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  1. #1
    lizzywednesday is offline Red Diamond level (10,000+ posts)
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    Default ADHD and Tantrums

    Let me preface this by saying that DD had a lot more tantrum-like behavior without her meds, so it may simply be a sign of a bad week (or a lousy night's rest because she did refuse to go to sleep when I sent her at 8:30p ... and was still up messing around with her toys & window blinds at 10:30p) but here goes:

    Over the past several weeks, DD has had a few destructive tantrums both at home and at school.

    At home, she has broken her bedside lamp (I still don't know how, but she snapped the bulb socket out of a PBK lamp), had a fit about not understanding a new subtraction task at school (broke a pencil & tore the cover of her math book), acted out for 90 minutes at a Girl Scout meeting with another troop (apparently, she was upset that another child was "yelling" in the space - DD's school cafeteria), acted out for 20 minutes at another off-site meeting (while visiting a food bank to hear the charitable organization's director speak, DD proclaimed she was bored after being told off for trying to head to a 2nd floor because she was "just so curious" then she started head-butting me and flipping the lights on & off until she finally asked to use the restroom) and had another fit where she detached the glass cover of her ceiling fixture and dropped it (it shattered on her bedframe, spewing glass all over her bedding, her detritus-covered floor, and most of her room.)

    Today, she got into an argument with a child (who has been a problem for her for at least a week, perhaps more) about a board game she and another classmate were playing, which resulted in both boys teasing her ... and the original child who'd begun the issue ended up with a bite. (He claims DD bit him. While I'd like to believe that she didn't, and she says she didn't, I wouldn't put it past her to bite or scratch this kid.)

    Most of her tantrums seem to happen when things change from her expected pattern - the new location for the Scout meetings, taking her tablet (or a game/app on the tablet) away, being taunted/teased, having a substitute teacher, etc.

    We have been trying to help her feel empowered enough to speak with whoever the on-site grownup is when incidents happen at school.
    For things at home, I try to lay out clear expectations for her behavior BEFORE we go into a new situation, but she isn't always a great listener. (And, well, she sometimes can't help it if her meds have worn off.)

    DH and I are trying to decide if these are enough evidence to call her doctor and try to tease out if this is a medication issue or just a disrupted schedule issue. She does have her physical coming up in a couple of weeks, and it seems that a lot of her acting out has to do with being kept indoors (it's been bitterly, dangerously cold outside lately), so it may just be excessive energy.

    How do other folks deal with this?
    ==========================================
    Liz
    DD (3/2010)

    "Make mistakes! Get messy!" - Miss Frizzle

  2. #2
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    DS1 (8) has adhd and he had way worse tantrums on Vyvanse. It made him very irritable. It could be a med thing. (Concerta is better for him.). Also, starting an anti-anxiety med (buspirone) really helped tone down Dsís emotions and irritability. Heís better able to manage frustration (which was what often caused tantrums) on the buspirone.


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  3. #3
    mikala is online now Diamond level (5000+ posts)
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    Who is prescribing her meds now? Pcp or child psychiatrist? I'd put a call in and at least make a future appointment.

    In the meantime I'd try to make sure she's getting enough sleep, eating well, not too much screen time, etc. If staying up late is an issue you might try a low dose of melatonin.

    Is she receiving any other therapies? If so, I'd also talk to those therapists and see if they have any suggestions. If she isn't in OT this might be a good time to look into it because they can work on emotional regulation and transitions.

    Have you been through full neuropsych testing? If not, that might also be another angle to pursue to help figure out what other services she could benefit from. The meds can help slow her negative reactions and give her a second to think but they won't reach her flexibility and other underlying skills to deal with stressors or minor changes in her routine.
    Last edited by mikala; 02-24-2018 at 10:23 AM.

  4. #4
    lizzywednesday is offline Red Diamond level (10,000+ posts)
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    Quote Originally Posted by mikala View Post
    Who is prescribing her meds now? Pcp or child psychiatrist? I'd put a call in and at least make a future appointment.

    In the meantime I'd try to make sure she's getting enough sleep, eating well, not too much screen time, etc. If staying up late is an issue you might try a low dose of melatonin.

