How can you tell if medication is working?

[Snow]

We started ds on adhd medication. This is his third day.

 

I'm wondering what things you saw that reassured you the medicine was working, and more specifically, that the child is at the right dose. I think I've noticed a few changes ... Obviously it's early on. But I wonder, is this it? A few small changes is good enough, no need to increase the dose?

 

Just looking forward, speculating and wondering about your experiences. It's early and we have an appt in a month to review officially with the doc.

[Storygirl]

Have you done any schoolwork yet (I ask because some people are still on their summer schedule)? The first thing that happened with my son is that he was able to sit down and complete his math. Previously just the idea of attempting it would throw him into a tailspin, so this was a BIG SIGN for us.  Some of the other affects were more subtle, but when he is off meds (he takes a second dose at lunch, which I have sometimes forgotten to give him), we can tell a big difference in his behavior, and that helps us see the effectiveness of the meds.

 

Generally, he is calmer (sometimes only slightly, other times a lot calmer than his normal), less argumentative, more willing to accept what I say without endless questioning, less angry and frustrated with siblings, more able to complete schoolwork without breaking down. Just easier to live with.

 

The meds do not take away all of his ADHD-ness but seem to make it possible for him to work on his behavior, whereas without them, he is unable to manage his behavior.

 

Because the medication does not make as big a difference in DS as it might in some kids, our ped has played with increasing his dosage and even switched him to a different med for a while. On the new one, he was super aggressive and argumentative. His behavior on the second medication seemed extreme to us, but when we really thought about it, he actually was just acting the way that he did all the time before meds. So back onto the original medication he went. The pediatrician put him back on at the lower dosage, because when he increases it, DS's anxiety picked up significantly. I do think the higher dosage works better, though, so I'm guessing at our next doctor visit he will have his dosage moved back up. We're working on some calming techniques for the anxiety, but DS might have to go on meds for that at some point as well (I think this is not uncommon).

 

He started on meds in April, and I'm not sure that we have the dosage correct yet, so it's not unusual for it to take some time to figure that out.

[Ottakee]

It also depends on the type of meds.  If it is a quick acting stimulant that is in and out of their system in 4-6 hours you will notice the changes right away.  Some meds take a few weeks to build up to the proper level in their system so might take longer to see the difference.

 

The test will be when doing school work, etc to see if you see a difference then.  Often the first dose is the lowest possible and it is very common to need to increase it over time to get the optimal effect.  It is always a balance of finding the best level of functioning with the fewest side effects.

[kbutton]

We are doing a trial of meds, and the doctor asked us to wait until we start school pretty much full-time so that we could have a really clear picture (he did give the script, just asked us not to use it yet).

[City Mouse]

With my DD it was very obvious in just a couple of days. She went from a kids who could not focus on anything but TV for more than a few minutes to building elaborate creations with Legos. Her anxiety lessened and she stopped arguing and fighting with other kids so much. The first time we sat down to do homework under the influence of the medicine was amazing. Stuff that used to take her hours was done in the minutes that it should have taken, and she no longer needed an adult sitting nright next to her the entire time.

[Snow]

Thanks everyone for sharing what you've seen!

 

Generally, he is calmer (sometimes only slightly, other times a lot calmer than his normal), less argumentative, more willing to accept what I say without endless questioning, less angry and frustrated with siblings, more able to complete schoolwork without breaking down. Just easier to live with.

 

The meds do not take away all of his ADHD-ness but seem to make it possible for him to work on his behavior, whereas without them, he is unable to manage his behavior.

 

 

This is similar to what we've seen in the last couple of days. We've only been doing light school so I have yet to see big changes there but we shall see what happens over the next few weeks.

[Snow]

We are doing a trial of meds, and the doctor asked us to wait until we start school pretty much full-time so that we could have a really clear picture (he did give the script, just asked us not to use it yet).

This is good advice. I think we will do our more typical stuff tomorrow and see what happens.

[PinkyandtheBrains.]

You know Billy from the Family Circus comics? Without meds my son takes the circuitous route for everything, usually forgetting what his goal was along the way. With meds he only makes a couple stops along the way.

 

He can get stuff done.

 

It was a pretty dramatic difference the first week if meds, then his body adjusted to them a bit and the effects were less striking but still very helpful.

 

He prefers being on the meds, it helps him do the things HE wants to do not just what we want him to do.

