Video discussing risks and lack of long-term benefits in using ADHD meds

[PeterPan]

Do you vaccinate your kids?  The risks of adverse reactions are pretty high with that.  I mean, we all choose to do things that have risk.  You may have accepted risk on some things and not others.

 

Your story about the boy going to bpd after ritalin still leaves a lot of things unanswered.  Was he already having symptoms (what they're calling prodromal)?  Was he actually on the spectrum?  I mean, that mix of labels is walking right up to an ASD diagnosis.  What is the comorbidity rate on ASD and BPD?  I mean, let's be honest, lithium is IN the generic good for you take this mix being marketed to ASD.  

 

Even to say someone is "severely adhd" is really non-specific.  He had severe SPD symptoms?  And were they controlled by dramatic amounts of OT?  He was highly impulsive?  He was severely inattentive?  Because my ds' ADHD diagnosis is a disputed, funky kind of thing.  On the one hand, they had to STRAP HIM DOWN to do speech therapy on him.  On the other hand, he can sit for 45 minutes and do something.  Sometimes his inattention tests really high, other times his inattention tests as totally normal.  The ONLY thing that is consistent on him is rocket high impulsivity and the SPD symptoms.  So to me, for someone just to say the child had severe ADHD and took meds and now they're bpd, that's really still pretty non-specific.  I'd like to be more precise and have that discussion, just so I can *understand* what the person is saying was really going on.

 

I think we get a lot of communication gaps online.  People assume severe or label to one person means the same to the next.  They might have a really strong picture in their mind, but they might be *imprecise* about conveying it.  And it's not just semantics.  We've had people on the boards with insurance coverage that gets them 3 hours of OT a week AND tons of other services.  And contrast that with the 15 minutes a week of OT my ds would get if he were in the ps with his IEP.  I mean, think about that.  That would have RADICALLY different outcomes with the same child.  Our ps said if they moved over to a certain label, they'd bump up to sensory breaks after every 15-20 minutes of school work.  Ok, my ds does not look ADHD if you do that when you think of ADHD in the vernacular.  What's really going on is his dysregulation is so severe (because of the SPD/ASD) that the stress of ANY school work is dysregulating.  So for him, just 5 minutes of sensory work (push-ups, hand stands, whatever) can be reorganizing.  That's not his ADHD, in the sense that he could have kept right on sitting and attending.  It's dysregulation.  But, in the vernacular, if someone weren't GETTING that kind of massive OT and sensory input, would they just *phrase* it as severe OT?  I think that's a valid question!

 

Ok, here's a question, because I always go back to the practical on this.  If not ritalin, then you're back to the caffeine question.  What *is* the correlation between necessary caffeine dose and severity or dose of ritalin to get symptom reduction?  How much is the l-theanine affecting that?  Why are people using ritalin if caffeine can (reputedly) do the same thing?  Can it?  If you get the caffeine dose high enough, could it get you there?  And then, what is the bpd rate for caffeine drinkers?  Is caffeine bringing it on? Because, to me, people drink pop with impunity but get really righteous about how unsafe ritalin is.  Lots, lots more people are addicted to caffeine and rotting their bones out with the effect of the chemicals on their bones, which actually KILLS you when you fall from the disintegrated bones and end up in a hospital bed.  But oh no, that 4 hour ritalin was dangerous.  Our society picks their outrage, their sin, what they vilify.

[PeterPan]

I'm googling here, and apparently chocolate covered espresso beans are the caffeine pop of choice.  Now you know.  I suppose people who like coffee would think that was yummy.  :D

 

Back to serious research.

[nature girl]

I'm in the middle of reading the second study you linked, but I found this study linked there that backs up the MTA study: http://www.ncbi.nlm.nih.gov/pubmed/12707559/

 

Anna has had a few "manic" episodes (pretty scary, actually, it's like she's not even in there for a little while), so it's good to know that's probably not a sign of anything other than her ADHD, that's been a huge worry of mine. But do the kids who later develop bpd show other bpd symptoms that might hint they'd eventually be pushed over that line? Signs of depression? Grandiosity? Psychosis? If we looked for signs of bpd in all kids diagnosed with ADHD before starting them on meds, would that make a difference?

Edited January 24, 2016 by Anna's Mom

[texasmama]

And I'd think it would be very easy to compare the incidence of juvenile bpd in kids who were and were not treated with meds. This is a crucial study! Why was it never done? Did the kids who developed bpd show any warning signs outside of ADHD symptoms before it developed, which really should have been caught? (I did see videos that showed the history of kids who were initially treated for ADHD, didn't get better on meds, and then within several months were found to have bpd. One boy was severely ADHD, showed anger and ODD but no sadness, went on Ritalin and suffered severe depression, they took him off Ritalin and BAM he started cycling and now has fullblown bpd. That's scary, because it does seem like it actually was triggered by treatment.)

 

Re: the bolded, this is much more complex a study than it appears at first glance.

 

Juvenile Bipolar is a relatively new diagnosis, for one.  A few decades ago, it was not even a consideration.  There is still a great deal of argument among mental health professionals about criteria.  The DSM is just a book of descriptors grouped together that mental health professionals have identified often enough to warrant a label.  These are essentially man-made constructs.  Mental health disorders exist, but in children these get conflated with developmental issues and other disorders at a rate that is not experienced within the adult population.  Children change and grow.  Adults are relatively static.

 

If you want to study whether or not people treated with Drug X for Hepatitis C develop impaired kidney function, that is a somewhat straightforward study (though medical studies never really are) because there is a blood test for Hep C, a large enough population of people with diagnosed Hep C who were treated with that drug versus another drug to make a run at a comparison.

 

But when the mental health professionals cannot agree on what Bipolar in kids even IS or when 3-4 doctors and mental health professionals look at the same kid with the same symptoms and suggest several different possible diagnoses, one of which may eventually lead to an adult Bipolor dx and the kid has comorbid ADHD symptoms, how exactly do you study this?

 

A single case "study" is not a study at all.  Results for one person experiencing one rare side effect (like the boy mentioned above) cannot be extraopolated in any way to the general population or even to the one child we have in our homes.

 

I am not a research scientist.  But I do know the above.

 

OhE, Depakote and other mood stabilizers are used with kids to treat a wide variety of symptoms and diagnoses.  Because a doctor prescribing a med must have a diagnosis in order to prescribe, one is assigned.  Is it correct?  Could it change?  Who knows?  When you are dealing with an 8 year old or a 10 year old or a 12 year old, only time will reveal what the adult functioning is.  And if a kid is not functional at 8 or 10 or 12 and is at risk of out of home placement or in-patient hospitalization or flunking out of school or the entire family is negatively impacted on a daily basis by behaviors and siblings are suffering and a marriage is at risk, then medicating with something that controls the behaviors to a manageable level becomes the best and most practical solution.  Kids don't live in isolation.  They live in families. Most of our kids are fortunate enough to have a stay at home parent who can tailor-make a life and an education, but the vast majority of kids with mental health issues have to get up every weekday at 6:30 am and get it together for 8 hours at school, socially, emotionally, and educationally, and then come home and function in a family of parents who have been at work all day and siblings.  

