What do I need to know about ADD medication?

[bethben]

I have been talking for years with doctors who believe my dd has ADD.  I’ve told them I would consider it when I noticed it interfering with school work (she’s in public school).  Dd is noticing it and telling me how much trouble she’s having concentrating.  I see it at home also.  Her teacher is also noticing it and one of her degrees is in special education.

She is going through puberty so I don’t know if that matters.  I hate to put her on medication but there are so many indicators that she is definitely in the ADD range.  She loses focus on everything.  Today, eating breakfast, she was using her bacon to make circles on her plate knowing that we were running late because it took her 20 minutes just to get dressed (we were constantly yelling at her to get going).  I’m constantly redirecting her.

So, tell me about medication.  

Thanks!

[kbutton]

I am not going to pull up research for you because I trust the practitioners that helped us make the decision to medicate.

Stimulants usually are more effective than non-stimulants. (via practitioners)

Concerta (methylphenidate extended release) is known for helping with impulsivity (inhibiting behaviors--obvious ones like darting off and not-so-obvious like "shouldn't be doing that right now").

Generics are often fantastic, but they are not all identical. For example, there are two kinds of generics for Concerta, and one of them has a different time-release mechanism (created some immediate and scary mood issues here). Most people prefer the identical delivery of the time-release, but a few do better with the other than was not good for us.

Start low and go slow is the usual recommendation, but I would caution that "enough to help the kid notice a difference" but "not enough to control behavior" is not a good place to be! You want efficacy for both things!

Lots of people have to try more than one med/dose before they find a sweet spot. 

There are genetic tests that can help determine which meds are most likely to be effective for the child or adult taking them. It's not foolproof, but I guess it helps to narrow things down and give a list of Most likely to Least Likely to be effective. I do not have a link for that right now. 

 

[Crimson Wife]

Our integrative neurodevelopmental pediatrician has an excellent talk on diet and natural things to try before resorting to a pharmaceutical. It's long but worth watching.

 

He is not 100% anti-medication and in fact recommended it after my DD exhausted his list of suggestions but was still having symptoms severe enough to interfere with being able to function in a mainstream setting. He just thinks pharmaceuticals should be a "last resort" rather than the first thing tried.

[Storygirl]

We were reluctant to try meds and put off a diagnosis for years after I was convinced DS had ADHD. Before starting meds, we consulted and got diagnoses from our psychologist, a pediatric psychiatrist, and our pediatrician. Once we started the meds, however, we found that they were very beneficial for DS, so we were glad that we gave it a try. That decision can be very difficult to make, I know. One thing that may be helpful is to know that the stimulant meds have a short life in the body, so they wear off within the day. This gave me peace of mind when we first tried them, because I wouldn't have to keep them on them for an extended time if they didn't work or had side effects -- we could just stop them (of course, always consult with your doctor about things like this).

kbutton mentioned this, but I think it bears repeating -- Don't be discouraged if you try a med and it's not exactly right. It took us several months and trials of several different meds, before we landed on what worked best. The first one we tried was perhaps the most effective, but had side effects that we didn't want to tolerate. Another did nothing other than make him sleepy during the day (the only time that's ever happened!). A third made him more verbally aggressive and mean, and we discontinued that one immediately, because it was intolerable. But our doctor was patient and worked with us to figure it out. We've made other adjustments over the years.

A couple of other things I think are worth noting.

1) One of the most important effects of the medication for DS is that it enables him to interact better with family. Yes, it helps him focus on schoolwork, but it has a great effect on his impulsivity, so that he is able to be.....well, to put it bluntly, less mean and defiant (officially he has an ODD diagnosis, though he is not defiant and is a rule-follower when at school). This is a major plus for our family, though, of course, there isn't a way to know if you would see the same.

2) At least some of the meds can come in an extended release and a short-acting form. For us, the short-acting is relatively inexpensive ($40ish with our insurance plan), but the XR is very expensive (over $200 per month). Our doctor prescribes a combination of short and long acting. We use the short acting on weekends, generally, and during the summer, when DS can take a second dose at lunchtime, and he takes the XR during the school year. He also can take a short acting pill after school as a bump for the evening, when he has homework. So one thing to know is that this is possible, if needed. Often the meds wear off for kids around 3 pm, just when they are arriving home from school, and the extra dose can be helpful for getting through both the homework and (in our case) the family interactions for the rest of the day. But it may not always be needed. DS usually doesn't take that afternoon dose now, but he used to.