    Is she receiving any other therapies? If so, I'd also talk to those therapists and see if they have any suggestions. If she isn't in OT this might be a good time to look into it because they can work on emotional regulation and transitions.

    Have you been through full neuropsych testing? If not, that might also be another angle to pursue to help figure out what other services she could benefit from. The meds can help slow her negative reactions and give her a second to think but they won't reach her flexibility and other underlying skills to deal with stressors or minor changes in her routine.
    Her pediatrician is the prescribing doc for her meds; we have her 8-year-old well visit coming up in a couple weeks, so I'd rather not take her in if it's not an absolute emergency. It doesn't feel super-urgent, but it *is* concerning.

    She's not allowed tablet this weekend due to her tantrum last weekend.

    She is not receiving other therapies but we haven't gotten any recommendations to put her into anything like OT or whatever. She does receive speech services at school and we just re-started private speech therapy which will run through late May or mid-June (I haven't counted the number of sessions we've been to.)

    She has been through a full workup at the cognitive & behavioral health clinic of the children's hospital where she was born/treated for her heart issues. They gave us an eval that DH dismissed as "overly general" and he was tuning the doc out (DH has ADD/ADHD himself, diagnosed as an adult; I haven't been evaluated, but maybe I ought to be, since some of my hindsight analysis of my own behavior points to ADHD-inattentive) and, even though complementary psychotherapy was recommended, we did not pursue it because DH decided against it.
    ==========================================
    Liz
    DD (3/2010)

    "Make mistakes! Get messy!" - Miss Frizzle

  5. #5
    lizzywednesday is offline Red Diamond level (10,000+ posts)
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    Quote Originally Posted by georgiegirl View Post
    DS1 (8) has adhd and he had way worse tantrums on Vyvanse. It made him very irritable. It could be a med thing. (Concerta is better for him.). Also, starting an anti-anxiety med (buspirone) really helped tone down Ds’s emotions and irritability. He’s better able to manage frustration (which was what often caused tantrums) on the buspirone. ...
    She's on Adderall XR, but has been having late nights and a bit too much media time because it's been bitterly cold outside.

    We haven't discussed any anti-anxiety or other types of medications for her.
    ==========================================
    Liz
    DD (3/2010)

    "Make mistakes! Get messy!" - Miss Frizzle

  6. #6
    cuca_ is offline Sapphire level (2000+ posts)
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    I would discuss a change of medication with her pediatrician. One of my kids had a horrible tantrum while we were trying Adderall. We changed the medication and the meltdowns practically disappeared.

    I would also suggest seeing a psychiatrist. I think their expertise is helpful in finding the right combination of medications that a child needs, including anxiety meds if she needs them. I would also look into Melatonin if she is having a hard time falling asleep.

  7. #7
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    1. Make an appointment with a psychiatrist, not your pediatrician. It will take a while to get in. Call now.

    2. Was your DD evaluated for anxiety? My DS was diagnosed with anxiety and ADD. First we put him on anti anxiety meds because that was causing the biggest problem. A couple of years later, we added Concerta. We have to watch the anxiety because Concerta (almost any stimulant) increases anxiety. A lot of what you are describing sounds like anxiety.

    3. Get a recommendation for a child therapist. Your DD NEEDS therapy to learn how to cope with her ADHD. Just meds is not going to do it. She also needs therapy for the anxiety if that is what is happening.

    4. Was your DD evaluated for autism/being on the spectrum? It is pretty interesting to look at the number of girls in the 9-11 yo age range who are diagnosed "late" because they are able to cope socially up to a certain point and then they can't. And their behavior gets called into question.

    You absolutely need to re-evaluate the meds and get your DD into therapy. Having that many tantrums in one week and at school is an issue. You want to address that now before things get out of hand and you have to do a ton of work to get back to functioning well.
    Mom to:
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  8. #8
    lizzywednesday is offline Red Diamond level (10,000+ posts)
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    Quote Originally Posted by cuca_ View Post
    I would discuss a change of medication with her pediatrician. One of my kids had a horrible tantrum while we were trying Adderall. We changed the medication and the meltdowns practically disappeared.