 

It is quite possible that some of what presents as ADHD in childhood is truly a Bipolar precursor.  Only time will tell.  

 

There are a lot smarter minds than mine working on these questions, but there are some that just do not have answers and possibly never will.  So we are all left making the best choices we can for our individual kids given our individual situations.

[PeterPan]

How can coffee induce depression and mania? - Quora

 

Ok, this is a little funky, so just read through to the middle where the respondent turns out some science terms.  Basically it sounds like they're saying caffeine does the same dopamine uptake inhibition as ritalin.  So, even as a non-scientist, it's really not rocket science for me to imagine a dose that was too high would set that off.  And they're saying the manic stages are dominated by excess dopamine.  That's not hard to imagine happening.  And really, the curiosity is to suggest that it's PERMANENT.  I mean, you're saying that something given in small doses that has a VERY BRIEF half life in the body is going to go in and make a PERMANENT change to this excessive or cycling state even when it's gone.

 

There are docs who prescribe too much meds.  I don't even mean just ritalin.  I'm just saying in general.  There are kids who are zombied by their meds and having their anxiety going through the roof clinically and they're NOT getting this procedure of tons of appts to get that fine-tuned, get the med changed, get that toned down.  So I really don't look at this and go this is how it has to be.  It's more cautionary that this is NOT how it should be. But yes, I think you could dig in the stats and find kids who are given these meds because it's cheaper for the system than giving them tons of other interventions and who aren't given follow-up appts and enough advocacy to say wow that's not how he should feel. 

 

Ok, let's rabbit trail back to that other article I linked.  It talks about economic effects of ADHD.  I mentioned this, but I think it's really instructive to think about how this has been handled HISTORICALLY.  And we can say ok, historically the person might have taken a job as an apprentice.  They might have done physical work to get that constant input.  They might have done something that could be done by themselves (blacksmithing, horse shoes, whatever), so they weren't constantly with people.  And they would have been HAPPY.  They would have said this is my lot, this is who I am, I am happy.  It's only now, in our culture that has devalued manual labor and exalted ONE PATH, that we now say Oh no, that's not acceptable.  MY brilliant whatever dc with ADHD is not going to go that path.  No, he must have meds so he can sit in a classroom and be this OTHER THING.  And sometimes I really stop myself, and I say ok, am I really thinking about what fits WHO HE IS?  And me, I'm cool with choices.  Make your choice.  But I think it's totally reasonable to ask the historical question of how this this was handled for thousands of years, whether there were AND STILL ARE perfectly good paths, and whether it's that our CULTURE has changed, not the kids.

[PeterPan]

I'm in the middle of reading the second study you linked, but I found this study linked there that backs up the MTA study: http://www.ncbi.nlm.nih.gov/pubmed/12707559/

 

Anna has had a few "manic" episodes (pretty scary, actually, it's like she's not even in there for a little while), so it's good to know that's probably not a sign of anything other than her ADHD, that's been a huge worry of mine. But do the kids who later develop bpd show other bpd symptoms that might hint they'd eventually be pushed over that line? Signs of depression? Grandiosity? Psychosis? If we looked for signs of bpd in all kids diagnosed with ADHD before starting them on meds, would that make a difference?

Well that's interesting.  That doesn't at all fit our journalist friend's narrative, lol.  And that *seems* like some pretty reasonable methodology.  

 

What you're looking for is "prodromal symptoms of bipolar disorder."  Google it and you'll get something like this  Prodromal symptoms of recurrences of mood episodes in bipolar disorder 

[texasmama]

Anna has had a few "manic" episodes (pretty scary, actually, it's like she's not even in there for a little while), so it's good to know that's probably not a sign of anything other than her ADHD, that's been a huge worry of mine. But do the kids who later develop bpd show other bpd symptoms that might hint they'd eventually be pushed over that line? Signs of depression? Grandiosity? Psychosis? If we looked for signs of bpd in all kids diagnosed with ADHD before starting them on meds, would that make a difference?

But kids are so emotionally labile to begin with as compared to adults, who would decide the criteria?  For what gain?  

 

My bias after being in the mental health field for almost 30 years specializing in children and adolescents is that giving stimulants to kids with ADHD does not CAUSE Bipolar.  So this is not something that would even be on a doctor's radar.  Many times, kids present with a hodge podge of symptoms which could be any one of many disorders.  Many times all a doctor or parent or therapist can do it target the symptoms to help the child function until he/she is a bit older and symptoms decrease or a diagnosis becomes clearer.  The medical community has come a long way in the past couple of decades by recommending EKGs on kids who are going to start stimulant meds to rule out kids with unknown, underlying heart function issues which stimulants can cause sudden death in.  It is rare but devastating, obviously.  Not all docs do it, but the good and informed ones do.  That is good science - doing EKGs.  Many young kids are grandiose as a "symptom" of childhood.  That is actually one of my favorite things about kids.   :D  Untreated ADHD and the social and educational ramifications can cause some depressive symptoms.  Kids without ADHD can present with depressive symptoms.  

Edited January 24, 2016 by texasmama

[PeterPan]

 And if a kid is not functional at 8 or 10 or 12 and is at risk of out of home placement or in-patient hospitalization or flunking out of school or the entire family is negatively impacted on a daily basis by behaviors and siblings are suffering and a marriage is at risk, then medicating with something that controls the behaviors to a manageable level becomes the best and most practical solution.  Kids don't live in isolation.  They live in families. Most of our kids are fortunate enough to have a stay at home parent who can tailor-make a life and an education, but the vast majority of kids with mental health issues have to get up every weekday at 6:30 am and get it together for 8 hours at school, socially, emotionally, and educationally, and then come home and function in a family of parents who have been at work all day and siblings.  

 

It is quite possible that some of what presents as ADHD in childhood is truly a Bipolar precursor.  Only time will tell.  

 

There are a lot smarter minds than mine working on these questions, but there are some that just do not have answers and possibly never will.  So we are all left making the best choices we can for our individual kids given our individual situations.

And unfortunately, this is where some people are at.  Like I think we're beyond (in this discussion) talking about people who are considering meds for mere wiggles.  They're actually serious issues that have serious consequences no matter WHICH way you go.  And this guy can use his quotes about how long-lasting the results are, but then look at the half-life and you see it doesn't fit.  And he can say the consequences are permanent and causing bpd, but then he admits the levels rebound.  And he's saying the diagnosis of childhood bpd is up, but he's not admitting that other, similar syndrome mix diagnoses are up too.

