A medication WWYD

[jenn-]

Long story short, William underwent some testing that declared him ADHD free, but with severe processing issues.  Although he passed the TOVA (the ADD test), he did show his squirminess to both the tester and the doctor.  He suggested giving him a baby dose of a stimulant to see if it helps with that and the processing speed issue.  He forwarded the results to our pediatrician and I had our follow up there this morning.

 

We have only used this pediatrician since April, so we do not have a long standing history to go from.  He is fairly certain that we will not see the results with the stimulant, but was willing to do a trial on them since that's what the clinical psych suggested.  He talked up a suspension formula that we would be able to manipulate down to the half mL if necessary.  He made it sound like he had prescribed this and seen great results.  He handed me a pamphlet with a discount card attached to it, which threw up red flags in my mind.  They only give those out for expensive things.  Sure enough the drug is a tier 3 drug on our insurance which means a $60 copay (with the card it will only be $20).  Even more concerning though, this formulation has only been around since April.  It is an old medication (the base drug is the same as Ritalin by the research), but a new way to suspend it or something. 

 

Should I worry about giving my child something that is so new?  Should I call and see if I can get the generic Ritalin in a suspended formula and do the same thing so it costs less?  As we homeschool, I am not overly concerned about the extended release formula (which mind you he didn't mention this was).  Should I just skip trying the meds since the pedi doesn't think they will help and implement some of the changes to curriculum he suggested (I LOVE having a homeschooling pedi)?  Right now I am leaning towards the last one, but I don't know if I can handle the hours of staring and accomplishing nothing we have dealt with since the beginning.

[jelbe5]

My son has autism and takes meds. While my dh and I are very conservative regarding meds we are not opposed to them. Having worked as a psychiatric social worker I have seen the wonderful things the right meds have done for many.

 

On that note, you have great options. You might want to try the suggestions your terrific doctor has suggested. Next, I would consider the older medication. Newer may be better at times, but it also sometimes means "less tested". It will also save you $. You can always give the new med a try if you see no change with the older medication. We have avoided newer meds for our son for this reason.

 

Also, when I was pregnant with my children, my doctor kept me on older asthma meds since they had been around for quite a while and had been used successfully in pregnancy. I had to keep my asthma under control, but the newer asthma meds had not been tested that much in pregnant women. This is just another example as to why sometimes it might be better to use older meds which have been around for a while . . . because they have been used for a longer period of time, the medical community simply had more information.

[AK_Mom4]

I would probably trot down and talk to our pharmacist.  She is usually up to date on how the new drug formulations work and can let you know about potential side effects and such.

[SKL]

Can you ask the doctor the questions about the drug that you listed above?  They sound like very reasonable questions.

Personally if I was told to try a "mild stimulant," I would ask why a little coffee or tea would not serve the purpose.

[LostSurprise]

Make a list of questions and take it down to your pharmacist. From that information, go back to your doctor or clinical psychologist (I couldn't tell from your post if you see a CP or whether your ped. got advice from one) and discuss your concerns before going on the medication. 

 

Definitely ask about other possible stimulants if you're not comfortable about this. The doctor doesn't seem sold on this either, so you shouldn't jump in quickly. 

 

You can ask the pharmacist how new this really is (a new way to suspend a drug is rarely considered a new drug). Why this particular suspension? What does it do? Is it more accessible to the body? Less? Time-release? Slow-release? Does it make it more palatable to children? Can other stimulants be suspended the same way? Why the price hike? Why on 3rd tier for insurance? Is there another way to get the same thing? 

 

Pharmacists are usually very helpful for this kind of thing, without the money out for another appointment. 

 

Once you have some answers you can call your doctor's nurse and tell her you have a few questions about the prescribed medication. She can usually take some of them down and have the doctor call you. If its a lot of information they may ask you to make an appointment. 

[Tap]

Go with the p-docs suggestions, not the pediatrician.  

 

I work in pharmacy, have a husband and son with add and a daughter with multiple mental health issues.  I have researched more than necessary, watched my own familes reactions to meds, and pay attention to the way my patients have reacted to certain meds.

 

 

I would go with the shorter acting because you have more control over when you give the meds and can see what happens when the meds are not in his system more clearly.  

 

Processing speed is related to, but not the same as ADD/ADHD.  The P-doc is looking for specific results from a specific med.  Switching meds may not give you the information you need or want.  

 

Really the only way to know what meds will make the difference for each person is to try them.  And just be aware that it can often take a trial of a few meds to find one that works for different people. 

 

I would always try the shortest acting, cheapest med first and then work up from there if that doesn't work.  The nice thing about the shortest acting meds, is that you can target certain times of day with the meds.  Every med has side effects, and long acting meds can have long acting side effects.  Sometimes, people can tolerate the side effects for short periods of time better than an all day side effect.  