    I would also suggest seeing a psychiatrist. I think their expertise is helpful in finding the right combination of medications that a child needs, including anxiety meds if she needs them. I would also look into Melatonin if she is having a hard time falling asleep.
    She's been on the Adderall for a year now; it's been fine until this month. The weather has greatly reduced our outside time, and she hasn't had outdoor recess in a while (except during the freak warm weather the other day) so it's hard to gauge whether this is meds or not.

    Quote Originally Posted by StantonHyde View Post
    1. Make an appointment with a psychiatrist, not your pediatrician. It will take a while to get in. Call now.

    2. Was your DD evaluated for anxiety? My DS was diagnosed with anxiety and ADD. First we put him on anti anxiety meds because that was causing the biggest problem. A couple of years later, we added Concerta. We have to watch the anxiety because Concerta (almost any stimulant) increases anxiety. A lot of what you are describing sounds like anxiety.

    3. Get a recommendation for a child therapist. Your DD NEEDS therapy to learn how to cope with her ADHD. Just meds is not going to do it. She also needs therapy for the anxiety if that is what is happening.

    4. Was your DD evaluated for autism/being on the spectrum? It is pretty interesting to look at the number of girls in the 9-11 yo age range who are diagnosed "late" because they are able to cope socially up to a certain point and then they can't. And their behavior gets called into question.

    You absolutely need to re-evaluate the meds and get your DD into therapy. Having that many tantrums in one week and at school is an issue. You want to address that now before things get out of hand and you have to do a ton of work to get back to functioning well.
    (1) I have to see who's nearby and in-plan. The last time I looked, one had a lot of "as seen on TV" lines on her website, which put DH off ... and the remaining one in-plan blew us off, so I don't really have a favorable opinion of the local psych community right now. I cannot go out-of-plan.

    (2) Anxiety wasn't a concern at the time, so I don't know if she was evaluated for anxiety.

    (3) I used to have a list of names; I'll have to check our insurance to see who's in-plan and cross-check with the pediatrician. I agree that meds alone aren't helping. I don't know enough about ADHD to help and I am frustrated that I don't know where to start. DH's know-it-all attitude makes me feel even more lost.

    (4) The eval was comprehensive; I will have to check her workup record to see whether they evaluated for autism in addition to ADHD. We've been learning that a lot of ADHD and autism behaviors overlap. (Also, she wasn't really coping socially before this, but the ADHD meds have helped a great deal with the way she presents herself. She's always had a larger-than-life personality, but she doesn't read body language as well as I'd like ... and she also seeks out much younger children.)

    ETA: I re-read what I wrote, and it looks like she had multiple tantrums/meltdowns over the course of a week. She did not.

    She had the broken bedside lamp tantrum on/about January 28th. (We'd taken the tablet away.)
    She had the issue with the other child at Scouts on Feb 2nd. (She was upset/acting out because the other child was "yelling." Normal caf rules forbid yelling.)
    She had the distracting/acting out behavior at the off-site meeting on Feb 13th. (She claimed to be bored/curious, but calmed down after she used the bathroom.)
    And she had the broken ceiling fixture tantrum on Feb 18th (we took one of the games on her tablet away.)
    The school/biting incident happened on Feb 23rd. (Disagreement over a board game, kid needling her, she was accused of having cheated at the board game, leading to the outburst. It's actually the first time that the vice principal has called since the time she bit the substitute teacher in kindy, which kicked off the whole eval cycle.)

    So, it's all been building up over the course of about a month.
    Last edited by lizzywednesday; 02-24-2018 at 10:17 PM.
    ==========================================
    Liz
    DD (3/2010)

    "Make mistakes! Get messy!" - Miss Frizzle

  9. #9
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    "She's been on the Adderall for a year now; it's been fine until this month. The weather has greatly reduced our outside time, and she hasn't had outdoor recess in a while (except during the freak warm weather the other day) so it's hard to gauge whether this is meds or not."
    All the more reason why you need a psychiatrist, not a pediatrician. When you say you didn't have many options in your area--how big of an area? I drove DS an hour each way to get a good, low cost neuropsych eval that I knew our school district would accept. I would look up to a 2 hour radius to find a good psychiatrist. Ask your pediatrician for a recommendation. The psychiatrist can also help with determining if evals are needed for anxiety or spectrum issues.

