Gifted Issues Discussion homepage Forums Twice Exceptional ADHD and Ritalin (mood swing question)

Hi All- We have been working with DS9 for several months trying to find a good medication for his inattentive-ADHD. We've tried Straterra, Intuniv and Vyvance. We started Ritalin this week. We started with 5 mg, then increased to 10 mg, then to 15. We saw no affect with the 5 or 10 mg dose. With the 15 mg dose, we saw a positive affect. Yesterday was his first day with the 15 mg dose. I noticed he was very withdrawn and grumpy around dinner time last night (when his afternoon dose would have been wearing off). I tried to find out if anything was bothering him, but he said no. This morning, I asked again if anything had been wrong and he said he just felt grumpy for no good reason. I know ritalin can do this. I'm wondering if any of you have any experience with this and whether it gets better over time?

Is there a long-acting option available? Yes, the stimulant ADHD meds can cause mood swings, especially as they wear off...

DeeDee

Yes, the doctor said that we would transition to a long acting once we got the dosage right. I would still think we would have the issue of it wearing off at night, however.

My DD9 has been on Biphentin for about 2.5 yrs. It is a slower-release from of ritalin and she has had good results with it. During her first few weeks, while we were trying to figure out dosing, she did have side effects that included mood swings. I think we inadvertently made it worse by not giving her the med on the weekends. It was like a rollercoaster for her and her body never got a chance to adjust. Once we saw the error of our ways and medicated her each day of the week, the mood swings stopped witin a week or two. We have tried to up her dose twice, and both times we her mood swings became quite severe and we had to go back to the lower dose. This also occured when we tried to different medications.

Unfortunately, it can be a bit of a guessing game in the beginning with sorting out the best medication for you child and the ideal dose. We were advised to give each change 1-2 weeks to take complete effect and for side effects to settle down.

Good luck!

Edited to add: My DD never did tolerate standard Ritalin, she need the slow release version.

My DS11 is on Concerta. It is a slow-release form and is supposed to last 10-12 hours. It seems to have a very gradual wearing off. We haven't noticed mood-swings. The only side effect we have noted is loss of appetite, especially at lunch. I have heard people say you get more "re-bound" with the shorter acting stimulants in general.

Maybe you are already doing this, but keeping a log of the medication, dosage and side effects (mood, appetite, sleep, etc) was very helpful for us. There were times when DS seemed moody and grumpy, but looking at the log, it didn't seem related to the meds.

I haven't heard of trying the short acting ritalin to find the dosage and then switching to a longer acting one. Even though they are based on the same molecule and may have approx. the same dosage, the delivery system is different, and they wouldn't necessarily have the same effect/side effects.

Good luck.

Thank you! We started our DS6 on chewable methlyn (Ritalin) about a month ago. It's definitely helping his focus over all, but this past week we've had several incidents of serious outbursts. Given his AS, this isn't unheard-of, but it's useful to be reminded that the meds will have an impact, and while his impulse control may be better, his mood swings might be worse. Worth discussing with his counselor.

Hi Perplexed!
Sorry to hear the medication just doesn't seem to be doing much for your son.

In the other post you said:
I was wondering if there were glimpses of 'hey it's working!' in between the pain of the intolerable side effects.

I'm also wondering if his educational needs are being met in the classrooms where he is reported to be so wiggly. Sometimes even the gifted classroom just isn't meeting an individual child's needs (LOG!)

Do the teachers notice that when a very novel bit of learning is happening that the wiggles slow down? This could be a sign of either ADHD-I OR being underplaced. But it's typical of 'our' kids.

What does the perscribing MD say? Ready to throw in the towel or ready to try a few more stims? Given how 'sensitive' our kids are, it doesn't seem unusual that you have gone through so many. Whatever decision you make it doesn't have to be 'final.'

Love and More Love,
Grinity

Thanks for the reply Grinity.

His teacher at school actually thinks he is doing fine. She seems to understand that he needs movement and it does not bother her. She accepts him for who he is and just lets him be.

It is his afterschool tutor that feels like he needs medication. She says that he is constant movement and she spends the majority of the hour trying to re-direct his focus back to the work they are doing. It is definitely "boring" stuff...mostly language arts remediation to help with his disorder of written expression.

So tutoring MAY be understimulating because of the rote nature of the work. It is Orton-Gillingham...meaning it is multi-sensory....but it still pretty rote stuff. If it is that tutoring is understimulating, I'm not sure how to help. I'm guessing that this is a common problem for the 2e child when trying to do remediation.

Can you move the tutor to before school or weekends? That's a long day for a 2e kid.

I had my 12 yo 2E in written language remediation this summer with an OG tutor. It was pretty boring. I worry about him getting a bad attitude toward writing, actually. Or a bad attitude toward himself. At this point, I'm planning just to let him take a break on the writing remediation.

Writing is a lot of effort even if you don't have the disability, I think!

So I agree with Grinity.