[nature girl]

Ok, let's rabbit trail back to that other article I linked.  It talks about economic effects of ADHD.  I mentioned this, but I think it's really instructive to think about how this has been handled HISTORICALLY.  And we can say ok, historically the person might have taken a job as an apprentice.  They might have done physical work to get that constant input.  They might have done something that could be done by themselves (blacksmithing, horse shoes, whatever), so they weren't constantly with people.  And they would have been HAPPY.  They would have said this is my lot, this is who I am, I am happy.  It's only now, in our culture that has devalued manual labor and exalted ONE PATH, that we now say Oh no, that's not acceptable.  MY brilliant whatever dc with ADHD is not going to go that path.  No, he must have meds so he can sit in a classroom and be this OTHER THING.  And sometimes I really stop myself, and I say ok, am I really thinking about what fits WHO HE IS?  And me, I'm cool with choices.  Make your choice.  But I think it's totally reasonable to ask the historical question of how this this was handled for thousands of years, whether there were AND STILL ARE perfectly good paths, and whether it's that our CULTURE has changed, not the kids.

 

I have to disagree just a bit. Would all kids with ADHD be happy in blue-collar jobs? Of course there's nothing wrong with those jobs, they're necessary and do give many people fulfillment, but shouldn't they be given the tools they need to become professionals if that's what they know they'd be happier with? If Anna decides to become the equivalent of a blacksmith, and is able to make a living at it, then that's great! But what if she finds her passion and it's something that will take a college degree, and a level of attention and responsibility and social acumen that she just won't have off meds? And does that give me the right (or a responsibility) to make the choice for her at 6, before I have even a clue what her passions might turn out to be?

[texasmama]

And unfortunately, this is where some people are at.  Like I think we're beyond (in this discussion) talking about people who are considering meds for mere wiggles.  They're actually serious issues that have serious consequences no matter WHICH way you go.  And this guy can use his quotes about how long-lasting the results are, but then look at the half-life and you see it doesn't fit.  And he can say the consequences are permanent and causing bpd, but then he admits the levels rebound.  And he's saying the diagnosis of childhood bpd is up, but he's not admitting that other, similar syndrome mix diagnoses are up too.

And since NO ONE was making the diagnosis of childhood bpd thirty years ago, of course it is "up".

 

I didn't even watch the video, but how ridiculous an assertion he makes.

 

I also think that the diagnosis of AIDS is UP since 1900.  Maybe that is caused by Ritalin, too.  Geez.

 

I don't have a kid with ADHD, and I did not even watch the video, but it makes me fighting mad when people are pushing one agenda or another with BAD SCIENCE, which is no science at all.  It's scary enough and hard enough making these decisions.  Don't lie to parents and scare them to the point that they won't even consider something that might potentially be beneficial.

[PeterPan]

Ok, now I want to be flip, and Texas can talk me down and give some actual facts and say wow that wasn't substantiated.  Ok, so let's say your dc has the brain chemistry that, when they get the stimulants the dopamine goes too high and they start into some bpd cycling.  And let's posit, just to flow with their arguments and be worst case scenario that the dc goes off the meds and the cycling remains.  So put them on lithium.  The world did not end.  You just put them on some lithium.  You can go to the health food store or amazon and buy lithium.  You can buy Perrier water and drink lithium.  It's a naturally occurring mineral.  It will shove your thyroid function down a bit and give you some constipation, so you're going to need fiber and some kelp. But you're STABLE.  And at that point your ADHD is treated, you're stable, moods stable, life is stable.

 

I'm sorry, but the people I know on lithium are their best versions of themselves.  It's a valid question, like are we making an unnecessary domino, was the issue never there TILL we started the ritalin?  But if the symptoms were there before and we're just getting honest a little earlier, is this really so bad?  It's just lithium.  And I told you I'm being a little flip here, but I want to say I have MULTIPLE family members on meds for bpd.  Now depakote, that has a lot more side effects.  Wouldn't want my 7 yo on Depakote willy nilly.  But lithium, tell me there are some really horrible side effects, yes?  Are there?  I'm just asking straight.

 

I'm just saying we can get really freaky about things, or we can be really practical and honest.  What IS the path if that happens.  What IS the path if you choose not to do any meds?  

[Azalea]

 

 

-

.

-So Shire and Oregon look at the lit and come to the same conclusions.  Either way, the best spin only shows half the studies as showing ANY benefit and the other half have no benefits or worse.  

 

49 minutes in.  I will not die.  Don't worry, he would NEVER cherry pick his data, he assures us.

 

-Now see, this is interesting.  The whole mental illness issue is complicated.  To have that discussion though about whether ritalin is playing a role, that's interesting.

-Hurray, 52 minutes in and we have clapping.  Now for Q&A.  How nice to hear Sroufe pronounced.  Quite the name!  But back to this stupid argument that not changing something over a population means we shouldn't act for the individual.

-See, this makes sense.  When he says pharma + psychs are in business to spin it as deficiency so they can pan the drugs.  That makes sense.

-But look how blanket this is.  No discussion, on his part, of whether some situations outweigh others.  It's SO EASY to have these sort of absolute convictions and say oh it's causing harm, without looking at the situations where the child is experiencing ACTUAL HARM *not* having the meds.

-Hurray.  Now we know that schizophrenia, ADHD, everybody is actually better off WITHOUT meds over the long haul.  Don't look at anyone in your family who got meds and is BETTER for it, like life-alteringly better.  Because he read a study that said for a population schizo drugs aren't necessary.  Your relatives are just on unnecessary meds and being harmed.

 

Can we NOT have some common sense and distinguish things???

 

Ok, it's about to end.  Let's ponder implications.

 

You might want to watch the video again. The speaker asserts that Shire and Oregon came to different conclusions. 

[PeterPan]

I have to disagree just a bit. Would all kids with ADHD be happy in blue-collar jobs? Of course there's nothing wrong with those jobs, they're necessary and do give many people fulfillment, but shouldn't they be given the tools they need to become professionals if that's what they know they'd be happier with? If Anna decides to become the equivalent of a blacksmith, and is able to make a living at it, then that's great! But what if she finds her passion and it's something that will take a college degree, and a level of attention and responsibility and social acumen that she just won't have off meds? And does that give me the right (or a responsibility) to make the choice for her at 6, before I have even a clue what her passions might turn out to be?

I think you're asking good questions.  I also think we can look at this historically.  What did people with high IQs do in the past?  Are all people doing blue collar work low IQ?  I'm not being snarky, just really direct.  I have a relative who is an EXTREMELY well-paid engineer in an extremely advanced field.  This relative's brother, with the SAME IQ, works very happily as a truck driver.  He gets his IQ kicks out and satisfies that drive with really custom boat engine work.  Same brains, same IQ.  Different lives.

 

So who is to say there is one path?  And I GET that idea of opening doors, because that's been our philosophy with dd in parenting.  But let's flip this a different way.  I think our culture has said I'll hold all the doors open, but some of those doors AREN'T GOOD ENOUGH.  I really think that is happening.  

