lot of positives that could work to his advantage, especially when he is older and can understand how to reign himself in. I truly hope the medications help him be able to pause long enough to think about the alternatives to impulsive acting out. And maturity is your friend. J. is not totally wild and out of control all the time. I expect him to improve with time and understanding and you have certainly tried everything you can so far and I have no doubt you will keep on trying until something clicks, either because you hit on a good intervention or because he himself has a lightbulb moment. He is very young and smart and I believe he may be one of the children who mellows out as he understands himself more. You have been right on him all the time, teaching him appropriate behavior. I hope for the best for both you and sweet, cute little J. (ok, so I know he isn't always acting cute, but he does seem like he has a good heart). This good heart is very important. Many of the kids who seem unable to be helped lack remorse and empathy and seem almost heartless. But that is certainly NOT the case with J.