Medication for J

[Malika]

To be honest, SuZir, I don't know how much J realises he is "on medications". I've told him that the pill he takes in the morning is to help him concentrate better but he's never referred to it, never shown any awareness that it changes him in any way. I did ask him today specifically how he felt since he had taken the pill and he just said "good" rather vaguely. I don't think he really understands.

The medications have worn off by the evening and when I picked him up from school tonight he was his usual rumbunctious self - roaring songs out to the world at large as we walked home and racing ahead on his "rolling shoes", a birthday present. At the same time he was not tantruming or oppositional, and has not been in the evening for a few days, so that is a good sign.

I hate diagnosis by internet and yet... have to say your ex-little guy sounds so very ADHD, SuZir

 

[Rabbit]

Hang in there Milika ! Its a hard decision and a hard process. We will continue to pray for u! Hugs Rabbit

 

[SuZir]

Malika, heh, my not-so-little-any-more-guy certainly does have some ADHD traits, was (and is) quite hyperactive and was even at the brink of a diagnosis, but he is just too good at managing his focus when he wants to. Normally you would easily believe he has an ADHD (he often is either scatterbrain or over focused, or both at the same time) but if you bribe him well enough, he actually can have rather normal attention to things for periods of time. I do assume it takes more than most people to be 'normally attentive' because usually he does so only when there is something in on it for him. But for his doctors ADHD was inability to manage attention, not unwillingness to do so. But it was a close call and we did get some non-drug treatments they always try first for ADHD kids around here (life/skill coaching/therapy, Occupational Therapist (OT), some accommodations for school and things like that.) It was same with Asperger which he also has some traits from.

Good to hear yesterday was better. Of course one day, good or bad, doesn't really tell much, but hopefully the side effects would start to lessen again and he would get some help from these drugs.

 

[Malika]

This is curious, SuZir! I thought it was standard in (knowledgeable) descriptions of ADHD to talk about how it is not a problem, in reality, of attention deficit but of attention duration - except when the subject is of inherent interest to the child/adult sufferer. I've seen this thousands of times with J - when he wants to, he concentrates very well. Even at school (boring) he concentrated well, although according to his neuro-pscyh evaluation, his actual attention capacity is minimal, pretty disastrous. So it must have been something he was deciding to do... It's true that it was this ability to concentrate at times that prevented a couple of specialists giving him the label when he was smaller... but then over time, it became more and more obvious in other ways and the diagnosis is now beyond doubt, really.

So maybe your difficult child is an example of what can happen to unmedicated ADHD-ers... ie they CAN survive and get through (at a certain cost, as with everything).

Wasn't really good day/bad day... it's all about time of day. In the morning he seems fine, then at lunchtime he is flat, colourless and irritable (mind you he can be irritable when not on medications) and then perks up in the evening. Today is also following that pattern.

 

[SuZir]

Malika, with my help those periods he was able to sustain attention with outside motivation were quite long, even hours. Hyper focusing, even very long periods, to something one has internal motivation is quite typical for ADHD (and my difficult child certainly does that), but mine could, and can, turn on also quite normal level of attention without internal motivation for extended periods. He just doesn't seem to like it a lot. He is also able to multi task efficiently and was from early on able to follow even long and multiple tasks involving directions, if he wants to. As I said, I do assume it is bit taxing to him, because he isn't doing it all the time and still needs motivation to do so, but he can. And that was a reason his evaluation team didn't think he had an ADHD either when he was five or when he was re-evaluated just before he hit his teens. He was close to the line of diagnosis, but those things in his attention management and his over all functioning tipped the scale to other direction.

 

[Malika]

Okay, that's a lot clearer for me: I understand now You must have been, and be, puzzled as to what was going on with him?

J now gone off to tae kwando with his friend and his dad... in the afternoon, he was rude, aggressive, disrespectful, for no apparent reason. Of course that would be true before medications also, particularly when tired/hungry. Sigh.

 

[InsaneCdn]

medications don't solve the hungry/tired problem!

 

[Malika]

No, of course they don't - but my point is that they create it (at the moment). Strattera is making him tired and he will eat hardly anything during the day.

I have had an idea... I'm going to try giving it to him after lunch.

 

[InsaneCdn]

or make it worse, at least...
timing sometimes is everything, so it doesn't hurt to try the 'after lunch' approach

 

[Malika]

So the unpredictable response continues. Today, the 8th day on 25mg, J seemed barely less hyperactive and implusive than usual though he was fairly cheerful - until a certain point in the evening when he started getting nasty and aggressive with one of his friends and (accidentally)stabbed the other one in the eye with a stick. He is invited to a birthday party tomorrow and I confess i I have a certain amount of dread about it...

 

[Malika]

We started with the taking the medication at lunchtime experiment yesterday. Means he is eating a lot better at least. The birthday party in the afternoon yesterday was a bit hair-raising: J teamed up with a couple of boys his age and they created various unseen degrees of mayhem (mainly instigated by J) such as breaking a glass lantern and climbing up a high wall. Then he suddenly kind of "flopped", which was kind of handy as it was the moment to sit down and sing happy birthday, etc...