 

So as a parent I've tried to slow myself down and say ok, what are multiple paths that could work with this?  What would it take to pursue each of them?  Would the things it would take to pursue a path be *worth* the costs, risks, whatever, or in reality is it ok to watch a few doors quietly close as a parent?  I think really hard about that.  My ds is gifted with every SLD and label they could find.  There's nothing left.  I don't see how he ever does the things I would have imagined based on both is IQ and giftings.  I don't know.  But I've decided I have to be comfortable with the idea that I can't hold every door open for him, that not every door is worth the cost.

[nature girl]

Ok, now I want to be flip, and Texas can talk me down and give some actual facts and say wow that wasn't substantiated.  Ok, so let's say your dc has the brain chemistry that, when they get the stimulants the dopamine goes too high and they start into some bpd cycling.  And let's posit, just to flow with their arguments and be worst case scenario that the dc goes off the meds and the cycling remains.  So put them on lithium.  The world did not end.  You just put them on some lithium.  You can go to the health food store or amazon and buy lithium.  You can buy Perrier water and drink lithium.  It's a naturally occurring mineral.  It will shove your thyroid function down a bit and give you some constipation, so you're going to need fiber and some kelp. But you're STABLE.  And at that point your ADHD is treated, you're stable, moods stable, life is stable.

 

I'm sorry, but the people I know on lithium are their best versions of themselves.  It's a valid question, like are we making an unnecessary domino, was the issue never there TILL we started the ritalin?  But if the symptoms were there before and we're just getting honest a little earlier, is this really so bad?  It's just lithium.  And I told you I'm being a little flip here, but I want to say I have MULTIPLE family members on meds for bpd.  Now depakote, that has a lot more side effects.  Wouldn't want my 7 yo on Depakote willy nilly.  But lithium, tell me there are some really horrible side effects, yes?  Are there?  I'm just asking straight.

 

I'm just saying we can get really freaky about things, or we can be really practical and honest.  What IS the path if that happens.  What IS the path if you choose not to do any meds?  

 

Juvenile bpd is usually much more severe than adult bpd, and can't fully be treated. Cycling is extremely rapid, sometimes 4-5 times within one day, and suicide is a very real possibility. Also, I don't think lithium is recommended, the meds they use are pretty hardcore, and have some hardcore side effects.

[PeterPan]

You might want to watch the video again. The speaker asserts that Shire and Oregon came to different conclusions. 

Yeah, I was rereading that and trying to figure out what I had meant, lol.  It was a little late.  But even though they came to different conclusions, the worst case scenario was half of the studies showing any benefit and the other half showing same or worse.  In other words, when you're down to 50/50 across studies, I was like ok then it's just a coin flip as to whether this is going to make a big difference or whether it will be a wash or possibly make it worse.  Coin toss.  Not dramatic evidence.  That's all I'm seeing.

 

And I go back to this point.  Do I have my kids on meds?  No.  I'm just saying show me the science.  I'm seeing coin toss results.  I'm seeing lots of vague quotes on p-meds in general that they're extrapolating to what happens in a specific med that has a crazy low half-life.  I'm seeing hints that some future study might show you utterly changed genetic expression.  That was interesting to me, so let's google it.  

 

I think they're valid questions and questions that need to be discussed.  

[MomatHWTK]

The downside of lithium is that you have to have multiple blood draws to determine a threshold level, and then ongoing testing to maintain/check levels.  Compliance for anyone with bpd is always a challenge.  

 

However, I think when there is a risk of bpd, they don't prescribe stimulants anyway.  Our doctor prescribed non-stimulant ADHD medication to good effect for us.  I do tend to think that it is possible that the condition is present and may manifest regardless.  With adolescents and teens, it is very hard to tweak out the specific cause of a mass of symptoms.  

 

But, having been on the roller coaster for a variety of conditions, at some point you have to do SOMETHING to improve your child's life and accept that there are consequnces to any choice.  If the child is functioning and you aren't at that point, then it makes more sense to avoid medications. But there is a tipping point where doing nothing is worse than doing something.  

[Tiramisu]

Ok, now I want to be flip, and Texas can talk me down and give some actual facts and say wow that wasn't substantiated.  Ok, so let's say your dc has the brain chemistry that, when they get the stimulants the dopamine goes too high and they start into some bpd cycling.  And let's posit, just to flow with their arguments and be worst case scenario that the dc goes off the meds and the cycling remains.  So put them on lithium.  The world did not end.  You just put them on some lithium.  You can go to the health food store or amazon and buy lithium.  You can buy Perrier water and drink lithium.  It's a naturally occurring mineral.  It will shove your thyroid function down a bit and give you some constipation, so you're going to need fiber and some kelp. But you're STABLE.  And at that point your ADHD is treated, you're stable, moods stable, life is stable.

 

I'm sorry, but the people I know on lithium are their best versions of themselves.  It's a valid question, like are we making an unnecessary domino, was the issue never there TILL we started the ritalin?  But if the symptoms were there before and we're just getting honest a little earlier, is this really so bad?  It's just lithium.  And I told you I'm being a little flip here, but I want to say I have MULTIPLE family members on meds for bpd.  Now depakote, that has a lot more side effects.  Wouldn't want my 7 yo on Depakote willy nilly.  But lithium, tell me there are some really horrible side effects, yes?  Are there?  I'm just asking straight.

 

I'm just saying we can get really freaky about things, or we can be really practical and honest.  What IS the path if that happens.  What IS the path if you choose not to do any meds?  

 

I think people on lithium have to get regular liver function tests.

[texasmama]

Ok, now I want to be flip, and Texas can talk me down and give some actual facts and say wow that wasn't substantiated.  Ok, so let's say your dc has the brain chemistry that, when they get the stimulants the dopamine goes too high and they start into some bpd cycling.  And let's posit, just to flow with their arguments and be worst case scenario that the dc goes off the meds and the cycling remains.  So put them on lithium.  The world did not end.  You just put them on some lithium.  You can go to the health food store or amazon and buy lithium.  You can buy Perrier water and drink lithium.  It's a naturally occurring mineral.  It will shove your thyroid function down a bit and give you some constipation, so you're going to need fiber and some kelp. But you're STABLE.  And at that point your ADHD is treated, you're stable, moods stable, life is stable.

 

I'm sorry, but the people I know on lithium are their best versions of themselves.  It's a valid question, like are we making an unnecessary domino, was the issue never there TILL we started the ritalin?  But if the symptoms were there before and we're just getting honest a little earlier, is this really so bad?  It's just lithium.  And I told you I'm being a little flip here, but I want to say I have MULTIPLE family members on meds for bpd.  Now depakote, that has a lot more side effects.  Wouldn't want my 7 yo on Depakote willy nilly.  But lithium, tell me there are some really horrible side effects, yes?  Are there?  I'm just asking straight.