3) We found that the extended release had a less steady effect -- it would kind of wear off a little, then come into effect again, as the next wave of meds were released by the time controlled system. The short-acting had a more consistent effect.  There are positive and negative factors to each kind of pill, in our experience, and over time, we have learned what works best for our situation.

4) If you have a short-acting pill, the student cannot give the med to him or herself at lunchtime. You would need to leave the pills with the nurse or school office for an adult to administer. This has been the rule for all meds at the schools my kids have attended, but doubly so for the controlled substances.

5) A common side effect is appetite suppression. I can talk more about how we deal with this, if you are interested.

6) Stimulant medications can exacerbate existing tics. DS has Tourettes, but he is still able to take ADHD meds, so having tics does not mean that you can't do the stimulants, but it may mean that certain types will be better choices than others.  I can also give more details about how this works for us, if you have an interest.

7) State laws will vary, but since the stimulant types are controlled substances, doctors cannot call prescriptions in to the pharmacy, and they can't be on auto refill. I have to take paper copies of the scrips to the pharmacy every month. Our doctor will give us three months of prescriptions at a time and writes "do not fill before X date" on them. We can then call to get three more months' worth of prescriptions. But she then cannot prescribe more without a med check doctor visit. So DS has to go to the doctor periodically between well visits. Whenever she makes an adjustment to the prescription, our doctor wants to see us after just two or three months, to see how it is going.

8 ) If your daughter thinks taking meds is something she would like to consider, it's worth thinking about, because it's important to have buy in from the child. By that, I mean that if the child refuses to take the meds, it can become an area of contention, which no one wants, of course. Her possible willingness to try, and her awareness that she could use help focusing may be signals that it might be a good time to think about trying the meds.

9) People do worry about the medications flattening out the child's personality, so that they are no longer "themselves." The wrong med, or too strong a dose, and this could be a side effect -- I'm not going to say that it can't appear to happen. But I'll say that it shouldn't. If that kind of shift happens, talk to the doctor right away for a med adjustment, because it does not have to be that way, with the correct med at the correct dosage. The child may seem calmer, but shouldn't seem flat.

10) With a few of the meds, we could tell immediately (same day, even same hour) whether it was having an effect. With a couple, it took a few days or maybe a week for us to notice all of the ways that it was helping and/or causing side effects. So you do have to be willing to give it some time. And you may notice some effects that the child does not feel. Now that he is a teen, DS is starting to be more aware of how the meds make him feel, but he used to say that he couldn't tell the difference (though we always could). This is going to vary, depending upon the child's self-awareness, as well as how attuned she is to how her body feels to her.

Feel free to ask any more questions you may have. There is a lot to think through.

[Storygirl]

Also, this is a minor thing, but you should know...

Doctors do not give a diagnosis of ADD any more. I notice you put ADD in your title. It is always ADHD, even if there is no hyperactivity. They designate it by type. So you could have ADHD inattention type, ADHD hyperactive-impulsive type, or ADHD combined type.

You can read more about the differences here:

https://www.webmd.com/add-adhd/guide/types-of-adhd

[bethben]

Storygirl, thank you for all the information!  I am thinking that she will need medication.  She is also constantly angry and feeling like we're trying to rush her constantly (yes - we are--45 minutes to get dressed is not going to fly around here).  If medication changed her personality a bit and calmed her down, I would be fairly ecstatic.  She is causing a constant firestorm in our house right now and wonders why no one in the family wants to interact with her.  I am making notes and will ask about extended release and short acting.  Right now, until I can talk to the doctor, I am dosing her with coffee and her teacher has agreed to let her draw during lectures in class as long as she knows she is listening.  We are beyond trying to treat this naturally. I have been giving her supplements to support her brain for a few months and they work a little, but not enough to really help.  We eat as healthy as a diet as we can and stay away from processed foods and extra sugars for the most part.  