 

[Malika]

For those of you following this journal of Strattera use - and it could be useful to some, as I've found it useful reading other such journals on other forums - I have stopped the (short-lived) experiment of giving J the pill at lunchtime because both nights his sleep was interrupted and both nights he had bad dreams from which he woke crying (never happened before). I think this tells me giving the pill at night is probably a no-no.
I am now talking openly with J about the medication and what it does, and trying to get his feedback about what he feels. He seems to readily accept that it helps him at school and seems to make him "be more good" - wisely, he said the best thing would be to take a pill in the morning and a pill a lunchtime. But this I cannot do because of the cost factor - unless I can find a way to get it prescribed to me in the UK.

 

[Malika]

So it seems like life on Strattera could be a life of permanent Jekyll and Hyde. Today was a great day. School until 12 and then we had the afternoon together. He was amenable, co-operative, pleasant to be with - not flat and depressed but joyful and full of beans. Was eating okay. And then... around 5pm it all "crashed" and the hyperactivity and not-listening/being rude started. Day ended pretty horribly with him being verbally abusive - is that overstating the case when it's a 7 year old with ADHD? Whatever it is I hate this rude, insulting, disrespectful way of talking and wish I knew how to address it.

 

[HMBgal]

Mmmyeah, I know how this goes. My grandson had a weeping, crying melt-down today while doing his homework. It's work he knows how to do, but wanted to do it his way, which was incorrect, and when nicely pressed to please starting adding and subtracting the columns from the right (ones place, then move left), he was insistent on doing it his way, then promptly fell apart. His mom just spent some quiet, hugging, talking time with him and got a few things from him (his father is a total jerk, and they share custody. She's tried to change it but California doesn't give 100% custody unless the other parent is in jail or a child molester. I'm exaggerating, but not by much.) But, he didn't act out, wasn't rude, and removed himself from the room. It was heartbreaking. As for the sass, he gives his Mom a lot of sass, but not me or my husband. And I've heard this comes into full bloom starting at around age 8. Ooooh man. I have no patience for that, so we'll see.

I hope your evening tomorrow goes better. I don't know if J's school is full of holiday goings-on, but my students in my classes have pretty much universally been dysregulated hot messes. I'm ready for a break, and I'm sure they are, too.

 

[Malika]

Lol, there is not a single holiday going-on in J's school - we live in a Muslim country and Christmas is non-existent. A total no show! However, in the school where I occasionally teach English, with European kids, exactly the same strange phenomenon as you describe can be observed.

I'm sorry your grandson had that meltdown (and will doubtless have others). I think the day on medications is probably taxing to them, in unseen ways that get seen once they wear off... nothing is without cost. I am sympathetic to that... crying and weeping I can understand, I can handle. It is the rude, aggressive, defiant "meltdown" that I find so hard and so unacceptable. To be fair, last night was highly untypical in that J stayed up two hours beyond his bedtime to watch a special football match... Usually he is asleep by 9.

 

[Malika]

On Saturday/Sunday night, J had an hour or more less sleep than he usually does - obviously, a lot for him. The medications did not seem to work AT ALL on Sunday.

Has anyone else experienced this?

 

[BusynMember]

Malika, as one who has taken medications, I know they do not work as well every single day, which is why I also recommend therapy to get through the tough days that will still happen. If there is less sleep, if you feel unwell, if you are just in a "down" cycle (and most difficult children cycle in behavior and mood, even if they do not have bipolar), then the medications may not be as effective one day as the next. Medication is not 100% consistent. I have been on the same medications for twenty years or more and they saved my life. But I still have down days or weeks and up days or weeks. They are just not as extreme plus I have learned many coping mechanisms to help myself when the medications are not enough.
Straterra is like an antidepressant and it should not wear off at any time during the day. The level in your son's blood is there...it is what it is. It is not like a stimulant which wears off and may have a rebound effect. But even when the medication is at a good level, it is not enough to change anyone completely all by itself. That isn't a bad thing. It should mostly take the extremes away. But that isn't 100% either. It should be making things better and more stable for J. and, most of all, he should be able to pay attention more often.
Good luck!

 

[Malika]

As I have said before... I do NOT expect ADHD medications to work like some kind of magic pill, resolving all problems and ironing out all wrinkles!

When I said that the medications did not work at all yesterday, I mean that whereas, on Strattera, J is ALWAYS no longer hyperactive and generally calmer and more amenable (if less joyous and exuberant) for the time that the medication is working - yesterday he was hyper all day long.

I'm afraid Strattera is wearing off, exactly like a stimulant. He takes it at around 7.30 a.m. and around 4 or 5 pm, all the effects of non-hyperactivity, greater focus and reduced hyper-emotiveness have all disappeared.

 

[BusynMember]

Malika, maybe he is tired by then. A lot of people who are differently wired are brighter eyed and better in the morning after a good night's sleep. Don't give up and J. hasn't been on Straterra long enough to see him when he has the full effect. It does sound like he is often doing much better, especially in school.
As your bright and cute little guy gets older, he will understand coping skills and strategies for when he needs to supplement the medication with his own strategies.
I love this idea of a blog on his site. Apparently you are getting quite a following. I think it is a nice record for those who are thinking about medication, but uncertain. Maybe you should do another blog online too.

 

[InsaneCdn]

My guess, rather than the Strattera wearing off, is that the medication is only effective on certain specific "causes" of his outbursts, and not on others.