ADHD meds and signs to change dose

[PunkyBoo]

DS2 started ADHD meds a month ago, before school started. We've seen a marked difference in his behavior, patience, and emotional regulation. And I can clearly see when it's worn off for the day because I'm usually the target of the grumpies that come (I'm the one home, I'm the one reminding to do homework and helping prioritize tasks, I'm the one cooking dinner...) At his 504 meeting last week most of his teachers commented that they would not have known that he had struggles because he's doing great both academically and behaviorally in their classes.
But this week has been rough. For some reason he's been very very grumpy and it's felt like he's making a list of all the wrongs he's experienced each day like to build a case that things suck. I've talked to him about his resilience and coping skills and letting things go, as did his therapist last night, but he's kinda been "in a mood" this week. I'm wondering if we should be looking at increasing his dose. How did you know you needed to increase your kids dose of ADHD meds?


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[vludmilla]

Who is managing the medication? Hopefully you have a specialist physician (pediatric neurologist or psychiatrist) who is carefully managing the titration of the dosage and who can advise you. I would not, however, assume that the behavior you mentioned warrants increasing the dose.

[PunkyBoo]

Who is managing the medication? Hopefully you have a specialist physician (pediatric neurologist or psychiatrist) who is carefully managing the titration of the dosage and who can advise you. I would not, however, assume that the behavior you mentioned warrants increasing the dose.

His pediatrician is handling medication. We started with a psychiatrist but they are so overbooked it's close to impossible to get an appointment and so we only saw her once, before we were ready to try the medication.

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[bisous]

So I'm SO not an expert here. Like I feel like I need to have a bright flashing light that highlights this fact! I do have 2 kids on ADHD meds and have listened to a lot of podcasts...so...take what I'm saying with a HUGE grain of salt!

I would not necessarily conclude that he needs more medication. The reason for this is that it appears to be working very well during the day. It is the "coming down" that seems to be a problem. From what I have heard, that could mean that he needs to add a small amount of medication to get a "boost" to the end of the day...or maybe he could need a slightly different formulation of a similar med...There are essentially two categories of stimulants but many different little differences between...not describing this well.

Definitely ask your ped and try to get in with a psychiatrist if you can! Good luck!

[WatchingThemGrow]

We have a booster dose for the afternoons if there’s a lot of homework, etc.


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[gatorsmom]

I would not necessarily conclude that he needs more medication. The reason for this is that it appears to be working very well during the day. It is the "coming down" that seems to be a problem.

I agree with this. I’m no expert either but Ds3 has been on adhd meds for 6 years and it’s been a learning experience for both of us. What you describe as grumpy at the end of the day seems to me that he’s settling into the “boring and predictable” routine of school days now that the initial back-to-school novelty has worn off. Adhd kids don’t like boring and predictable. And he’s more likely to feel this and express this when he’s coming down from his meds.

Do you have him in behavioral therapy? If so, ask your therapist for some suggestions. Maybe it’s something you want to medicate for but maybe not. Learning to deal with boring and routine is something our kids are going to have to do. Many of their day-to-day activities for the rest of their lives are going to feel boring and routine. Jmho but it’s better if he learns healthy ways to accept and deal with this now. Also, he needs to learn better emotional regulation. How he expresses his frustration (instead of targeting loved ones to show his grumpiness) will be an important thing to learn too. That last fact I’ve learned all too well. HTH!

eta- if his school work is affected, then like watchingthemgrow said, I’d add in an afternoon booster pill.

[PunkyBoo]

I agree with this. I’m no expert either but Ds3 has been on adhd meds for 6 years and it’s been a learning experience for both of us. What you describe as grumpy at the end of the day seems to me that he’s settling into the “boring and predictable” routine of school days now that the initial back-to-school novelty has worn off. Adhd kids don’t like boring and predictable. And he’s more likely to feel this and express this when he’s coming down from his meds.

Do you have him in behavioral therapy? If so, ask your therapist for some suggestions. Maybe it’s something you want to medicate for but maybe not. Learning to deal with boring and routine is something our kids are going to have to do. Many of their day-to-day activities for the rest of their lives are going to feel boring and routine. Jmho but it’s better if he learns healthy ways to accept and deal with this now. Also, he needs to learn better emotional regulation. How he expresses his frustration (instead of targeting loved ones to show his grumpiness) will be an important thing to learn too. That last fact I’ve learned all too well. HTH!

eta- if his school work is affected, then like watchingthemgrow said, I’d add in an afternoon booster pill.

Thank you so much for this. His therapist is great, so I will discuss this with her. I think you hit the nail on the head, because I keep having to repeat that we all have to do things we don't want to/feel like doing, like me with cooking dinner. And you're absolutely right, the novelty of starting junior high had worn off and now they are requiring work to be done (his school started with 2 weeks focusing on mental health and social skills because they acknowledged that none of the kids had been in person learning for all of last year-it was great but now curriculum is going and his excitement is waning).

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[lizzywednesday]

...

I would not necessarily conclude that he needs more medication. The reason for this is that it appears to be working very well during the day. It is the "coming down" that seems to be a problem. ...or maybe he could need a slightly different formulation of a similar med...There are essentially two categories of stimulants but many different little differences between...not describing this well. ...

This is actually really good advice - DD started on extended-release Adderall, but when she came down from the meds it was really rough. We switched her to Concerta XR and she's much more even-keeled, emotionally, when she comes down off the meds. I might consider a short-acting booster dose if she seems to struggle with homework, but right now she's doing OK.

[PunkyBoo]

This is actually really good advice - DD started on extended-release Adderall, but when she came down from the meds it was really rough. We switched her to Concerta XR and she's much more even-keeled, emotionally, when she comes down off the meds. I might consider a short-acting booster dose if she seems to struggle with homework, but right now she's doing OK.

Interesting... DS2 is on Adderall XR. I'll have to monitor this.

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[candaceb]

You might want to look at the stuff from ADHD Dude. Sounds like you are dealing with some of the issues that he talks about alot. I keep thinking I'm going to sign up for his subscription plan and do some of the parent training but haven't managed to get around to it yet... I follow him on facebook and while a lot of it is self-promoting, he also has some valuable info.