[Storygirl]

So that you know how much support I feel for you in your situation, i will share a bit of my story.

When DS14 was diagnosed, he was nine, almost 10. Third grade. Up until that time, he had always been homeschooled, but I had reached a breaking point. I was breaking emotionally. Not just due to dealing with him, but also because of stress from my other children, as well. I was at an end of my personal resources, and I spent a lot of time crying. Daily. But I didn't know what to do, because I knew that all of them had learning struggles (not yet diagnosed), and I was afraid their needs would not be met in school. Until then, I had been determined to set aside my own misery, in order to put their needs before my own.

But I was desperate, so I finally told DH that we had to put the kids into a local Christian school, though it was the middle of the year. They had to have admissions testing and meet with the principal. And DS14 was not accepted, though the other children were.

It was devastating.

In hindsight, we probably should have enrolled in the public school, but I was extremely hesitant to do so in the middle of a school year, with no IEPs, so I kept going with the homeschooilng for the remainder of that school year. And the next year as well, because by that fall, we had decided we would be relocating, and I didn't want to start a new school and not even finish a year before moving.

The one GOOD thing that came out of the school rejection was that it spurred me to get evaluations for DS, not only for ADHD, but full neuropsych evaluations, which ended up being very, very valuable. And evaluations for another of my children, as well, after that.

I was really at an extremely low level, personally, before we got that school rejection. The demands of mothering and teaching my children seemed too great a burden for me, yet I had to do it anyway. I remember saying to DH (who was always very helpful when he was home), "Here is how it feels to me. How stressful would it be for you to have people working for you at your job who were resistant to being taught, were defiant and argumentative, would not listen, could not seem to remember instructions from day to day or even minute to minute, so that they needed constant guidance, yet were rude and ungrateful and uncooperative......and then you had to take them home with you at night and cook them supper and put them to bed." I felt trapped.

Years later, having had my kids enrolled in school for several years, and having DS's ADHD treated, and getting a team of people to help with the LDs.....it's better. We still have hard times, but it is no longer a constant stress on DH and me, because we have some support. And the ADHD meds are a major aspect of the support, in our situation. They don't solve all of the issues, and I don't expect them to. But they take the edge off DS enough for our family dynamics to be more workable. And so they are very worth it for us. And I say "us" deliberately, because though DS takes the meds, they have a positive effect on the whole family. And they help him have success at school, as well, since we can't homeschool any more. I loved the idea of homeschooling, but I just can't, ever.

And it is okay for our family to have made these choices.  I pray that your family will find the support that you need to get to an okay place again. as well.

By the way, my children were adopted internationally, as well.

((hugs))

Edited September 19, 2018 by Storygirl

[kbutton]

13 hours ago, Storygirl said:

9) People do worry about the medications flattening out the child's personality, so that they are no longer "themselves." The wrong med, or too strong a dose, and this could be a side effect -- I'm not going to say that it can't appear to happen. But I'll say that it shouldn't. If that kind of shift happens, talk to the doctor right away for a med adjustment, because it does not have to be that way, with the correct med at the correct dosage. The child may seem calmer, but shouldn't seem flat.

1

I will note that one of my kids did get more flat, but it was largely the impulsivity was tamped down, and the ASD was more prominent. The flat affect was really the ASD, not the meds, and the impulsive behavior had been making him seem more naturally animated. Just in case that may be a factor for you. 

My other kiddo is both more himself (back to being kind and considerate) with meds, but also less himself in that he's not as goofy. But again, he was "more" goofy than what was always fun due to his ADHD. So, sometimes different is not necessarily bad, but it is an adjustment! 

3 hours ago, bethben said:

Storygirl, thank you for all the information!  I am thinking that she will need medication.  She is also constantly angry and feeling like we're trying to rush her constantly (yes - we are--45 minutes to get dressed is not going to fly around here).  If medication changed her personality a bit and calmed her down, I would be fairly ecstatic.  She is causing a constant firestorm in our house right now and wonders why no one in the family wants to interact with her.  I am making notes and will ask about extended release and short acting.  Right now, until I can talk to the doctor, I am dosing her with coffee and her teacher has agreed to let her draw during lectures in class as long as she knows she is listening.  We are beyond trying to treat this naturally. I have been giving her supplements to support her brain for a few months and they work a little, but not enough to really help.  We eat as healthy as a diet as we can and stay away from processed foods and extra sugars for the most part.  