 

I'm just saying we can get really freaky about things, or we can be really practical and honest.  What IS the path if that happens.  What IS the path if you choose not to do any meds?  

Well, you know lithium was the original med used to treat Bipolar disorder, right?  It was pretty sedating.  There are much better mood stabilizers out now which are widely used with fewer side effects.  No meds have no side effects, of course, and not treating mental health disorders has side effects, too.

 

What it boils down to is that no one has a crystal ball, and we are making decisions for children who are unable to make decisions for themselves, which is a heavy burden.  Not a person on this thread has made any decisions lightly.

 

If I was faced with a child with ADHD to the point at which it triggered me to consider meds, I would not be happy.  It would not be an easy decision.  I would be conflicted.  But it would be a reasonable course of action to research, talk to the doctor, look at my individual child, and try a course.  And even when you try a course, it may take several adjustments of dosages or changes of meds to get an acceptable balance between risks and benefits.  Stimulants cause anorexia.  They can worsen anxiety.  All of this has been discussed in this thread.  But people report that their dc's anxiety was actually improved on stimulants.  No one (not even docs) can predict how an individual person's brain chemistry and body will respond to a medication with any certainty.

 

For years, the "treatment" for hyperactivity was coffee.  There are still many, many adults who self-treat ADD with caffeine.  It is semi-effective.  But it can cause a racing heartbeat and can increase anxiety.  So even caffeine has side effects.  (forget sodas with the extra chemicals - think of organic coffee with no cream and sugar added)

 

Of the major mental illnesses, Bipolar Disorder is not the most disabling one.  Schizophrenia is, by far.

[PeterPan]

Ok folks, this gets really juicy! What we're talking about here is dopamine-regulated gene expression of striatal neurons.  Head swimming yet?  Don't worry this is fascinating stuff!  

 

Methylphenidate (Ritalin) induces Homer 1a and zif 268 expression in specific corticostriatal circuits. - PubMed - NCBI

 

So yes, read it and see that if you give rats 2mg/kg of ritalin, the effect on the corticostriatal circuits (I have no clue what I'm talking about) will, thanks to the effect of the dopamine on the genes, be addictive and be like cocaine.

 

But don't get too self-righteous just yet!

 

Caffeine regulates neuronal expression of the dopamine 2 receptor gene. - PubMed - NCBI

 

See, my friends, CAFFEINE affects the gene expression and neuron firing in striatal cultures!!  

 

And even better, this little article, this hotbed of research, has FINALLY SOLVED the mysteries of the universe.  Sexual dimorphism will be affected by this too!  Hmm, so does that mean we can change the gender of our kids if our hubbies drink enough coffee?  Or men on ritalin birth more of one gender over another?  I don't know, but man we can really get in the weeds here and have some fun.

 

I mean, what stinkin' HYPOCRITES.  They drink caffeine with impunity every day of the week, get addicted, brag about it in the Starbucks line, but no, only kids taking Ritalin are doomed.

 

So please, someone do the necessary research and find me the stats on people in prison who drink coffee, because I need to save my child.

[PeterPan]

Juvenile bpd is usually much more severe than adult bpd, and can't fully be treated. Cycling is extremely rapid, sometimes 4-5 times within one day, and suicide is a very real possibility. Also, I don't think lithium is recommended, the meds they use are pretty hardcore, and have some hardcore side effects.

You have data on that?  Not saying I doubt you, but I was just wanting to see some data.  

[PeterPan]

However, I think when there is a risk of bpd, they don't prescribe stimulants anyway.

So you're saying if the ped or p-doc hears family history of bipolar they go non-stimulant, yes?  But interestingly I'm seeing plenty of discussion online (research, etc.) of using stimulant meds paired with bipolar treatment.

[nature girl]

Just did a quick search and found this:

 

http://www.thebalancedmind.org/learn/library/about-pediatric-bipolar-disorder?page=all

 

Just, as juvenile diabetes is generally a more severe disorder than adult-onset diabetes, pediatric bipolar disorder appears to be more perilous than adult-onset bipolar disorder. The rationale for early intervention is compelling. 

Common outcomes of pediatric bipolar disorder are school refusal, suspension, and dropping-out; impulsive acts of aggression; self-injury; substance abuse; and suicide attempts and completions. Teens with symptoms of untreated bipolar disorder are arrested and incarcerated. Suicide is the third leading cause of death among teens. Children as young as six have attempted to hang, shoot, stab or overdose themselves. Suicide Prevention Tips.   

The longest study on pediatric bipolar disorder is ongoing under the direction of Barbara Geller, M.D., a child psychiatrist at Washington University in St. Louis. In the mid-1990s, Dr. Geller began observing 93 children whose average age was 10.8 years. All of the children had mania (Bipolar I) which had begun to onset at an average age of 6.8 years. Assessing the children after four years, Geller and colleagues found that children with mania were sicker than adults, less likely than adults to recover, and relapsed sooner than adults with mania.⁴   Differences in symptom severity and frequency of cycling between manic and depressive episodes have presented questions as to whether bipolar disorder in youth is the same illness as in adults. A study published in 2006 by Dr. Geller and colleagues showed that early-onset Bipolar I disorder does appear to be the same illness as adult-onset Bipolar I disorder.⁵

Another study of three major subtypes of bipolar disorder that affect children and adolescents is ongoing under the direction of David Axelson, M.D., a child psychiatrist at Western Psychiatric Institutes and Clinics in Pittsburgh. A report on the 263 children and adolescents, ages 7-17 years, confirmed that bipolar disorder affects children and adolescents more severely than adults.⁶ â€œStudy participants had comparatively longer symptomatic stages and more frequent cycling (changing from one mood to another) or mixed episodes. Children and adolescents also converted from a less severe form of bipolar disorder to a more severe form at a much higher rate than seen in adults.â€⁷

[nature girl]

So you're saying if the ped or p-doc hears family history of bipolar they go non-stimulant, yes?  But interestingly I'm seeing plenty of discussion online (research, etc.) of using stimulant meds paired with bipolar treatment.

 

From everything I've read, they say it's crucial to start treatment of the mood disorder first, that ADHD symptoms can then be controlled later. Otherwise the bpd apparently becomes more severe, and harder to treat. I can find links, but I've read that in several places.

[PeterPan]

Texas, the racing heart thing is interesting to ponder.  Is there a level of caffeine where that tends to occur?  

 

And yes, I have family who pushed over to schizo-affective.  I don't think any of us comes to where we are in a vacuum.  

[PeterPan]

Just did a quick search and found this:

 

http://www.thebalancedmind.org/learn/library/about-pediatric-bipolar-disorder?page=all

 

Just, as juvenile diabetes is generally a more severe disorder than adult-onset diabetes, pediatric bipolar disorder appears to be more perilous than adult-onset bipolar disorder. The rationale for early intervention is compelling. 

