ADHD Med Tolerance

[nature girl]

We started DD7 on stimulants at the end of June last year. We did trials of 3 different meds before settling on Concerta last October, which works perfectly for her with no side effects.

 

Last month, after 5 months on Concerta, we realized that the dose was no longer as effective as it needed to be, so increased her dose from 27mg to 36mg. Since she developed a tolerance so quickly, I'm now terrified that she'll need to continue upping the dose, and I'm already worried about the dose we're giving her now.

 

I've looked everywhere for information on whether giving med holidays reduces tolerance, and haven't been able to find studies (other than one that's in progress.) I have her signed up for 5 weeks of half-day camp this summer, which she'd never survive without meds, but I'm wondering if it would make a difference if we did that long summer med holiday through the other weeks. It would be miserable for all of us, she's so much more of a joy, and happier herself when she's able to control herself, but it would be worth it if it meant not having to increase the dose again anytime soon.

 

Realizing this can only give anecdotal evidence...Those of you whose kids are on stimulants, how often have you had to increase the dose? Do they take med holidays? Have you heard evidence that med holidays can reduce tolerance? Her doctor says it probably doesn't make a difference, but I'm not 100% confident in his expertise. I also wonder if alternating between methylphenidate and methamphetamine might make a difference. (She was on Vyvanse for awhile, and it worked well but had a harder come-down in the evenings.)

 

Thoughts?

 

[kbutton]

My son has needed a bump in meds for growth spurts, and then the dosage plateaus. He still has more dosage options within the med he's currently taking.

 

There are kids on multiple ADHD meds, but we've not had to go there. 

 

We've been doing meds for nearly three years.

[Butter]

My son's doctor, anecdotally, has noted less tolerance development in her patients if they have med holidays, but it usually is enough to just skip a day (for example, my kid gets his medicine - he's on Adderall - Sunday through Friday and has off Saturday).  We had to up Adrian's dose after four or five months.  He probably just grew in that time or the original dose really wasn't quite enough.  He's been on the same dose for around 9 months now and it's still absolutely perfect for him.  We expect to go up next time he has a growth spurt.

[Butter]

My son's doctor, anecdotally, has noted less tolerance development in her patients if they have med holidays, but it usually is enough to just skip a day (for example, my kid gets his medicine - he's on Adderall - Sunday through Friday and has off Saturday).  We had to up Adrian's dose after four or five months.  He probably just grew in that time or the original dose really wasn't quite enough.  He's been on the same dose for around 9 months now and it's still absolutely perfect for him.  We expect to go up next time he has a growth spurt.

[Targhee]

My kids rarely have med holidays - we give them meds because of the toll their behavior has on relationships and social interactions mostly, and that is a constant thing. However, we recently switched one from Concerta to STraterra and found it (so far, 3 months in) to be much better for her.

 

Something of note, some things, like anxiety for example, can present like ADHD. So if you see behaviors coming back it may not be the underlying ADHD but an overmasking anxiety. This was the issue with DS who at times would have spikes in ADHD behaviors even though meds had not changed. We only recently discovered with him it is anxiety, so we are addressing that now as well, and slowly but certainly his ADHD behaviors are reducing.

Edited April 22, 2017 by Targhee

[nature girl]

Thank you all for your input.

 

 

My son has needed a bump in meds for growth spurts, and then the dosage plateaus. He still has more dosage options within the med he's currently taking.

 

There are kids on multiple ADHD meds, but we've not had to go there. 

 

We've been doing meds for nearly three years.

 

 

I've been told (and read) that growth spurts shouldn't affect dosage, but maybe it's only that weight in general doesn't impact dosage, but in the same kid as they grow they'll need a higher dosage? Can I ask how long the dosage plateaud for? My concern is that DD was only on the first dose of Concerta for 5 months. Since then she's gained maybe a pound, not much...

 

 

My kids rarely have med holidays - we give them meds because of the toll their behavior has on relationships and social interactions mostly, and that is a constant thing. However, we recently switched one from Concerta to STraterra and found it (so far, 3 months in) to be much better for her.

Something of note, some things, like anxiety for example, can present like ADHD. So if you see behaviors coming back it may not be the underlying ADHD but an overmasking anxiety. This was the issue with DS who at times would have spikes in ADHD behaviors even though meds had not changed. We only recently discovered with him it is anxiety, so we are addressing that now as well, and slowly but certainly his ADHD behaviors are reducing.

 

 

That's interesting...I haven't seen anxiety in DD for a very long time, though, and even when she seemed a tad anxious a couple of years ago, it was quite mild and only for things like fear of monsters in the dark, and getting upset if we didn't follow our usual bedtime ritual. None of it was debilitating. We started Suntheanine a little over a year ago, and those issues cleared up almost immediately. I haven't seen them at all since then. Since upping her dose, she's in the same place she was in the first weeks of her last Concerta dose, calm, she behaves and attends well. (Before we switched to this dose she was just being more defiant and silly at school.)

 

 

My son's doctor, anecdotally, has noted less tolerance development in her patients if they have med holidays, but it usually is enough to just skip a day (for example, my kid gets his medicine - he's on Adderall - Sunday through Friday and has off Saturday).  We had to up Adrian's dose after four or five months.  He probably just grew in that time or the original dose really wasn't quite enough.  He's been on the same dose for around 9 months now and it's still absolutely perfect for him.  We expect to go up next time he has a growth spurt.

 

 

That's interesting, thank you! We were taking weekends off for awhile, but they were hard for all (worse than they were before starting meds) so we stopped. I think we can handle one day a week though, especially now that the weather's nicer we can spend most of that day outside.

[kbutton]

I've been told (and read) that growth spurts shouldn't affect dosage, but maybe it's only that weight in general doesn't impact dosage, but in the same kid as they grow they'll need a higher dosage? Can I ask how long the dosage plateaud for? My concern is that DD was only on the first dose of Concerta for 5 months. Since then she's gained maybe a pound, not much...

 

Well, we bumped from short-acting to a Concerta XR generic, and the original dose had him doing well in the afternoon but not early in the day. I think we did that for just a month of two, and then we bumped to a higher dose. He started on a very low dose for Concerta. He's been on the higher dose for months now and doing fine. I can't remember what he's on, but he has room to go up quite a bit before maxing it out.

 

As for growth spurt, he went from around 75-80%ile in height to 97%ile in height in a few months, and he's just not stopped! Maybe it wasn't growth-related, but he changed enormously in the last year and we haven't seen an end in sight. Normally, he grows very predictably each year during a certain 5 or 6 months of the year. Now it's just constant growth (and eating).