2

My 2nd kiddo fit the bolded, once he hit a certain age, but he had always been pretty sweet when he was younger. The meds don't fix the slowness entirely, but he feels less picked on when he's being herded out the door. He takes things FAR LESS PERSONALLY when he's on meds, so the sweetness is back. Also, he feels more in control of his focus and time instead of being out of both perpetually. (The rest of the slowness is due to super slow processing, lack of coordination, etc. plus some things like a lack of understanding of time--an EF skill that isn't necessarily fixed by meds!)

[PeterPan]

23 hours ago, bethben said:

Storygirl, thank you for all the information!  I am thinking that she will need medication.  She is also constantly angry and feeling like we're trying to rush her constantly (yes - we are--45 minutes to get dressed is not going to fly around here).  If medication changed her personality a bit and calmed her down, I would be fairly ecstatic.  She is causing a constant firestorm in our house right now and wonders why no one in the family wants to interact with her.  I am making notes and will ask about extended release and short acting.  Right now, until I can talk to the doctor, I am dosing her with coffee and her teacher has agreed to let her draw during lectures in class as long as she knows she is listening.  We are beyond trying to treat this naturally. I have been giving her supplements to support her brain for a few months and they work a little, but not enough to really help.  We eat as healthy as a diet as we can and stay away from processed foods and extra sugars for the most part.  

Have you done evals yet? A ped will give you meds, sure, but without psych evals you don't have info to advocate in school, to make sure EVERYTHING has been identified, or to make changes at home. It sounds like she needs increased structure, visual schedules, tech, the right words for what is going on, etc. Meds do not cure ADHD. They just bump speed and attention enough to let her use her tools. She needs tools and to get them you need a psych eval and probably some CBT.

ps your dose of caffeine is probably too high. Google for charts. Could make it worse and the half life of caffeine is short anyway 

Edited September 20, 2018 by PeterPan

[cintinative]

I don't want to take away from the OPs question, but could some of you comment on if you have had to change dosage over time? Last fall my DS (then 10) went on methylphenidate and it was like a miracle occurred. School was going so much better.  I was so encouraged.  Then, around spring, when we were "wrapping up" our main school year and going into the summer session of a lighter amount of school, things started to get harder and harder. At first I thought it was because we were all sort of burned out. Then over the summer it just kept getting worse. I blamed it on the lack of a real rigid schedule. Then fall arrived and it seemed just like the prior fall, except we were on medication.  So I called and they increased his dosage from 20 mg to 30 mg. Unfortunately I haven't really noticed a difference. I am really hesitant to do any more increases. My best idea at this point is to make him do some form of vigorous exercise.  Last fall he was mostly having the inattentive behaviors. Now I am noticing both inattentive and hyperactive behaviors.  Could this be hormone related (puberty)? He is 11 now.  

Does anyone have BTDT experience with medication not working as well anymore? TIA!

[Crimson Wife]

Just now, cintinative said:

I don't want to take away from the OPs question, but could some of you comment on if you have had to change dosage over time? 

Does anyone have BTDT experience with medication not working as well anymore? TIA!

Yes, we have had to change medications a few times since my DD first started in 2014. She started with Methylin (short-acting version of Ritalin) and then was on Metadate (extended release version) for a while. Adding Clonidine at night helped with the hyperactivity. Then last year, she started getting anxiety symptoms so after trying various combinations of drugs and dosages, she's now taking Prozac and Clonidine but no stimulants.

[Ravin]

Needing to increase meds after/during a growth spurt (and the brain can have growth spurts in development that aren't visible from outside) is not unusual at all. Puberty can also bring other issues with it. My little brother was prescribed a second medication to deal with aggression at age 11. How is your DS sleeping? Poor sleep is the root of much bad behavior IME.

