DS 15 ADHD, other? (ASD?) - School Failure - Writing/Thinking - Advice needed

[Heathermomster]

I want to jump into this convo, but I don't have much time.

OP, when is the school year over?  When are the assignments due? 

My 2e maths/handwriting/reading SLDs eldest child has completed research papers and writing assignments.  Your child is more than able to learn to write with specific instruction, practice, maturity, and accommodations.  Teaching an older dysgraphic student can feel uncomfortable because they require tons of support, and they don't naturally intuit the process.  

For son's last big writing assignment, I picked up IEW's Research Paper curriculum.  The back of the curriculum provides organizers to help structure different types of papers.  Each paragraph has a descriptor to explain the purpose of each paragraph.  For bibliography cards, we used an app called EasyBib.  His notecards were typed up on paper.  IEW teaches an alternative to bib index cards.  For book annotations, DS used sticky notes and attached them to book pages that seemed interesting.  He kept two outlines.  One outline maintained the overall structure, and the other organized individual paragraphs and was written on a dry-erase board.  Besides typing, DS also used speech to text software on my Ipad.

Narrowing the topic to develop a thesis was difficult.  DS struggled to see that he needed to fully understand the subject prior to writing.  He really struggled to sit with a book and sticky notes in hand and DO THE WORK.  It was difficult for DS to recognize that the writing itself is a thinking and arguing exercise.  He had to shift his thought process from style to substance. He did it in the end, but the process was difficult.  Basically, I came along beside DS and walked his butt through the process.  He wrote his paragraphs and we edited together.  There were multiple rewrites.  Editing was fun because we used the text to speech function on the PC and listened to the paper.  You can detect all kinds of writing errors that way.  One thing that DS struggles with is starting early enough.  He hates doing things far in advance.  

The best therapy my DS ever received for dysgraphia was work with a ped PT, typing instruction, and work with a writing tutor during 7th and 8th grades.  Organization work has improved after meeting with a CBT for EF, brain maturity, and mom supports.  In order for any of these things to work, your child has to express a willingness to try and see his need for help and support.  

I need to go.

 

 

[geodob]

It would be well worth trying the Methylphenidate,  as that will increase the levels of Phenethylamine.   Which in turn, will increase Epinephrine,  Nor-epinephrine and Dopamine.

You wrote that you want to figure out what Methylphenidate does to his brain?  But what it effects, is the way that signals sent through the brain. Along nerves or neuro-transmitters.   Where the signal is a complex chemical process. Basically how it works, is that when a signal is recieved by a Neuron cell ?  Each Neuron,  is surrounded by different Receptors.  Where the signal will turn certain Receptors On.  

How Receptors are turned On?  Is that each Neuron Cell, has a collection of Sacks.  Where it stores the different chemicals.  For example,  their is a Sack where Epinephine is stored, and another for Nor-Ephinephrine.  Though Epinephrine, is the official term for Adrenaline.  Where Adrenaline heightens our attention.  So that when a Neuron Cell recieves a signal to pay attention?  An enzyme takes a molecule of Epinephrine out of its sack, and places it on the Receptor for it.  Which it leaves in place, until the heightened Attention is no longer needed.  When it removes the Epinephrine, and puts it back in Sack.   Turning Off the Receptor.

This 'putting it back in the sack', is called: 'Re-uptake'.    Though this Re-Uptake process, is where many dys-functions occur.  Where the molecule is removed too early from the Receptor, turning it off.    So that various medications have been developed,  which prevent this 'too early removal'.    Which 'inhibit the re-uptake',  and are called 'Re-Uptake Inhibitors'.

So coming back to Methylphenidate ?  It is a Re-Uptake Inhibitor,  that prevents the Epinephrine and Nor-Epinephrine.   From being removed from its Receptors.   So the Adrenaline remains in place, and maintains attention.  

 

Though supplements need to be taken with caution, when taking medications such as Methylphenidate.   Where I note that SamE was mentioned.  When taken with Methylphenidate, it can increase the levels of another Receptor molecule called Serotonin.  Which can cause a serious condition, called Serotonin Syndrome.  That can even become life threatening.

[Pen]

Geodob, Are you sure that methylphenidate is a serotonin reuptake inhibitor such that it and SAMe together are likely to lead to Serotonin syndrome? I thought it is somtimes prescribed along with an SSRI if there is concomitant depression. And that it inhibits dopamine and epinephrine reuptake. But not serotonin.