[swellmomma]

The shortest the boys shrink has waited for a change has been 3 weeks, but typically we go 3 months on a dose before it is adjusted.  That gives time for us to see if it works AND to determine if it is a dose that works for a bit but then doesn't any longer.  Typically it takes 2-3 weeks to really see if an adhd med is working at all.

ds10 for example, was on the lowest dose of the med he is currently on for 3 weeks then it was increased and we waited 3 months.  It makes a huge difference in his focus while learning but you could tell it was wearing off by about 2-3 pm after about 6 weeks on the med.  Today it was increased again, and we go back in 3 months to discuss how he was on it.  

I think the biggest mistake parents make about adhd meds is expecting too much too soon, and then thinking they aren't working at all and so they stop giving them thinking there is no point when really the kid just needed a longer trial and an increase. We had some improvement right off but not enough initially to think "this is it, we found something that works", however on the dose we just changed though he needed more to make it through the day, the difference was impressive.  So while little improvements can be seen in under a week, really give it a solid several weeks before determining if it is working or not.

[Snow]

The shortest the boys shrink has waited for a change has been 3 weeks, but typically we go 3 months on a dose before it is adjusted. That gives time for us to see if it works AND to determine if it is a dose that works for a bit but then doesn't any longer. Typically it takes 2-3 weeks to really see if an adhd med is working at all.

 

ds10 for example, was on the lowest dose of the med he is currently on for 3 weeks then it was increased and we waited 3 months. It makes a huge difference in his focus while learning but you could tell it was wearing off by about 2-3 pm after about 6 weeks on the med. Today it was increased again, and we go back in 3 months to discuss how he was on it.

 

I think the biggest mistake parents make about adhd meds is expecting too much too soon, and then thinking they aren't working at all and so they stop giving them thinking there is no point when really the kid just needed a longer trial and an increase. We had some improvement right off but not enough initially to think "this is it, we found something that works", however on the dose we just changed though he needed more to make it through the day, the difference was impressive. So while little improvements can be seen in under a week, really give it a solid several weeks before determining if it is working or not.

ITA and thanks for the advice. I've spent a lot of time on meds myself and am very familiar with what to expect and waiting. With ds we stupidly didn't ask about what positive results to expect - we only asked about negatives and side effects to watch for. After seeing a few changes already I'm surprised and was wondering what's a reasonable expectation. Thanks for sharing. Good to know that you still saw new results/changes after a few weeks.

[Ottakee]

To add to the mix, you have to realize that the meds might make him feel different.  It might make things more "normal" for him but it is still a different normal than he was used to.  Sorta like getting new glasses (esp. if the prescription is quite a bit different).  It takes time to adjust.

[geodob]

Something that you could do, is to write a daily diary and record today's observations?

Where it can be helpful to look back over your daily observations, as they develop.

 

[kbutton]

Something that you could do, is to write a daily diary and record today's observations?

Where it can be helpful to look back over your daily observations, as they develop.

 

Another boardie suggested I do this with my son in checklist form for general behavior. I am at a point where trying to do this in any open-ended fashion would cause me to obsess and be in overwhelm territory, so the checklist is a way of being more objective and not putting me over the edge.

 

I am thinking (at least for the ADHD stuff) to use the Vanderbilt survey but maybe add some sub-categories for behavior that is specific to our situation.

 

Thanks for starting this thread...it's going to be really helpful for the next few weeks.

[Snow]

Another boardie suggested I do this with my son in checklist form for general behavior. I am at a point where trying to do this in any open-ended fashion would cause me to obsess and be in overwhelm territory, so the checklist is a way of being more objective and not putting me over the edge.

 

I am thinking (at least for the ADHD stuff) to use the Vanderbilt survey but maybe add some sub-categories for behavior that is specific to our situation.

 

Thanks for starting this thread...it's going to be really helpful for the next few weeks.

Great ideas KB, ottakee and geodob. I'll have it look up the survey.

 

You know what's interesting is that the NP specifically said she didn't see much evidence of hyperactivity and I agree - he's never been particularly rowdy or wild. He avoids those kids, lol. But if I sad to sum up the overall effect so far, I'd describe it as calming. Now I'm thinking maybe he always was hyperactive but was presenting more like teenagers and adults (restlessness, angst). He's just sort of more relaxed overall. And content. He's played by himself a ton, been reading a ton (probably since he's been staying up until 11:-) ).

 

I have not seen an increase in focus or mental acuity. Yet.

 

All very interesting, really.

[Snow]

.