    Go back through her eval--see what all it covered. If you don't entirely understand it, ask the pediatrician. Or, make an appointment with a therapist who will be able to read and explain it to you. (I had to have a professional co-worker explain it all to me despite having had it explained it to me by the person who did the eval)

    Therapists: check people out. They don't have to have experience just with ADHD, this is getting help for your DD to get some coping skills etc. This needs to happen now for your DD. Even with all of those outbursts over the course of a month--not ok. They were pretty intense. She needs support and help. Ask the therapist about evaluations for anxiety and spectrum behaviors. They often look alike. I am saying this as someone who has a best friend with a daughter who still tantrums at 13 and it is HARD. Her inability to function socially is having a huge impact on her academics. huge. I also see these issues where I work (psychiatric hospital with day treatment programs for kids and teens) Getting help early is key.

    Gain Knowledge: Your DH's attitude is not helping and I can tell you that it seems to be a very common attitude of the husbands of moms and professionals I talk to!! It's almost as thought they are uncomfortable not knowing something so they cling to what they do know and won't consider anything else. My DH can be the same way. So I read up on Dyslexia and Anxiety and got it down. I just checked amazon and they have "The Everything Parents' Guide to ADHD in Children". That't the books series I started with for Dyslexia. Very good place to start.

    Good luck. It's a long road and it changes a lot! I put in a ton of time in the trenches but DS really started coming out of it in 6th grade and has been doing really well in MS. Next year is HS and I am buckling in for another round!!
    Mom to:
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    DD '05
    Simon--the King Charles cutie
    RIP Andy, the furry first child, 1996-2012

    "The task of any religion is not to tell us who we are entitled to hate but to teach us who we are required to love."

  10. #10
    lizzywednesday is offline Red Diamond level (10,000+ posts)
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    Quote Originally Posted by StantonHyde View Post
    ...
    All the more reason why you need a psychiatrist, not a pediatrician. When you say you didn't have many options in your area--how big of an area? I drove DS an hour each way to get a good, low cost neuropsych eval that I knew our school district would accept. I would look up to a 2 hour radius to find a good psychiatrist. Ask your pediatrician for a recommendation. The psychiatrist can also help with determining if evals are needed for anxiety or spectrum issues.

    Go back through her eval--see what all it covered. If you don't entirely understand it, ask the pediatrician. Or, make an appointment with a therapist who will be able to read and explain it to you. (I had to have a professional co-worker explain it all to me despite having had it explained it to me by the person who did the eval)

    Therapists: check people out. They don't have to have experience just with ADHD, this is getting help for your DD to get some coping skills etc. This needs to happen now for your DD. Even with all of those outbursts over the course of a month--not ok. They were pretty intense. She needs support and help. Ask the therapist about evaluations for anxiety and spectrum behaviors. They often look alike. I am saying this as someone who has a best friend with a daughter who still tantrums at 13 and it is HARD. Her inability to function socially is having a huge impact on her academics. huge. I also see these issues where I work (psychiatric hospital with day treatment programs for kids and teens) Getting help early is key.

    Gain Knowledge: Your DH's attitude is not helping and I can tell you that it seems to be a very common attitude of the husbands of moms and professionals I talk to!! It's almost as thought they are uncomfortable not knowing something so they cling to what they do know and won't consider anything else. My DH can be the same way. So I read up on Dyslexia and Anxiety and got it down. I just checked amazon and they have "The Everything Parents' Guide to ADHD in Children". That't the books series I started with for Dyslexia. Very good place to start.

    Good luck. It's a long road and it changes a lot! I put in a ton of time in the trenches but DS really started coming out of it in 6th grade and has been doing really well in MS. Next year is HS and I am buckling in for another round!!
    Thank you for the book recommendation; I have a list in the eval, but I keep misplacing my printout.

    It's not that we're in a small or inconvenient area; we're in a decent metro area for services, but the list we got from the pediatrician was very short and we haven't checked outside that list. (Again, DH kept insisting the therapy wasn't something DD needed. Because he didn't need it when he was diagnosed with ADD. Also, his professional life involves dealing with the local psych community and he's not impressed with them.)
    ==========================================
    Liz
    DD (3/2010)

    "Make mistakes! Get messy!" - Miss Frizzle

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