[4KookieKids]

On 9/18/2018 at 2:51 PM, Crimson Wife said:

Our integrative neurodevelopmental pediatrician has an excellent talk on diet and natural things to try before resorting to a pharmaceutical. It's long but worth watching.

 

He is not 100% anti-medication and in fact recommended it after my DD exhausted his list of suggestions but was still having symptoms severe enough to interfere with being able to function in a mainstream setting. He just thinks pharmaceuticals should be a "last resort" rather than the first thing tried.

 

For anyone else interested, here’s the full length video. I already watched it twice...

 

ETA just found this updated one from 2014 so I linked it instead. It is good stuff!!

Edited September 27, 2018 by 4KookieKids

[Terabith]

When my daughter had her neuropsych evaluation, he said mild ADHD without hyperactivity or impulsivity.  I don’t think he did any actual testing for it, though.  The main issue was her processing speed and working memory are really, cripplingly low, while her IQ is very high.  He suggested trialing meds to see if it would help.  We had had amazing results from anxiety meds, and the short acting nature of ADHD meds made me willing to try.  We started with a nonstimulant, since she has anxiety and was underweight at the time.  It really had no effect, so we tried a short acting stimulant.  It...definitely improved her processing speed, but it changed her personality.  Made her much more extroverted and focused, but in an almost manic way.  It made me very uncomfortable, so that was the end of our experiments with that kind of medication.  We might consider trying again when she learns to drive, since she’s gone through puberty and I worry about processing speed while driving.  But I honestly don’t think she is ADHD, so it’s a different situation. And she has improved with age.  

[PeterPan]

2 hours ago, Terabith said:

, so we tried a short acting stimulant.  It...definitely improved her processing speed, but it changed her personality.  Made her much more extroverted and focused, but in an almost manic way.  

Your stimulant meds are methyl donors, so it would be really tricky to tolerate them if you have COMT defects, VDR issues, anything that leads you to not tolerate methyls well. And yes, there's a lot of discussion that what people are calling manic and bipolar is linked to over-methylation. You could test it by giving niacin and seeing if it pulls them down. There's also data on the increase in diagnosis of juvenile bipolar and connecting it to ADHD meds, and I think that's why.

What you're describing is why we haven't tried ADHD meds on my ds. The ped said the non-stimulant meds wouldn't do what we need and the stimulant meds would aggravate the aggression and methylation-related issues. I still keep pondering them, because if there were a way it would be good.

If you're going to try them again, maybe what you want to do is pair them with something to pull down the methyl levels. If she has a TPH2 defect, then taking 5HTP, which comes as a time-release (which for us lasts 12 hours), is pretty slick. And if you're thinking through the logic then of short-acting meds, they're dumping a ton of methyls, boom, meaning you'd need a solid dose of something (niacin) to get those methyls down. Whereas doing time-release, extended-release stimulant meds you could pair with a time-release thing that hangs in the system longer to get those methyl levels down. That would be like 5HTP (time release) or vitamin D which is fat soluble and hangs longer.

My dh's theory on driving is give them exposure to other kinds of driving and machinery (mowing, etc.) earlier. I also read somewhere to get them a clunker so the really feel the roads. My dd had a car that, if you tried to go over the speed limit, would feel so awful she was NEVER tempted to speed, lol. That road feedback is really helpful.

Btw, you can also take l-tyrosine for attention. It's a precursor to dopamine. Can affect 5HTP levels unfortunately.

[Terabith]

I haven't run genetics on her yet.  I ran them on me, but honestly, I couldn't make heads or tails over it, even after spending hours on it, and other than a couple clear things (apparently I have a gene associated with not really making vitamin D, which explains why i'm always deficient, and that a certain antidepressant class works well for me, which I'd already figured), I really couldn't figure it out.  I think one MTHR gene was one was one way and the other the other way.  I should try to make sense of it again, but it was SO baffling that I just don't know that I can face it.  I make her take vitamin D, since I have that gene and because when we ran her D, it was super low, too.  

We have a family bipolar history, so I was nervous about the meds.  But the symptoms went away as soon as we took her off them.  Really, it was more like she was high on speed than anything, which, I guess she was.  I actually had more concerns about the SSRI they put her on for anxiety when she was five, because there's a major history of that triggering bipolar stuff, but she didn't have any problems like that.  

