ADHD, teenagers, medication - very confused and looking for advice.

[MaryChristmaZEverybody]

I tried posting this in SN teenagers, but there isn't a lot of traffic there. And I tried in chat, but no-one noticed, so I'm hoping a few of you might be kind enough to give me your opinions, thanks.

ds2 is 14 and has just been diagnosed with ADHD (he should have been diagnosed years ago but for complex reasons slipped through the net). The doctors want to trial medication and have given me some bumpf to read, and I have also googled - which was a massive mistake .

I have to make a decision by Friday if he wants to trial it over the holidays. He is keen, as despite his best efforts he is struggling at school and constantly in trouble with teachers for moving/twitching/fiddling/not paying attention, as well as forgetting and losing everything.

Having been down a somewhat similar route with ds1 with disastrous consequences, I am leaning towards medication (if ds1 had received help at 12/13 he might have escaped a lot of the trouble he has had, and not started the self-medication which led to addiction).

But I don't just want positive stories, lots of varied input, including hearsay and scare stories are welcome, so that I can have a good think about it all (very quickly).

As well as drug suggestions, as I'm still trying to get past Ritalin.

Ta ever so

Hi Maryz,

I also have a ds 14 who has adhd and also ASD. In the past we've tried him on methylphenidate -generic ritalin.

Feedback from the teachers was ambiguous - we understood it as they didn't think it was helping him much:occasionally he seemed more focused but at other times he seemed more confused than usual. We only saw a deterioration because pick-up time at school coincided with the time when it was wearing off, so he seemed noticeably more confused to us eg seemed to struggle to understand questions and started repeating himself/talking in a loop. Psychiatrist initially felt the small windows of increased concentration represented progress but in the end both school and parents saw more problems than progress so it was discontinued.

Having said all that, I wouldn't hesitate to recommend it to you and your son.

Firstly because from what I've read it is a drug with a very short life - it is quickly absorbed and if it works, works very quickly but it is also quickly processed out of the body and can be stopped very quickly without adverse side-effects, so the risks of trialing it are minimal.

Secondly I know some families where they feel it has made all the difference to their child's ability to function.

Some children get on better with the slower release/longer acting forms of the drug such as concerta. There is also another drug - atomoxetine which acts on a different part of the brain's chemistry and is not a stimulant which works for some children who don't respond positively to methylphenidate.

Again more from reading around the subject, I think it is important that the titration of the dosage is done slowly and carefully and that school are prepared to spend time and effort monitoring the child's response to the drug at regular intervals during the day. To facilitate this we drew up a simple chart for the teachers to fill out.

One of the best books I've read is Attention Deficit Disorder by Dr Thomas E. Brown.
www.amazon.co.uk/Attention-Deficit-Disorder-Unfocused-University/dp/0300119895/ref=sr_1_2?s=books&ie=UTF8&qid=1355869458&sr=1-2
There are some online support groups which can be helpful eg www.adders.org/.

Good luck with the trials if you do decide to go ahead.

not sure how that snuck in there, but hey smileys are good.

Thanks pink, your post is very useful. I think they want him to start over the holidays so that we can watch and see if it makes any difference. As he gets up at about 3 in the holidays and doesn't really have to focus on anything I suspect we won't learn an awful lot until he gets back to school.

And Polter, I think you are right - and ds is keen to try medication. Unfortunately, I suspect he thinks that he can take a tablet a day and go back to being a straight A student - the doctor pointed out to him that medication might help him to focus, but he would still have to actually study .

I think they are suggesting short acting low dose Ritalin short term, to see the affect. And then if they work out a dose, they can give him a slow-release one with the correct dose.

ds2 really wants to get some help. And we have been down the CAHMS route with ds1 who really didn't want any help and fought us every step of the way, so yes, we have to go with what ds wants.

Do you know Polter, that's exactly what i thought .

He got straight A's throughout primary school. He is very bright, but constantly in trouble. Not for major badness, but for silly things. He is the child who shoulders others in the corridors, falls off his chair, clicks his pen repeatedly, talks back to teachers etc. He spends half his life arguing on others' behalf instead of just shutting up.