[Pen]

or dopamine and norepinephrine?

[Pen]

Geodob, I'm concerned that OP --who already seems to be extremely reluctant to have her son take any medicine for his ADHD situation -- may be unduly frightened that death is likely to result.

[geodob]

Pen,  the main effect of Methylphenidate, is to inhibit the re-uptake of Dopamine and Nor-Epinephrine.   But a secondary effect, is that it inhibits the re-uptake of Serotonin.

This re-uptake is carried out by 'Transporters',  and the Transporters are blocked.

You wrote that it is sometimes prescribed with an SSRI for depression. Where the SSRI is also Blocks the Transporter.  This doesn't cause a problem, as they are both 'Transport Blockers'.

Though their are other steps in the process, with: 'serotonin precursors, serotonin agonists, serotonin releasers'?  The 'Precursors' are the molecules that serotonin is made from.  The 'Agonists' put the molecules together and form Serotonin.  Then the Serotonin 'Releasers',   cause the Serotonin to be Released and act on the Neurons.

With SAMe, it acts on the Releasers and increases the amount of Serotonin being released.  But if one is taking an SSRI Transport Blocker, then this increased Release of Serotonin?  Will cause an accumulation of Serotonin, as it isn't being removed !  Serotonin also regulates our 'Central Nervous System' CNS, and our 'Para-Sympathetic Nervous System' PNS.

When too much Serotonin accumulates, is causes the CNS and PNS to dys-function.  Which is what Serotonin Syndrome is.  

But this is why any supplements need to be taken with caution.  Which first need to be confirmed that they dont have an effect on the 'Precursors, Agonists or Releasers'?   As they could cause an excess of Serotonin?  One particular herb of concern, is St Johns Wort.  As it acts on the 'Precursors, Agonists or Releasers', all at once. 

Though rather unduly frightening the OP.   Being very cautious about taking any supplements or herbs, will make Methylphenidate much safer to take, and probably reduce any side effects.

 

[PeterPan]

I'm doubting the effect of the methylphenidate on the serotonin is as dramatic as taking an actually SSRI. We've been combining sam-E on top of Vyvanse just fine. So you've got maybe a theoretical path but not one that is going to be significant in reality.

Again, if the doc is giving you the list, he's actually used it in that combination before and knows how it rolls. The worst gig with sam-E is if the person is an over-methylator. You ain't never had fun till you've amped the methyls on someone who is already over-methylated. But just the odds of that are super low, statistically, and you'd already have symptoms of the over-methylation that would have caught the doc's attention.

Also, the half-life on this stuff is pretty reasonable. Google it for each thing, but your half life is going to be very brief. To imply that someone will start a Ritalin scrip, add sam-E. and in one day go directly to serotonin syndrome just isn't reasonable. It's not how the things work. It takes TIME to get the serotonin levels up, time for the body to use the parts and actually make it. And you would see symptoms that ok, that dose is more than I needed, and you would back off. Even if a dose is too high for the methylphenidate or the sam-E or some combination, the most you're talking is 12-24 hours of un-fun. We've btdt. It happens. Life happens. But to scare the pants off someone, like this is very possible to happen, boom, it's not reasonable. You would see it coming and back off the dose. The levels would go back down and you'd be fine.

The one thing that IS super issue with stimulant meds is unrealized heart issues. There are some docs who won't prescribe meds without a heart scan first. For real. Not every doc or many, but I'm just saying you want a serious possible side effect, THAT is the one to be thinking about. There are isolated cases of kids starting stimulant meds and having a heart attack, boom, and dying, because it aggravated unrealized heart problems. That's SO UNCOMMON statistically that many docs aren't screening for that. But if you want to talk freaky stuff that is actually statistically possible (even if it's like 1:50000 or something), sure, go there.

[PeterPan]

And the reason docs, counselors, etc. are using sam-E instead of SSRIs is because there's so much data on teen suicide on SSRIs. 

We can sit here and go in circles all day, but this was actually a doctor saying he's done this mix before, it works, it's reasonable, it's effective, it's warranted. It's not like she went to the health food store and read something in some book.

[Pen]

"this was actually a doctor saying he's done this mix before, it works, it's reasonable, it's effective, it's warranted." I cannot do "like" feature anymore. But would have "Liked" if I could and wanted to emphasize this.