I wish we had stuff they could drive, like riding lawn mowers and stuff, but we don't.  My older daughter is coming up on time to get her permit, and she has no experience.  They've only been able to ride in the front seat for a year or so.  

[PeterPan]

My mom tried to teach me herself at the typical time and I SO was not ready. I took driver's ed when I was in grad school (age 21) and got my license right before I got married (age 22). I'm definitely in the later is fine camp. 

[trulycrabby]

On 9/20/2018 at 9:23 AM, cintinative said:

I don't want to take away from the OPs question, but could some of you comment on if you have had to change dosage over time? Last fall my DS (then 10) went on methylphenidate and it was like a miracle occurred. School was going so much better.  I was so encouraged.  Then, around spring, when we were "wrapping up" our main school year and going into the summer session of a lighter amount of school, things started to get harder and harder. At first I thought it was because we were all sort of burned out. Then over the summer it just kept getting worse. I blamed it on the lack of a real rigid schedule. Then fall arrived and it seemed just like the prior fall, except we were on medication.  So I called and they increased his dosage from 20 mg to 30 mg. Unfortunately I haven't really noticed a difference. I am really hesitant to do any more increases. My best idea at this point is to make him do some form of vigorous exercise.  Last fall he was mostly having the inattentive behaviors. Now I am noticing both inattentive and hyperactive behaviors.  Could this be hormone related (puberty)? He is 11 now.  

Does anyone have BTDT experience with medication not working as well anymore? TIA!

Is she taking rest days away from the medication? DS14 takes weekends and summers off of the medication, and will also skip meds on school days if he doesn't have math or biology. 

[cintinative]

11 hours ago, trulycrabby said:

Is she taking rest days away from the medication? DS14 takes weekends and summers off of the medication, and will also skip meds on school days if he doesn't have math or biology. 

He doesn't take rest days. Can you explain why we would do this? Have you noticed that it helps him?

Edited September 28, 2018 by cintinative

[PeterPan]

Fwiw, I think that dose is still quite small. I've talked with people with 6 yos on higher doses. Yes, a lot of people take breaks to reset the system. Our ped said you shouldn't have to, but when I talk with people irl they do if they can safely. My dd will take breaks randomly and for maybe a month if she's sick, on break, that kind of thing. 

My dd started at a starter dose, was on the line, and bumped up after a year when it became obvious she needed more. It could be tolerance, but I think it was also that she was having higher demands in college than she had in high school. With a younger dc, I think you have them growing, their demands increasing, etc. I think you just have to roll with it. 

Yes, put him in activities that get him moving or get habits, definitely!! My ds has fast twitch muscle fibers (which we found through genetic testing), and he has always just had this need to MOVE and sprint. People were like oh that's the autism, that's ADHD. Well it's also that his body is designed to MOVE and needs to move. To me, increase the activity level, see if it helps, then bump the meds. It's a combo approach of behavioral approaches, lifestyle, cognitive choices, AND meds. 

The other thing I find, and I don't know if this is an issue for your dc or not, is that sometimes the ADHD person isn't the most organized at using their BEST time to do their most attention-hogging work. Like if you take an XR or ER med, you still might have windows that are better. I'd watch my dd take her meds and then use that focus to do OTHER things and then end up staying up late (as her meds wore off!!) to do her college homework. I'm like darling, that is the DUMBEST THING EVER. So they could chart, realize their best times, and organize themselves better too. I have totally refused to pay for any kind of non-ER/XR meds for my dd to get her through the evening after her regular meds wear off. I think the potential for abuse in college is too high, that it's just too much temptation. And maybe that's super mean mama, but it's safer. So she has to organize her life and work when her meds are in her system or suffer with working more slowly. She usually just tops it off with caffeine in the evening I think if she has that issue. She knows and she knows WHY we aren't doing that. And that's just unfortunate reality. I doubt even the best of us would resist taking more if we had a bottle of them sitting there. That was what the ped offered, and I was like whack whack NO WAY.