[Storygirl]

Our NP didn't see the hyperactivity in DS either, and our pediatrician never saw it in his behavior during our visits there, so it took some time to convince him that it was actually an issue. I think in DS's case, his anxiety combined with introversion makes him pull inward when he is interacting with people outside the family. He's always held himself together at Sunday school, gymnastics, etc., but at home, he lets it all hang out.

 

Also, some people do not have the hyper component but only inattention and/or impulsivity. What you say about how your son's hyperactivity presents itself in a way that is more internal makes sense to me, too.

[Snow]

I think in DS's case, his anxiety combined with introversion makes him pull inward when he is interacting with people outside the family. He's always held himself together at Sunday school, gymnastics, etc., but at home, he lets it all hang out.

 

Yes! That's exactly how my ds is. He's like a model child in outside situations :)

[Jennifer-72]

Our developmental ped made us go to ADHDratingscales.com and fill out a rating checklist once a month or so while we tried out medication. Not sure if you can do it if your doctor is not on the list.

 

Good luck! I hope the medication proves useful to him. Happy to hear the OT is going well! Zones is such an awesome program.

[Crimson Wife]

This is our 2nd day of Methylin (short-duration Ritalin). Yesterday I didn't notice any difference. This morning at soccer DD was noticeably calmer and more focused than she normally is. Kindergarten starts on Monday so we'll have to see how that goes.

[Storygirl]

:hurray:  Crimson Wife!

I hope it goes well on Monday!

 

 

[Targhee]

Responding when I said his name.

Going to do something after I asked.

Engaging more fully in conversation (like not walking out of the room in the middle of them).

Fewer noises (humming, whistling, drumming, beat boxing, yelling through the house)

Less hyperactivity (less often under the chair, on his head, pacing in place at his desk, jumping on other people, fidgeting, breaking things, etc)

Some improvement in inhibition (less grabbing, less interrupting, less getting up and leaving in the middle of things, etc)

 

The difference was monumental.

[Heathermomster]

Our Ped will not prescribe meds without a TOVA administered before and after taking meds.  She claims the TOVA will provide real, measurable results.  Does anyone have any experience with that?

[Storygirl]

I just looked up what the TOVA test is, because I'm not familiar with it. Our pediatrician uses the Quotient computer test, which may be similar. He likes to have some data that he considers objective, since the typical diagnostic questionnaires are more subjective. I have to say that before DS took the test the first time, I had a little worry that he would totally pass it and that our pediatrician would then discount our concerns. I shouldn't have worried about that. The test showed that DS's issues are severe. The pediatrician re-ran the test after beginning medication (I think DS has taken it three times so far) and compared the results to see if the meds were making a difference. I think the Quotient is an interesting and useful screening tool when used in combination with the traditional screening questionnaires.

 

Just so you will know if Quotient and TOVA are at all similar -- with the Quotient, you have a headband that logs your movement as you sit before a computer screen to do the test. The screen shows two kinds of stars, and you just hit a button whenever you see the right star come onto the screen. It takes 15 minutes. That's it. Sounds simple, but DS found it impossible to do. The Quotient generates a two page report with a bunch of graphs and statistics, etc., so it is interesting.

 

I do think there are probably other things that kids could have going on other than ADHD that could prevent them from being able to perform on this kind of test, which is why I consider it useful along with (but not in place of) Connors, etc. Our pediatrician, in contrast, considers it the best thing out there. I was glad that we also had a diagnosis the usual way via our psychologist to back up what the Quotient test showed. And I was glad to have the Quotient as evidence that the Connors screening was correct.

[kbutton]

Responding when I said his name.

Going to do something after I asked.

Engaging more fully in conversation (like not walking out of the room in the middle of them).

Fewer noises (humming, whistling, drumming, beat boxing, yelling through the house)

Less hyperactivity (less often under the chair, on his head, pacing in place at his desk, jumping on other people, fidgeting, breaking things, etc)

Some improvement in inhibition (less grabbing, less interrupting, less getting up and leaving in the middle of things, etc)

 

The difference was monumental.

 

Oh my word. If this happens in my house, I'll be ecstatic. That's awesome.

[Crimson Wife]

We got to my little one's K class about 12 minutes prior to pickup so I was able to observe her through the window. She was sitting quietly at her desk filling out her worksheet like a model student. Leaving aside the developmental inappropiateness of the task for a 5 y.o. (thank you Common Core!), I was very heartened to see that the Methylin appears to be helping her focus and remain calm.