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    #119213 01/03/12 06:50 PM
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    Nik Offline OP
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    My DD18 is home from college and she informed me that she quit taking her meds a month ago because they stopped working. In short, my question is: is this normal? Do some ADHD meds just stop being effective or does this indicate that maybe ADHD wasn't the underlying issue after all?

    As background, I sought an eval last year due to her serious difficulties producing written work in a timely fashion. DD was diagnosed with ADHD inattentive and PDD-NOS last spring and she went on a trial of Methylphenidate over the summer - eventually settling on 30mg XR in the am and 20mg XR in the pm - the max dose according to her doc. DD said it seemed to be working (the other dosages worked for a couple days then stopped, but at this dose she felt it was still working after a couple weeks). This was the first and only med she tried, and it had no negative side effects so we were ecstatic thinking we got the right one without the merry-go-round ordeal. Long story short she survived her first semester but produced only about 1 page of written work for every 5 assigned for a whopping total of 4.5 pages for the semester, 3 of which were written without the meds according to her.

    I am tempted to just be thrilled that she is able to squeak by without meds but it really was an 11th hour decision by the school to let her return for the spring given she turned the overdue and overly brief papers in on last day. I am wondering if there is any point in asking her Dr to try a different ADHD med or if we should just let it be and hope she can cut it med-free. (Or maybe just get some anxiety meds for me???)

    Help!

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    I have read that there is no real hard data that ADHD drugs actually improve your GPA or things like that long-term. I've read that the meds make it easier to focus on boring repetitive tasks but make it harder to do original, creative thought.
    I have also read that for most kids/adults, you may have to keep taking higher and higher doses for it to keep working. There can be alot of side effects too- it can shrink your amygdala, an important part of the brain. It can affect your growth rate and make children shorter than they should be. It can cause weight gain and provoke diabetes. It can provoke manic depression in susceptible kids.
    It can give you bigger problems than you started with. We don't use any meds but as a doctor, I've read about it.

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    Originally Posted by Nik
    My DD18 is home from college and she informed me that she quit taking her meds a month ago because they stopped working. In short, my question is: is this normal? Do some ADHD meds just stop being effective or does this indicate that maybe ADHD wasn't the underlying issue after all?

    Hi Nik,

    That your DD is still not functioning successfully (squeaking by rather than producing adequate work) indicates that *something* should be addressed. I'd seek further help. But I think you should be aware that the PDD-NOS may affect schoolwork as much as the ADHD does-- it brings its own issues (such as perfectionism, anxiety, not caring what others think-- a slew of issues that can affect school performance). ADHD meds may not be enough to help her overcome her disabilities.

    Is she in touch with the college's disabilities office, and is she getting any accommodations?

    Are you willing to keep paying for college in this mode, or would you rather have her take a leave of absence, let her spend some time doing therapies and adjusting meds to reduce the severity of her symptoms, and then try again? I know she probably won't like this solution, but I think it's worth considering.

    You were joking, but treating your anxiety may become necessary too-- it sounds pretty harrowing.

    DeeDee

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    Nik Offline OP
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    Jack'smom, I had a lot of anxiety about her starting the meds but this is the first time I have heard any of these particular issues related to ADHD meds - and I thought I did a lot of research! Could you point me in the right direction to find your sources? I am not at all concerned about GPA, she is extremely bright and she is doing very well in all other areas at this very rigorous school (which is why I think they are letting her stay). It is just the writing...

    DeeDee, yes, I am willing to continue to keep paying, a voluntary leave of absence is not an option. She has totally blossomed since going there, she is really happy for the first time in years, she has real friends now (she explained "I really like them, they are not just the people I despise the least!!!") and she is overcoming a lot of anxiety by facing things that she would otherwise have avoided with her group of friends (positive peer pressure?).

    Since writing is the only serious roadblock and the ADHD meds were the only thing I had to go on as a possible solution, I am a bit lost for how to help at this point.

    I dont want to keep upping the dose or have her addicted to something terrible but I just wondered if anyone had experience with one type of ADHD meds not working but another one working fine?

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    DeeDee brings up important points - there are aspects within her profile that may interfere with writing beyond the ADHD - and these issues should be addressed too. Could it be that the meds actually did help with concentration, but that the other underlying issues that were not addressed are causing the havoc? I agree that if she is not getting the support she needs in terms of accommodations and or perhaps private tutoring, perhaps this is one step she can take to help.

    Regarding the meds - if they are truly not working, I would seek medical help to either change the med or adjust the dosage. Generally one can stay on the same dosage for quite awhile, but it is possible that one can develop a tolerance and require higher doses. This usually happens over a number of years - not months or weeks. If your current doctor is not an expert in ADHD - either a psychiatrist or neurologist with a specialty in the area, you may want to consider seeking a second opinion. Many general practitioners may not have the experience to help with more complex cases - especially doctors that treat adults - they probably don't deal with ADHD much at all.

    You might also want to check out millermom proboards - it is a forum that specifically addresses ADHD and LD. If you post in the ADHD section, you most likely will hear from very knowledgeable people that can give you further direction. http://millermom.proboards.com/index.cgi?board=general

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    Nik - my first thought is "Has her body changed significantly since starting school?"

    I know mine did first semester!

    If she changes her excercise routine, gains or losses body weight, or her hormones change one can expect to 'hop back on the medication merry-go-roung.'

    Will she accept a writing/organizational skills tutor? Nowadays coaching can be done over the Internet or in person. Was she at all impressed that the school almost didn't let her return?

