Mini-Update: Medication Trial & Checkup

[lizzywednesday]

For those of you who have been following the saga I've had with DD and her ADHD (diagnosed at the end of October), here's a mini-update:

On 3/8, we had her well-check. She is healthy as a horse, doesn't show signs of scoliosis, stands just over 4' tall, and is in the 63rd and 70th percentiles for height & weight, respectively. (She's a very solid little girl.)

On 3/10, I met with her doc to discuss medication options, what goes into a trial, and starting meds. We'd intended to start on 3/13, but DH wasn't comfortable starting her on meds with the potential of a snow day or two (we had 3/14 off due to snow/ice, and 3/15 was a 90-minute delay), so we held off 'til the end of the week.

On 3/15, I attended a meeting designed to give an overview of parenting kids with ADHD. The things mentioned in the presentation and resources listed on the handouts will be very helpful as I navigate DD's ADHD and DH's ADD (though maybe it should also be ADHD per DSM-V) and figure out how I can modify my parenting to so I explode in frustration less often.

On 3/16, we started our trial of Adderall XR. She earned a stamp at school (followed classroom rules, stayed focused on classwork, etc.) and was fine at home, but didn't eat dinner ... and was up past 1:30am. The next day, she also earned a stamp ... but was then up past 3:00am.

Yesterday, she took her meds in the morning, earned a stamp, did fine through homework and Daisies, ate dinner (YAY!), and went to bed on time.

She seems to be responding well to this dosage and medication; we have a follow-up on Friday, 3/24, to see what else is going on.

Fingers crossed that the two nights she didn't sleep were related to the completely messed up schedule last week, with Sunday starting Daylight Saving Time and the storm Monday into Tuesday.

[trcy]

Great update. Fingers crossed things continue to go well!


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[hillview]

hurray! great update fingers crossed!

[sdjeppa]

Great update! My DS2 (5/2010 birthday) just started Adderall XR in January, so I have been following your research. He doesn't eat much for lunch, but makes up for it at home. So far, the low dose we are on is also working well.

[lizzywednesday]

Great update! My DS2 (5/2010 birthday) just started Adderall XR in January, so I have been following your research. He doesn't eat much for lunch, but makes up for it at home. So far, the low dose we are on is also working well.

DD has been eating lunch just fine, though she's been a little low on dinner consumption.

We have our follow-up tomorrow to check her stats.

[egoldber]

The first couple days my younger DD started on ADHD meds, she also stayed up really late. But that was only the first couple days, and then she seemed to get used to it.

[lizzywednesday]

So, the doc says DD's body is tolerating the meds fine (and she actually grew half an inch from her well check) but she wants to increase her dose by 5mg starting next week.

With this news in mind, DD did not earn a stamp at school (but her schedule was disrupted - the appointment was midday) and needed a lot of redirection in class ... and, when the meds were wearing off, she was tearful and almost inconsolable. So the first bit feels like evidence that an extra 5mg would be a good idea, but the tears (like almost 2 hours of sobbing and sulking after school, which she has not done all week) make it feel wrong.

DH is adamant that DD should NOT have her dosage increased - she's been responding well to the meds, and he doesn't see the sense in upping the dose right now.

I will have to do some more reading about how medication trials work, etc.

In the meantime, it may be moot because the pharmacy emailed me that the 5mg pill was out of stock, so we have a couple more days to work out what's going on ... and to phone her doc on Monday to report the crying jag.

[trcy]

So, the doc says DD's body is tolerating the meds fine (and she actually grew half an inch from her well check) but she wants to increase her dose by 5mg starting next week.

With this news in mind, DD did not earn a stamp at school (but her schedule was disrupted - the appointment was midday) and needed a lot of redirection in class ... and, when the meds were wearing off, she was tearful and almost inconsolable. So the first bit feels like evidence that an extra 5mg would be a good idea, but the tears (like almost 2 hours of sobbing and sulking after school, which she has not done all week) make it feel wrong.

DH is adamant that DD should NOT have her dosage increased - she's been responding well to the meds, and he doesn't see the sense in upping the dose right now.

I will have to do some more reading about how medication trials work, etc.

In the meantime, it may be moot because the pharmacy emailed me that the 5mg pill was out of stock, so we have a couple more days to work out what's going on ... and to phone her doc on Monday to report the crying jag.

Full disclosure, I am not knowledgeable about stimulant ADHD meds. DD is on the lowest dose of Intuniv (a non-stimulate, so a totally different type of medicine) and I have no plans to to increase her dose unless the current on stops helping. I would find out why the doc wants to increase the dose when the current dose is working.


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[egoldber]

There is a lot of art to finding the correct stimulant dose. If she is on a low dose for her age/weight, then it is not uncommon for a doctor to want to continue ramping up until they get to what is considered a more common dose. From this, it sounds like 30 mg is a typical dose of Adderall XR: https://www.drugs.com/dosage/adderall-xr.html

The emotional crash in the afternoons is called rebound, and again is not uncommon with ADHD meds. Like the insomnia, this may be a side effect that disappears as she gets used to the medication. It is possible that an increase in meds may actually help with that. Some kids also take a low dose, short acting booster in the afternoons so that the meds wear off more gradually.

If you find that the Adderall is not a great fit, then there are other meds to try. Doctors seem to prefer to try Adderall or a methylphenidate based (e.g., Ritalin) med to start with, but there is no reason to prefer one over the other. Some kids do better on one class if med vs. the other.

[lizzywednesday]

There is a lot of art to finding the correct stimulant dose. If she is on a low dose for her age/weight, then it is not uncommon for a doctor to want to continue ramping up until they get to what is considered a more common dose. From this, it sounds like 30 mg is a typical dose of Adderall XR: https://www.drugs.com/dosage/adderall-xr.html

Thanks, Beth. 30mg is the max dose for a child under 18, or so DH understands. He is really adamantly against DD increasing her dose. She is currently on 10mg.

I think that, at this point, we're really trying to avoid having her take meds at school unless it's unavoidable because she doesn't know how to swallow pills yet and is unwilling to learn. I give her the contents of the Adderall capsule mixed in a spoonful of pudding after she finishes her breakfast every morning, which is what we did for the amoxycillin when she had strep the last two times.