 

 

DS18 takes methyphenidate short acting sometimes and long acting sometimes.  If he has a full day of studying or exams he will use the long acting. Otherwise, he uses the short acting to target his study hours.  IF he takes the long acting, and then doesn't need to study for the full time it affects him, he struggles with his brain trying to do too many things at once.  He can't even play a video game while on long acting because his brain is trying to hyper focus on 20 things, instead of just the one or two he wants to focus on.  LOL      With the short acting, he can always take a booster dose if he finds he needs to study longer than he thought.

 

 

For dh, He finds that the long acting makes his heart race, but the short acting doesn't affect him as much.   He too, will only take it if he really needs to. If he is on a time crunch at work and has to get something done no matter what, he will take it.  If he can deal with his distractablity and just spend an extra hour working for the day, he won't take it.  He would rather struggle a little in every day, than deal with the side effects.  

[jenn-]

Go with the p-docs suggestions, not the pediatrician.  

 

I work in pharmacy, have a husband and son with add and a daughter with multiple mental health issues.  I have researched more than necessary, watched my own familes reactions to meds, and pay attention to the way my patients have reacted to certain meds.

 

 

I would go with the shorter acting because you have more control over when you give the meds and can see what happens when the meds are not in his system more clearly.  

 

Processing speed is related to, but not the same as ADD/ADHD.  The P-doc is looking for specific results from a specific med.  Switching meds may not give you the information you need or want.  

 

Really the only way to know what meds will make the difference for each person is to try them.  And just be aware that it can often take a trial of a few meds to find one that works for different people. 

 

I would always try the shortest acting, cheapest med first and then work up from there if that doesn't work.  The nice thing about the shortest acting meds, is that you can target certain times of day with the meds.  Every med has side effects, and long acting meds can have long acting side effects.  Sometimes, people can tolerate the side effects for short periods of time better than an all day side effect.  

 

 

DS18 takes methyphenidate short acting sometimes and long acting sometimes.  If he has a full day of studying or exams he will use the long acting. Otherwise, he uses the short acting to target his study hours.  IF he takes the long acting, and then doesn't need to study for the full time it affects him, he struggles with his brain trying to do too many things at once.  He can't even play a video game while on long acting because his brain is trying to hyper focus on 20 things, instead of just the one or two he wants to focus on.  LOL      With the short acting, he can always take a booster dose if he finds he needs to study longer than he thought.

 

 

For dh, He finds that the long acting makes his heart race, but the short acting doesn't affect him as much.   He too, will only take it if he really needs to. If he is on a time crunch at work and has to get something done no matter what, he will take it.  If he can deal with his distractablity and just spend an extra hour working for the day, he won't take it.  He would rather struggle a little in every day, than deal with the side effects.  

 

The P-doc did not suggest a specific medication in his report, just the drug classification.  Methyphenidate HCI sold under the brand name as Quillivant XR is the medication the pedi wrote the prescription for.  My DH feels as though he prescribed it because a drug rep had a good sales pitch.

 

[Tap]

The P-doc did not suggest a specific medication in his report, just the drug classification.  Methyphenidate HCI sold under the brand name as Quillivant XR is the medication the pedi wrote the prescription for.  My DH feels as though he prescribed it because a drug rep had a good sales pitch.

 

Oh, gosh. I misread a line in your post and thought the Pdoc suggested Ritalin and the pediatrician was suggesting the xr form.  

 

Sorry, just misunderstood.

[kroe1]

No, I would not give my kiddos amphetamines under any circumstances, especially not for squirminess. It is frightening to think that we are expected to treat squirmy kiddos with a pill. I work in an ER so I see what happens to the adults who were on daily amphetamines as children.

 

My own DD with "squirminess" and ADHD I treat with rollerblades, chairs with wheels, and rapidly rotating subjects, bright colored curriculum, etc. I am not anti-meds, but very much anti--amphetamines. I do not know of any med that is approved for squirminess.

[City Mouse]

The liquid version Ritalin is not that new. I remember considering it for my DD just as Datrana patch came out. At that time the liquid version was not time release, but that may have changed.

 

I actually like that your ped is suggesting the liquid so that the dosage can be fine tuned specifically for your child's needs. When using a pill form, you are limited by the dosage available.

 

That being said, the many horror stories that I have heard regarding Ritalin side effects were usually kids that were improperly diagnosed and medicated.

 

I would probably give it a try for 1 month since it was recommended. If you don't like the results you could stop.

[jenn-]

The liquid version Ritalin is not that new. I remember considering it for my DD just as Datrana patch came out. At that time the liquid version was not time release, but that may have changed.

 

I actually like that your ped is suggesting the liquid so that the dosage can be fine tuned specifically for your child's needs. When using a pill form, you are limited by the dosage available.

 

That being said, the many horror stories that I have heard regarding Ritalin side effects were usually kids that were improperly diagnosed and medicated.

 

I would probably give it a try for 1 month since it was recommended. If you don't like the results you could stop.

 

I am going to try and get the original version.  I do not like the time release idea.  DD takes a non time released version of Adderrall and it is what I prefer.  If she is done her work before lunch, she just doesn't take her second dose.  William cannot afford to lose weight and he is already a light eater.  A 12 hr med will probably mess with his food intake too much.

