ADHD meds/titration 15 year old boy

[SarahhMumOfBoys]

Has anyone been through a difficult early titration period with ADHD meds for a teenage boy and come out the other side positively? I feel absolutely broken...

Our son is 15, recently diagnosed ADHD (combined type), and has just started methylphenidate. We started on Meflynate XL 10mg, increased to 20mg, and are now switching to Medikinet because the side effects are becoming quite hard for him.

The frustrating thing is… the meds ARE helping. School are already reporting improved focus and engagement during lessons. But emotionally and physically he’s really struggling with:

• nausea
• appetite suppression
• difficulty sleeping
• anxiety
• emotional crashes later in the day when they wear off

This morning he’s refusing school because he’s exhausted and frightened of feeling awful again.

We honestly feel completely emotionally wrung out as parents. We’re trying to support him, work with school, manage titration properly, keep life stable, and make the right decisions, but at the moment it feels relentless.

I think I’m mainly looking for lived experience from parents who’ve been through this stage.

Questions I’d especially love insight on:

• Did early side effects settle?
• Did switching formulation help?
• How long did it take to find the “right” medication/dose?
• Did anyone move from methylphenidate to Elvanse and find it smoother?
• How did you handle school refusal/anxiety during titration?
• Did things improve once the correct dose was found?

Please be kind. We’re trying really, really hard and feel quite broken today if I’m honest. I just feel hollowed out most of the time.

Thank you x

My DC was diagnosed at 16 and we had a tough time during titration. Mainly because nothing worked. We moved to Elvanse and it’s the most effective one for us. It does come with appetite suppression and difficulty sleeping/waking up. Other than that nothing notable, no anxiety. Might be worth switching for a trial.
mine is now at uni and the meds have been life changing. The school/ 6th form years were hard because of the regimented school times (they missed a lot of school due to the sleep issues) but uni is much easier as they can sleep in and only attend relevant lectures.
I do worry about work years which will arrive in few years but they say money will motivate them to wake up!

Has his prescribing doctor discussed slow release vs quick release? It sounds like slow release might work better for him. Elvanse made my DS anxious and destroyed his appetite but DH has no issues with it.
We moved to a quick release, so sounds like the opposite to you. Push them to tweak things, he does not have to feel shit. I believe once you find the right drug/dose it really can smooth out. We were with ADHD360 originally and they were awful for actually listening and so we went to a private doctor, cost a lot more but he genuinely listens to my son.

Finding the right medication is definitely a journey. It might even be that stimulants don’t suit your son and you need to try non stimulants.

My daughter has quite complex SEND, including ADHD which the paediatrician questioned at 18 months and diagnosed at age 6.

For her, the Medikinet was a game changer. Her 1:1 TA can spot within minutes if she’s not taken it. We had slight side effects initially (mainly rebound when it wore off and increased insomnia) but this improved after about a week. She now has a top up dose of Clonidine in the evening to avoid the rebound.

My son is also diagnosed, but for him it presents less ‘obviously’ (his primary need is autism). He started on Medikinet a few weeks ago, and his teacher has noticed he is less impulsive at school, but the insomnia is extreme and he has become very emotional/tearful. After about five days I could sense the benefits didn’t outweigh the side effects, and the side effects weren’t starting to reduce (they did with my daughter) so we are speaking to his paediatrician next week with a view to trying something different. Given his other needs, I suspect a non stimulant may suit him better.