Common outcomes of pediatric bipolar disorder are school refusal, suspension, and dropping-out; impulsive acts of aggression; self-injury; substance abuse; and suicide attempts and completions. Teens with symptoms of untreated bipolar disorder are arrested and incarcerated. Suicide is the third leading cause of death among teens. Children as young as six have attempted to hang, shoot, stab or overdose themselves. Suicide Prevention Tips.   

The longest study on pediatric bipolar disorder is ongoing under the direction of Barbara Geller, M.D., a child psychiatrist at Washington University in St. Louis. In the mid-1990s, Dr. Geller began observing 93 children whose average age was 10.8 years. All of the children had mania (Bipolar I) which had begun to onset at an average age of 6.8 years. Assessing the children after four years, Geller and colleagues found that children with mania were sicker than adults, less likely than adults to recover, and relapsed sooner than adults with mania.⁴   Differences in symptom severity and frequency of cycling between manic and depressive episodes have presented questions as to whether bipolar disorder in youth is the same illness as in adults. A study published in 2006 by Dr. Geller and colleagues showed that early-onset Bipolar I disorder does appear to be the same illness as adult-onset Bipolar I disorder.⁵

Another study of three major subtypes of bipolar disorder that affect children and adolescents is ongoing under the direction of David Axelson, M.D., a child psychiatrist at Western Psychiatric Institutes and Clinics in Pittsburgh. A report on the 263 children and adolescents, ages 7-17 years, confirmed that bipolar disorder affects children and adolescents more severely than adults.⁶ â€œStudy participants had comparatively longer symptomatic stages and more frequent cycling (changing from one mood to another) or mixed episodes. Children and adolescents also converted from a less severe form of bipolar disorder to a more severe form at a much higher rate than seen in adults.â€⁷

Wow, when you read that, don't you go OK, now show me how many of those kids were on stimulants?   ;)  I mean, seriously, if our journalist friend is onto something here, then that study should have fessed up, like ok 90% of those kids were on stim meds and pushed over.  Because that's a really serious allegation.  And I think it's important to say ok, in the kids who DO push over it can be really severe.  But then I ask reasonable questions, like if they were on meds, how carefully were the meds controlled?  Were they being highly medicated for convenience?  Because I've seen it happen.  I'm sorry that's crass, but we know these meds have an element of convenience.  And what is the family life?  What is the correlation between how those symptoms play out and family life and ability to afford medical care to fine-tune the meds?  

 

The diabetes parallel doesn't make sense.  Adult onset is connected to health (diet, weight, insulin resistance) and it's REVERSIBLE.  I have family who've gotten off their meds by losing weight and changing their diet.  Juvenile onset is typically considered permanent and genetic, not environmental.

Edited January 24, 2016 by OhElizabeth

[Tiramisu]

When I had my oldest evaluated by a psych for the first time because I had ADHD and anxiety concerns, the psych was concerned about prescribing anything because of any possibility of bpd. Even though my dd really had no bpd symptoms, he was still worried about any family members having bpd. In fact, we have some quirky people in our family but no one with bpd, but quirky was enough of a concern for him.

 

Fastforward ten years, we've seen two psychs with another of my children. Neither had any trouble prescribing meds and they specifically said it wouldn't cause bpd but could trigger it. 

 

In that ten year span, what I witnessed in dealing with psychs is more of an awareness of ASD and less of a concern with juvenile bpd.

 

To talk about risk of not doing anything: We all have some kind of attention issues in my family. I'm talking about my siblings. I don't know if it's ADHD or possibly some kind of spectrum issue. I am the only one who is/wasnot a drug user or alcohol abuser. One sibling who very hyperactive and impulsive as a kid, besides being highly gifted. He was an alcoholic as an adult but, very thankfully, is not anymore because of a very scary experience. One day, he was using caffeine and couldn't sleep and drank beer to try to relax. When the beer didn't work, he used an OTC sleeping pill. He started seeing things and ended up in pscyh ward for a couple of days. If he hadn't learned from that experience, he might have wound up being a chronic alcoholic and possibly with a serious mental illness diagnosis. Thankfully, things are good with him and have been for almost fifteen years. My other sibling has never learned a lesson though she's been in so many bad situations due to poor decision making while using drugs and alcohol. She has put our family through so much stress and the pain she's caused her kids is tragic and will last forever. We have no hope that she will ever change. I always wonder if all of us would have had different lives if more was done when my siblings were younger to figure out what their problems were and have the appropriately treated. I wonder if they were born today when there is more understanding of developmental issues, perhaps they would have had a better chance, whether through medication or therapy.

 

The thing that I am sure of is that no matter what the issue, you have a much better chance of a happy, healthy life, if alcohol and drugs don't become part of the picture. I've heard people say that ADHD meds increase the chance of drug use later, but I've heard the opposite from professionals. 

[PeterPan]

From everything I've read, they say it's crucial to start treatment of the mood disorder first, that ADHD symptoms can then be controlled later. Otherwise the bpd apparently becomes more severe, and harder to treat. I can find links, but I've read that in several places.

I read that, but I think they're referring to adults.  Every time they talk kids, they're saying screen for prodromal symptoms, give the stim meds, watch and see what happens, then say oh crap and give them the mood stabilizers.

[Tiramisu]

Based on some recent experience, I've been wondering if my dd does just as well with a latte from DD as with Concerta. Concerta is less expensive, but what's safer long term?

[PeterPan]

The thing that I am sure of is that no matter what the issue, you have a much better chance of a happy, healthy life, if alcohol and drugs don't become part of the picture. I've heard people say that ADHD meds increase the chance of drug use later, but I've heard the opposite from professionals. 

This is SO true.  We have these conflicting models of addiction, with the church telling  you it's all your fault and the DSM telling you you have a disorder or disease.  To me, I see this middle ground, where you have choice, but you better realize *your body* might be extra prone to respond a certain way and that you're REALLY DUMB to ignore that possibility.  And I think it can make us compassionate understanding there might be some reasons why people struggle.  

 

I think the risky part about the meds is that they *can* be used with an addictive mindset.  It's there and it's easy to have happen.  And we CANNOT GUARANTEE whether our kids will go that direction.  Nobody knows in their own soul what they would do even.  I think that's always real.  I was researching this issue pretty heavily a while back and found a whole website/discussion board dedicated to nothing but this discussion of breaking addiction to prescription stims.  Even people who started off just using them straight seemed to, in some instances, have moved over, that it didn't have to start with illegal use.  And see that, to me, was why this guy's exploration of the topic was so incomplete, because as a mother I CAN think of things that give me pause and reasons why we aren't using them and he didn't even go into those.  

 

But whatever.  I'm not anti med.  I'm quite happy to be objective and suggest them (strongly) to someone else.  I could see if I could find that website I was on.  It was a month or two ago and it had a cream home page.  I have no clue, lol.  It just made me cynical enough to think there was a LOT more potential there than what the "studies" would show us and that we couldn't *guarantee* outcomes because we can never ever guarantee responses of another person or even our own.  We can only hope and pray.

