What ADHD symptoms subside with meds?

MirandaHobbes

Here's a question I should have asked DS's psychiatrist, but now I have to wait for next week's appt. DS is in week 3 of ADHD med trial (intuniv). We doubled his dosage after seeing no affect at all on him the first two weeks. He did show signs of sleepiness this weekend. Nothing that prevented him from functioning, in fact it was nice. He acted a lot like when he's sick. He did fall asleep once in the car while running errands. On Sunday he sat in a chair and watched a good 30 minutes of a football game with us, commenting and asking questions appropriately. Like he sat, without hopping around the room, pacing, or jumping off or climbing on the chair. That was definitely new. He also didn't pick up the Ipad all day, which was really weird (good). He just kindof hung out with me and DH and I took turns playing with him in his room (typically I'd have to cajole him to break away from the Ipad). He did watch a couple hours of TV. Doing his homework was as bad as ever though. The anxiety piece is almost clearer with this new med, maybe because the ADHD symptoms have been blunted? The idea is that once we figure out the ADHD piece we'll add another drug for the GAD. Is this what I'm supposed to be looking for? What kinds of improvements did you see if you have tried meds for ADHD?

Also, our insurance covers intuniv but only after we trial the generic, guanfacine. From what I understand, the generic is immediate release while the intuniv is extended release for kids. This seems redic. Insurance confirmed there isn't an exception for kids. Will our psych get around this somehow, or will we really have to trial the generic? Right now we're still using samples.

hopecounts

That's the upside to the ADHD meds, it'll clear the deck a bit so you can see what else is going on and address it.

Is the homework issue anxiety driven (perfectionist and doesn't want to do it wrong) or inattentive (can't focus to get it done)? 

And some of it may be behavioral/habit that now that you are treating the ADHD and seeing improvement may need to be addressed with executive function supports (visual/written schedule for example) and setting up his schedule to work for him.

When does he attempt homework, after dinner/when he gets home from school/etc? You may have to set up a consistent homework time after you fiddle around and find out when he is best able to get it done. He may need some time after he gets home to do some heavy work or chills to regain the ability to sit and focus, or he may need to go straight to it with free time as his reward when he is done. 
long post to say, there may be a med that will work better or not, discuss with the Doc and go from there.

ppants

DS takes generic concerta.  He is able to stay on task and move from one to the next without getting "distracted".  Before meds, he would be in his bathroom for 30 minutes where he's supposed to go to the bathroom, shower, and brush teeth.  I would check on him and he hadn't done any of it because he "forgot" or "got distracted". 

His blurting has improved.  We complete all homework and spelling words without him asking "how much longer/much more".  He brings home all needed items from school ie water bottle, agenda, lunch bag.  He's not lost any items this year. 

We did forget his med one day.  The teacher said DS was not the kid she'd known over the past 7 weeks.  DS said that it was good to see how much the medication has helped him and he even reminded DH he needed to take it this weekend.

MirandaHobbes

hopecounts said:

That's the upside to the ADHD meds, it'll clear the deck a bit so you can see what else is going on and address it.

Is the homework issue anxiety driven (perfectionist and doesn't want to do it wrong) or inattentive (can't focus to get it done)? 

It's 100% perfectionist. He couldn't even get his name on the paper. He didn't melt down crying over it though, although we argued about it for probably 10 minutes. I sent him to his room to take a break because he was getting increasingly ticked off. When I went in to check on him he was at least clearly articulating to me that he was frustrated with his handwriting and he is "tired of everyone telling him that his handwriting is so great when clearly it looks like a kindergarteners." He's in first grade and his handwriting is pretty bad, although when he is trying hard it is fine. Writing is his most pressing academic concern at this point, so at least it is on everyone radar and we have new IEP goals with regards to it.

And some of it may be behavioral/habit that now that you are treating the ADHD and seeing improvement may need to be addressed with executive function supports (visual/written schedule for example) and setting up his schedule to work for him.

When does he attempt homework, after dinner/when he gets home from school/etc?

He only has homework once a week, and we do it on Sunday evenings. He wants to delay until the last possible second (it's due Monday). I think you're right that as the situation becomes clearer we have to tweak our methods. I may have to "prep" his homework and break it into chunks for him to digest. It's always been a struggle, but he usually responds to bribery (i.e. you can have the ipad when you're done with your homework). Now he seems to have found a new mental block where before the ipad alone was enough to get it done.

MirandaHobbes

-auntie- said:

 

DS is in week 3 of ADHD med trial (intuniv). We doubled his dosage after seeing no affect at all on him the first two weeks. He did show signs of sleepiness this weekend. Nothing that prevented him from functioning, in fact it was nice. He acted a lot like when he's sick. He did fall asleep once in the car while running errands. 

Did he complain about this at all? DS was pretty vocal about how crappy he felt on Tenex.

No, and I asked him several times how he felt. He kept saying he was fine and wanted to know why I kept asking him. I reminded him that the new pills he is taking are to help calm his mind and body and he won't respond. He's the type of kid that is extremely elusive with his feelings. Like he will refuse to talk about having autism, but then out of nowhere he'll say something like "if I didn't have autism I wouldn't have to go to all these doctor's appointments."

ADHD meds should make him available to learn better behaviors. I wouldn't be happy with a healthy school aged kid napping in the car or acting as he does when he doesn't feel well. I'd definately share that with the prescribing doc if it continues to be an issue. Will do. She did say that parents complain about kids falling asleep in the car on Intuniv and she commented that she doesn't think a cat nap is a bad thing. I didn't think much of it. I'm very curious to see how he does at this week's den and pack meetings. Last month was miserable- 50 boys running around wreaking havoc. Total sensory overload. DS had a sleepover with a friend this weekend and they played so nicely. No sleep issues, melting down, fighting, nothin.

We got the biggest bang with a stimulant and adding an SSRI for the anxiety piece. It's frustrating, YMMV. All kids are different. You may need to trial a number of meds and titrate doses until you find a best fit. You'll find, too, that growth can impact dosing as well.  Yeah it sounds like this will take awhile. I'm in a bit of a tizzy because the psych is moving offices way out in east Egypt, so I would like to get this somewhat straightened out asap. Wishful thinking. She used to be able to do Skype but not with the new practice.

MirandaHobbes

-auntie- said:

Time to get an assistive tech assessment and get that boy on an Alphasmart.

That's exactly what it is- drawing. It comes and goes, sometimes he doesn't think about it and he just writes and then no one can read his writing, including him. His mainstream teacher thinks we should wait until second grade to resort to assistive tech, while also acknowledging that his own inability to read his writing is alarming. She seems determined to keep trying. OT is using Handwriting Without Tears but have had to break down sessions into 15 minute increments due to the fatigue it brings him. We have had some success with his spelling words by using scrabble tiles. She isn't using them in class but it is useful for practicing at home.

Another Mom and I joke that Pack meetings should be renamed "Boys Running."