This year is exam year for him. And it's all sort of caught up. Currently he does about 20 minutes homework a night and is getting B's. But is constantly on report. An hour a night and staying on the right side of the teachers would make him a very good student. I hope.

Oh, I know, and I am proud of him. And I never row with him because I know he can't help his jitteryness which is what gets him into trouble in school all the time.

He can just be such an idiot - and he knows that. He gets caught all the time for really stupid things.

It's defintely worth a trial and as pink says, it's short lasting so if it doesn't agree with him you can stop straight away without any withdrawal effects. Longer term your consultant might want to progress to short release versions but not without a successful trial of immediate release first and with your (and your son's) agreement.

I liken methylphenidate and the like to anti-depressants, in that when they work they are amazing, but when they don't they can be rather crap. But you won't know which is true for your son unless you give it a go.

One thing to bear in mind though is dosage. It seems that many NHS practitioners start off with a 10mg dose and that can be too much for some people. We were fortunate in that the NHS refused to treat ds (long story) and we ended up with a private psychiatrist who started him at 5mg twice a day with a very gradual increase. It meant that initial side effects (most people have them to begin with, difficulty sleeping and loss of appetite are most common) were very minor but we could see straight away what benefits he could get.

Careful monitoring is key and dosage should be increased very gradually. Ds is now on 25mg per day (10mg morning, 10mg lunch and 5mg tea time) plus a dose of atomoxetine (Strattera) in the morning for longer-lasting effects. This is a 24 hour drug which prevents him from becoming totally unmedicated when the methylphenidate wears off. The aim is to gradually wean him onto this drug longer term and off the methylphenidate altogether.

The results for ds are variable. He can focus better on work (he's electively home educated so I can monitor this carefully) and copes better with life generally, but he's still a 14 year old boy and no amount of medication can take away the overall numptiness of teenagers. He has his ups and downs but the drugs have definitely helped him. Socially he does loads better than he used to, even with hormonal grunting taken into account .

I think your doctor's suggestion to trial over the holiday period when you can closely observe him for any changes is a sensible one, and you won't get another chance like this till Easter so bear that in mind.

This is very helpful. I have posted about 'Fred'in SN Children as I thought here was more traffic there. Just want to tell Steaky and Pink their posts are really useful. Maryz - how is it going? We are seeing Paed tomorrow.

Sorry - I have found this thread rather late. Maryz - did you start the trial over the holidays? How did it go?

My DS1 has ADD (inattentive type), rather than ADD, but he was assessed with that at 15 and put onto Medikinet (methylphenidate hydrochloride) almost immediately. He has mild dspraxia and the overlap between the two had effectively masked the ADD until the last year before GCSEs.

So he has been taking it for about three years now, although only takes it on the days when he needs to study or concentrate on something, as he does not have the hyperactive behaviour. In school term he took an extended release version to cover the school day, plus an immediate release version for the evening, if necessary. He did not take it in the summer holidays.

For him, it is a 'wonder drug' that helps him concentrate and learn so much better. But, as streakybacon says, it doesn't stop them still being teenagers and therefore making some stupid decisions.

His side effects are loss of appetite and inabiility to sleep with the drug still in his system. But that can be managed, with a big breakfast before taking it and snacks when the drug is in his body, then ready supplies of toast as soon as the dose wears off! And he has to reduce his dose in the holidays gradually, rather than going 'cold turkey', as he gets stomach and head aches otherwise.

My sense is that, if there were any of the severe side effects, such as mood swings or personality changes, they would happen quite quickly and you would know that it didn't suit your son. Similarly, you know very quickly if it is having any effect. DS1 can't actually feel physically when the drug is working, but can feel that he can concentrate much better and is less vague, and we can certainly see it too.

Do let me know if you have any questions, since I am three years down this road.

Sorry Mary, only just seen this. My friends DS was diagnosed at 13, she reluctantly allowed meds. They were like flicking a switch. From this unreaonable thing that she couldn't stand to be around and felt very guilty about feeling that, to a pleasant young man again. He is now 16 and an absolute pleasure.

How did you get on? Did you try them? How did it go?