[PeterPan]

Based on some recent experience, I've been wondering if my dd does just as well with a latte from DD as with Concerta. Concerta is less expensive, but what's safer long term?

I don't know, I haven't used Concerta.  You're saying that it's enough less effective that she might as well just be using caffeine?  And maybe prescription stim meds are a bit stronger than caffeine and therefore Concerta is weaker?  I don't know.  Someone else here would know.  But that's why I brought up the Energems, because I think that's a really obvious question, like why people aren't just dosing caffeine with pills and being done with it.  Consistent dose, no other clutter in it.  Seems really obvious to me as an option. 

[PeterPan]

Ok, I'm wandering into fun here.  Let's look up bpd and adhd diagnosis rates in the South.  In areas where people drink lots of black tea, are these rates lower?  Is the laidback culture of the South actually do to the caffeine in their tea?  Could all the midwesterners and northerners just solve their problem if they'd get on board with tea?  LOL

[PeterPan]

ADHD & Kids: The Truth About Attention Deficit Hyperactivity Disorder

 

Ok, this is a Time magazine article, still in the light realm but expedient.  Poverty IS linked to ADHD diagnosis, and there's a map of prevalence by state.

[texasmama]

Mental health disorders, including ADHD, increase the incidence of substance abuse regardless of meds history. It's common and understandable to self-medicate. Pot smokers with Bipolar are a dime a dozen. So common. Everyone wants to feel "normal" and is driven to achieve that regardless of diagnosis or treatment with prescription meds.

[nature girl]

Mental health disorders, including ADHD, increase the incidence of substance abuse regardless of meds history. It's common and understandable to self-medicate. Pot smokers with Bipolar are a dime a dozen. So common. Everyone wants to feel "normal" and is driven to achieve that regardless of diagnosis or treatment with prescription meds.

 

I read an article recently that said medical marijuana is actually a safe and highly effective treatment for ADHD. But of course that will never become common practice, because imagine the uproar the medical community would get if they suggested dosing kids with pot.

[PeterPan]

Still scanning that article.  About 40% of kids who get therapy and interventions don't need meds or need dramatically less.  That's pretty telling and feeds back into my suggestion that meds are the low cost substitute for more expensive interventions.

 

Gives some stats on parenting.  We've had a lot of fear in this thread, like oh if I do this or don't do this their risk of this or that is 4 or 5 times higher.  Well then you get the studies showing PARENTING makes a difference.  We know that because that's why we HOMESCHOOL!!  Not a guarantee either, but maybe that tells us, ok, what CAN be done with parenting and positive support to mitigate, we're doing.

 

Ok, now I'm into the part of the article where it's like just accept their brains are messed up, they CAN'T have expected behavior, blah blah.  That's not really where I am.  I mean, there's a point where that's really philosophical.  That's not the same as saying I'm going to provide supports, have goals, and help you achieve your goals.  They talk about goals, yes, but I really think CAN'T conversation isn't appropriate.

 

Ok, finally to the map.  They're blaming No Child Left Behind.  But wasn't it really the economic collapse and the increase cost of TEA?  I mean, seriously, SURELY massive amounts of tea consumption WOULD AFFECT these rates.  Or decreased drinking of tea due to more time spent in school?  I have no clue, I'm just being cynical.

 

Yup, and then it says what I was assuming, that it's cheaper to fund meds than therapies (cognitive/behavioral, OT, etc.), so the rates are directly related to areas with high poverty.

 

The non-stim meds are actually sometimes BLOOD PRESSURE meds???  I had not heard that.  Wow, that would not be appropriate for all kids.  That's scary to me.  

 

It mentions neurofeedback and Play Attention.  We haven't done this one, but Guffanti recommends it.  They have a very aggressive marketing approach.  Zengar is more common with therapists.

 

Love how they end this article with the suggestion that kids who exercise more and get out more will have less symptoms.  I'll have to remember that add add more.  Snort.  I mean, I know this is an issue in our culture, where massive numbers of kids don't hit the target of one hour of red face a day.  We're just already at quite a bit.

[PeterPan]

Mental health disorders, including ADHD, increase the incidence of substance abuse regardless of meds history. It's common and understandable to self-medicate. Pot smokers with Bipolar are a dime a dozen. So common. Everyone wants to feel "normal" and is driven to achieve that regardless of diagnosis or treatment with prescription meds.

Does marijuana actually help the bipolar? 

[PeterPan]

I read an article recently that said medical marijuana is actually a safe and highly effective treatment for ADHD. But of course that will never become common practice, because imagine the uproar the medical community would get if they suggested dosing kids with pot.

Oh no, we had marijuana on the ballot in our state.  There were provisions for marijuana brownies, products marketed to kids (gummies), you name it.  Opinion IS changing in the public.  And I'm not pro-marijuana, mind you.  I just really chuckle over the hypocrisy of what our culture calls bad and what they pat themselves on the back for and allow. 

[texasmama]

Does marijuana actually help the bipolar?

Evidently it helps with symptom management.

[PeterPan]

Evidently it helps with symptom management.

I could have guessed that.   :lol:   But I mean like does it actually affect dopamine levels, or is it like woo, I'm so good and the world is so good that I don't NOTICE things, kwim?  Like I have no clue.  Never done anything even remotely illegal or previously illegal.

Edited January 24, 2016 by OhElizabeth

[Tiramisu]

I don't know, I haven't used Concerta.  You're saying that it's enough less effective that she might as well just be using caffeine?  And maybe prescription stim meds are a bit stronger than caffeine and therefore Concerta is weaker?  I don't know.  Someone else here would know.  But that's why I brought up the Energems, because I think that's a really obvious question, like why people aren't just dosing caffeine with pills and being done with it.  Consistent dose, no other clutter in it.  Seems really obvious to me as an option. 

 

We've been on a roll lately with schoolwork. I thought it was the Concerta, which I think is long-acting ritalin. She can only manage the lowest dose because higher doses give her a headache.

 

So the thing is, dd has OT now two mornings a week. I like to give a treat after it and her treat of choice is a latte. I won't give her a latte AND meds. AND I want her to go to therapy med-free, AND I don't like to give her a long-term meds that late in the day. So, because of all this, she got a latte and no meds one day this week and got just as much school work done. I am somewhat tempted to make her a home-made latte this week and see how she does.

 

At the same time, I need to be cautious of caffeine use because of a heart rate issue she inherited from me. Three doctors cleared her for stimulant use. But one of them, the cardiologist, warned us about caffeine when we met with him. But that was without an actual comparison of the risks of caffeine versus stimulants.

 

Yes, we are doing really well but that is WITH tomato staking and constant redirection.

[texasmama]

I could have guessed that. :lol: But I mean like does it actually affect dopamine levels, or is it like woo, I'm so good and the world is so good that I don't NOTICE things, kwim? Like I have no clue. Never done anything even remotely illegal or previously illegal.