360 Thinking and SKLAR both have excellent materials on time and EF issues in ADHD. A couple years ago 360 Thinking had a webinar I had my dd watch. Anything you can do along that line is wise. Anything to make them more aware of themselves, reading books about EF, learning strategies, etc. is good. You want them to become an active participant, self-monitoring and making suggestions on how they can do better. There's also the Educational Therapist field that tries to work with that, helping them learn EF skills and function better. Some psychs will specialize in ADHD and do CBT. It's all good, just whatever you can find. 

[Storygirl]

We have adjusted the dosage a number of times over the years and just increased it again. This time, we noticed it was not lasting as long through the day, and we also noticed that DS14 was eating more. Eating more is not a bad thing for him! He is very thin. But normally his meds suppress his appetite, so when that side effect diminished, it was a sign for us that his meds were acting less effectively over all (we do have strategies for getting him to eat enough when his appetite is suppressed, so increasing the appetite was not our primary concern; it was just a change that we noticed).

We do not take med breaks generally, because DS's meds help him not only with schoolwork but also with interpersonal relationships at home (as well as boosting EF in general). But we do use a different version over the summer and weekends -- short acting instead of extended release -- to accommodate a different eating schedule and work around the appetite suppressant side effect.

cintinative, there are a couple of options for you to consider and discuss with your physician. These options may not be right for your family, but if you are aware that they exist, you can consider them and get a medical opinion.

* We have a secondary med that DS takes at night (Clonidine). There are multiple reasons that he takes it, but one of them is that it can help with ADHD. I've heard others mention taking a non-stimulant type of med at night in conjunction with a stimulant during the day. So it is possible to add on a secondary med.

* We have found that the extended release version of the same type of med works slightly differently than the short acting version, so trying a different variant might make a difference.

* I know that others have noticed that different drug makers will produce generics that work differently, even if they have the same dosage. We have not noticed this ourselves, but I'm not discounting the observations of others, and this kind of thing might affect you. If you have switched generic makers recently -- either because the pharmacy had a different source, or because you used a different pharmacy -- you might see a different effect.

* You may consider trying a different kind of med, since there are options. We tried many before we found what works for DS, so we are inclined to stick with what we use. But I know that others have switched things up, to good effect.

* Consider whether it may be wearing off sooner than it was previously. DS14 does sometimes have a little rebound effect, where he gets extra spunky when his meds wear off in the afternoon. Not always, but I noticed this especially around 5th grade, when we would have been about 11. It was not only the meds, but also the transition from school to home at that time of day, for him. Our doctor prescribed an additional evening dose of a short acting med, to get through the evening.

You may be aware of these ideas already.

We did have to make some med adjustments here during the 5-8 grade years. I'm not sure if it is puberty hormone related, or just from the body growing, but DS's dosage has gone up a few times over those years.

[PeterPan]

33 minutes ago, Storygirl said:

But we do use a different version over the summer and weekends -- short acting instead of extended release -- to accommodate a different eating schedule and work around the appetite suppressant side effect.

Ooo, I really like that idea!! Gonna pass that on to dd.

[trulycrabby]

15 hours ago, cintinative said:

He doesn't take rest days. Can you explain why we would do this? Have you noticed that it helps him?

The breaks from the medication have helped DS14 avoid tolerance to the meds and have helped us keep the dosage low during the three years he has taken it. 

 

[cintinative]

8 hours ago, trulycrabby said:

The breaks from the medication have helped DS14 avoid tolerance to the meds and have helped us keep the dosage low during the three years he has taken it. 

 

 

Thank you. I had not considered tolerance at all and that makes sense.  Is tolerance a factor with all ADD medications or just some of them?

 

[PeterPan]

2 hours ago, cintinative said:

Thank you. I had not considered tolerance at all and that makes sense.  Is tolerance a factor with all ADD medications or just some of them?

There are only two major classes of stimulant meds and then the non-stims. I think all the stimulant meds have issues with tolerance, yes. I think what Story was describing was doing an XR med during the school year (maybe with a topper to finish getting them through the day) and then in the summer going to only a short-acting med that would be in the system 3-4 hours. I think there was an online class on Coursera a few years ago about ADHD and meds. You could see if it's still available.