 

 

[MomatHWTK]

I don't think I would give a stimulant for that reason alone.  I guess it would depend on the circumstances and what else I had tried.   

 

We are using a non-stimulant ADHD medication.  DS does take other medications as well.  But they all have side effects, so I strive for the lowest possible dosages of the least side effect laden medicaitons.  Sometimes something stronger is necessary to get us on track, but then I work with the doctor and trial and error to get us to the minimum. 

 

Personally, for a true processing issue, I can't see medication helping- I've not heard of it doing so.  If the movement was impairing the existing processing, then maybe.  Does your other child have any processing issues so that you can compare? 

[jenn-]

I don't think I would give a stimulant for that reason alone.  I guess it would depend on the circumstances and what else I had tried.   

 

We are using a non-stimulant ADHD medication.  DS does take other medications as well.  But they all have side effects, so I strive for the lowest possible dosages of the least side effect laden medicaitons.  Sometimes something stronger is necessary to get us on track, but then I work with the doctor and trial and error to get us to the minimum. 

 

Personally, for a true processing issue, I can't see medication helping- I've not heard of it doing so.  If the movement was impairing the existing processing, then maybe.  Does your other child have any processing issues so that you can compare? 

 

The squirming is really not a big issue for me.  The inability to focus long enough to formulate an answer and then get it written down is a problem.  He passed the TOVA which is the ADHD test, but he loves computers and can focus on them for hours if I let him (30-45 minutes is all he gets after school is done though).  I'm not sure watching a computer screen and hitting a button is a good indication for this child.  Could what appears to be a focus issue completely be the processing issue?  Possibly.  If I don't see a response to the medicine, I will stop.  I started our homeschooling journey nearly 6 years ago because I didn't want to medicate my oldest child.  I am not quick to go this route.

 

The pedi agrees that we probably won't get the results we want with the drug, but he was willing to let us try it for a month and then we will go back in and discuss the results.  William's other testing (WJ-III and WISC-IV) clearly show a processing speed issue.  I don't have any other child with processing issues that I know of (the youngest is still too early to tell).

 

[AngieW in Texas]

For my oldest, we started off with short-acting, but she is on time-release now. She did better with the time-release action of Concerta rather than the time release action of Rital LA.

[WishboneDawn]

No, I would not give my kiddos amphetamines under any circumstances, especially not for squirminess. It is frightening to think that we are expected to treat squirmy kiddos with a pill. I work in an ER so I see what happens to the adults who were on daily amphetamines as children.

 

.

I'm not questioning your experience but I'm always leery of advice framed like that. It's like a teacher I was talked to who was against homeschooling because he'd had some very unimpressive former home schoolers in his class.

 

I pointed out that he was only seeing a very biased slice of homeschooling and that small sub group might have been in his class because homeschooling want a good fit for the family. But he didn't get to see the large group of home schoolers for whom it works well because they simply didn't need to be in his classroom.

 

It's similar with you. Working in an ER you are going to see the worst cases in all kinds of scenarios rather then the much larger and complete picture.

[WishboneDawn]

I've even heard that something simple like coffee can help in mild cases.

When you're dealing with low doses the med probably isn't much riskier then the coffee but it has the advantage of tracking very specific doses.

[jenn-]

When you're dealing with low doses the med probably isn't much riskier then the coffee but it has the advantage of tracking very specific doses.

 

Not to mention, getting a 9 yo to drink coffee requires an insane amount of sugar and cream.

[kroe1]

Here's just a quick article. Seeing one of these people, and knowing childhood drugs induced these effects, will scare anyone from using amphetamines in his kiddos. I will agree, however, that I see the worst of the worst in an ER.

 

http://emedicine.medscape.com/article/289973-overview

 

 

 

 

 

 

I'm not questioning your experience but I'm always leery of advice framed like that. It's like a teacher I was talked to who was against homeschooling because he'd had some very unimpressive former home schoolers in his class.

 

I pointed out that he was only seeing a very biased slice of homeschooling and that small sub group might have been in his class because homeschooling want a good fit for the family. But he didn't get to see the large group of home schoolers for whom it works well because they simply didn't need to be in his classroom.

 

It's similar with you. Working in an ER you are going to see the worst cases in all kinds of scenarios rather then the much larger and complete picture.

[SKL]

Not to mention, getting a 9 yo to drink coffee requires an insane amount of sugar and cream.

 

Not necessarily.  My kids have always loved to drink my coffee.  I make instant with 2/3 water and 1/3 skim milk.  No added sugar.  It's not that hard to develop the habit; the caffeine helps with that.  :)

 

As for the previous comment that it's not as easy to measure coffee, I would still try it first.  To me, giving a child a chemical that has to be prescribed is risky business.  The whole "right dose," "right medicine" thing would make me very nervous.  Plus it's very expensive, especially when you look at it over a long term.