That is a more scientific question than I can answer, but my guess is yes, it affects the brain chemistry in a way that normalizes mood.

[PeterPan]

Decreased dopamine brain reactivity in marijuana abusers is associated with negative emotionality and addiction severity

 

If you can make heads or tails of it, I THINK this says don't take marijuana if you have ADHD.  It lowers what is already low and makes the meds not work right.  

[PeterPan]

We've been on a roll lately with schoolwork. I thought it was the Concerta, which I think is long-acting ritalin. She can only manage the lowest dose because higher doses give her a headache.

 

So the thing is, dd has OT now two mornings a week. I like to give a treat after it and her treat of choice is a latte. I won't give her a latte AND meds. AND I want her to go to therapy med-free, AND I don't like to give her a long-term meds that late in the day. So, because of all this, she got a latte and no meds one day this week and got just as much school work done. I am somewhat tempted to make her a home-made latte this week and see how she does.

 

At the same time, I need to be cautious of caffeine use because of a heart rate issue she inherited from me. Three doctors cleared her for stimulant use. But one of them, the cardiologist, warned us about caffeine when we met with him. But that was without an actual comparison of the risks of caffeine versus stimulants.

 

Yes, we are doing really well but that is WITH tomato staking and constant redirection.

Ok, fill me in.  What is your logic on doing OT without meds?  I don't put the kinesio tape on ds on OT days, because I think that's changing his brain waves when we're trying to work on them with the neurofeedback.  But meds aren't messing with sensory.  To me, I would just give the meds every day.  I would think that would be really jarring to be on them, off them.  Or maybe it isn't?  Does she take them on weekends?  

 

And one of your kids already had the heart reaction, yes?  

[nature girl]

http://www.details.com/story/weed-may-treat-adhd-better-than-adderall-study-says(Very small study, but it says marijuana actually increases dopamine.)

[MomatHWTK]

This professor's work is useful in understanding ADHD:

https://www.doximity.com/pub/anthony-rostain-md?show_more=true#publications

[Tiramisu]

Ok, fill me in.  What is your logic on doing OT without meds?  I don't put the kinesio tape on ds on OT days, because I think that's changing his brain waves when we're trying to work on them with the neurofeedback.  But meds aren't messing with sensory.  To me, I would just give the meds every day.  I would think that would be really jarring to be on them, off them.  Or maybe it isn't?  Does she take them on weekends?  

 

And one of your kids already had the heart reaction, yes?  

 

Originally, my only goal for OT was IM. And my feeling was that I want her to be working from her true baseline.

 

We only started meds this summer. We don't do meds on weekends or holidays now, though we did at first, and I don't plan on using them this summer. I feel like, overall, her impulsivity has improved ant that's made life much, much better. Impulsivity improved a ton on focalin, but we had to stop due to headaches.

 

I think using focalin gave her a self-awarness about her impulsivity and it doesn't seem as bad as it once was. I don't think Concerta is hitting impulsivity as hard, though she seems calmer with it. If impulsivity were to become an issue again, I would use the meds on off-days.

 

The other thing is that is possible is that our relationship improved when her impulsivity was managed, so there's less negativity coming out in impulsive ways. Does that make sense?

 

She does have some vocal stims that I think could be related to impulsivity/self-control but they are happy sounds now and mostly limited to in the house.

 

ETA: I have two kids now with heart questions. One, who is not on any meds, was dx'd with vasovagal syncope, which means she can pass out due to blood pressure changes. She also has an irregular heart beat that's usually not a concern but it's coming from an unusual place in her heart. She had to have a stress test and the results were considered good because the irregular beat went away with exercise. The dd on meds has a high heart rate (from me) and irregular beats (from dh). I decided to have her checked after her sister was dx'd and I was concerned that she could have something similar and had just started the stimulant. I found she had a high heart rate at home and took her to the pediatrician who sent her to a cardiologist. In he meanwhile, I stopped meds and her heart rate did not decrease. From testing we found out her irregular beats don't go away with exercise like her sister's did, which is more of a concern, so she'll have to be watched more closely. But her pediatrician, psychiatrist, and cardiologist agree the ADHD med won't increase any risk.

Edited January 24, 2016 by Tiramisu

[nature girl]

http://www.ncbi.nlm.nih.gov/pubmed/17064428/

 

Rate, risk, and predictors of switching from attention-deficit/hyperactivity disorder (ADHD) to a prepubertal and early adolescent bipolar I disorder phenotype (PEA-BP-I) were examined in a blindly rated, controlled, prospective 6-year follow-up that included assessments at 2-year intervals. Subjects were outpatients obtained by consecutive new case ascertainment. There were 81 subjects who were 9.7 +/- 2.0 years. Subjects had DSM-IV ADHD (hyperactive or combined subtypes); a Children's Global Assessment Scale (CGAS) score of < or =60, consistent with moderate-severe impairment; and no BP or major depressive disorder (MDD) diagnoses. PEA-BP-I was defined as DSM-IV BP I (manic or mixed phase), with cardinal symptoms (elation and/or grandiosity), to avoid diagnosing mania by symptoms that overlapped with those of ADHD, and by a CGAS score of < or =60. Morbid risk of switching to PEA-BP-I was 28.5%. Significant predictors of switching in a multivariate Cox model were more severe baseline CGAS, paternal recurrent MDD, and less stimulant use. BP I in first-degree relatives, antidepressants, psychosocial measures, and life events were not predictive.

 

(Less stimulant use???)

[PeterPan]

This professor's work is useful in understanding ADHD:

https://www.doximity.com/pub/anthony-rostain-md?show_more=true#publications

Any particular article or thing he has done really standing out to you?  I clicked that and got three links.  The first one was kind of interesting because it was saying there isn't really an emphasis on long-term outcomes in the research and treatment.  Wasn't really sure what to do with that though.

[PeterPan]

http://www.details.com/story/weed-may-treat-adhd-better-than-adderall-study-says(Very small study, but it says marijuana actually increases dopamine.)

No clue, because that other study I linked found the opposite.  Sigh.  I agree that seems odd.  Makes you wonder why anyone would take it if that's the case.

[PeterPan]

Misu, that is FASCINATING.  

 

 

I think using focalin gave her a self-awarness about her impulsivity and it doesn't seem as bad as it once was. I don't think Concerta is hitting impulsivity as hard, though she seems calmer with it. If impulsivity were to become an issue again, I would use the meds on off-days.

 

The other thing is that is possible is that our relationship improved when her impulsivity was managed, so there's less negativity coming out in impulsive ways. Does that make sense?

I think that's a really important observation.  It's so easy to say oh I would never do that terrible thing (give my kid some drug that acts on the brain like cocaine), but reality is that's a HUGE change!  A life-altering change, for her to realize what her body was doing and that you were on the same team, not opposite teams.  Wow.