    I love the book 'Transforming the Difficult Child Workbook' by Lisa Bravo to help parent these tough to motivate kids. Just this week as DS was returning to school and his airplain reservation was dissapointing, he started up (in public) his 'Mom You Don't Even Care what I Go Through" Whining, and without even thinking about it a turned my body away very slightly and broke eye contact (as is suggested) and he twitched, took a breath, and said: 'Opps, sorry' and then went back to his normal mature behavior. What was so amazing is that I didn't even have any mental thoughts about my behavior of turning away - I just no longer tolerate being disrespected by him and it was natural to shift my body without any thought in the matter. It was only after he responded that I even knew what I had done. That's after about 6 months without 'practice.'


    I don't share their view on ADHD medications. I'm sure that in 20 years all the current medications will look 'barbaric' but for now they are making a very strong and positive difference at our family.

    Love and More Love,
    Grinity


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    Originally Posted by mich
    DeeDee brings up important points - there are aspects within her profile that may interfere with writing beyond the ADHD - and these issues should be addressed too. Could it be that the meds actually did help with concentration, but that the other underlying issues that were not addressed are causing the havoc?

    Based on what I have seen, the concentration issues were resolved entirely by the better educational fit. There is definitely something to do with writing that wasn't addressed with the ADD meds, but I am at a loss for how to address it - she thinks now that it may be just psychological?

    She said all of her early attempts at writing were judged harshly due to her awful penmanship so she just stopped trying and never really learned how to develop an essay. By the time she had keyboarding available, her anxiety over not really knowing how to produce what was expected had her making excuses rather than trying and by then she had figured out she could pass classes without writing the longer papers anyway. Sounds sort of plausible to me.

    Originally Posted by Grinity
    Nik - my first thought is "Has her body changed significantly since starting school?"

    She started getting a lot more exercise and eating much healthier, she lost 12 pounds...Hmmm, maybe she fixed the root causes of the specific issues that were actually being helped by the the meds so they became moot and thus seemed to stop working????

    Originally Posted by Grinity
    Will she accept a writing/organizational skills tutor? Nowadays coaching can be done over the Internet or in person. Was she at all impressed that the school almost didn't let her return?

    No and, no! She seemed very calm about it, said she believed she would be fine...I think that may be due to the Aspie in her. (I am the one getting panic-inducing correspondence from the school). Her roommate didn't fair so well so hopefully DD realizes now that they clearly mean business there.

    Originally Posted by Grinity
    I love the book 'Transforming the Difficult Child Workbook' by Lisa Bravo to help parent these tough to motivate kids. Just this week as DS was returning to school and his airplain reservation was dissapointing, he started up (in public) his 'Mom You Don't Even Care what I Go Through" Whining, and without even thinking about it a turned my body away very slightly and broke eye contact (as is suggested) and he twitched, took a breath, and said: 'Opps, sorry' and then went back to his normal mature behavior. What was so amazing is that I didn't even have any mental thoughts about my behavior of turning away - I just no longer tolerate being disrespected by him and it was natural to shift my body without any thought in the matter. It was only after he responded that I even knew what I had done. That's after about 6 months without 'practice.'

    Love it! Good for you! I am not sure if my DD would pick up on those subtle gestures though...I may have to
    bring that book back out for the summer.

    Originally Posted by Grinity
    I don't share their view on ADHD medications. I'm sure that in 20 years all the current medications will look 'barbaric' but for now they are making a very strong and positive difference at our family.

    I think its a very individual quality of life thing, I was so against meds at first but I heard lots of very compelling testimony from people who swore it had made their lives much better.

    RE Accommodations: The College is structured in the most accommodating way that I can imagine - very small discussion based classes, writing labs and tutors are available at no charge (but she has to ask for the help, and there is still the anxiety). I really wouldn't know what else to ask for. I am hopeful that she might have less anxiety about asking for and accepting help now that she has gotten to know her tutors (teachers) and fellow students over the last semester (they will all be the same for next semester). They showed her mercy in accepting her short papers and she had one teacher email to compliment the quality of writing in what she did turn in, so she seems to be gaining some confidence -YAY.

    Although the writing issues remain a mystery, I think I have resolved my question about the ADHD meds. Thanks for helping me think this through!


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    Originally Posted by Nik
    There is definitely something to do with writing that wasn't addressed with the ADD meds, but I am at a loss for how to address it - she thinks now that it may be just psychological?

    She said all of her early attempts at writing were judged harshly due to her awful penmanship so she just stopped trying and never really learned how to develop an essay. By the time she had keyboarding available, her anxiety over not really knowing how to produce what was expected had her making excuses rather than trying and by then she had figured out she could pass classes without writing the longer papers anyway. Sounds sort of plausible to me.

    Nik, lots of people on the autism spectrum have multiple strikes against them where writing is concerned; usually these are not "just" psychological blocks. Often there is co-occurring dysgraphia (disorder of written expression). Even when that's not the case, there is often a motor deficit that makes writing a challenge. Then there are the executive function (organizational) difficulties-- getting one's thoughts in order and getting them onto paper is a sophisticated activity with lots of steps. Then there is the not caring much what people think, and anxiety about grades, which makes a student who does the work sometimes fail to turn it in at all.

    Does any of that sound familiar?

    The motor stuff can be addressed through hand strengthening and occupational therapy-type exercises. The organizational stuff could be improved with a writing tutor, if the tutor understands the deficits. (But warning: you don't want someone to fix all her papers, you want someone to teach her to write. There's a big difference.)

    Now that she's an adult, she gets to say what would be useful; but to me it sounds as though she has developed certain habits of thinking such that she will excuse her problems rather than choosing to work on them. A sensible coping mechanism for a teen, but perhaps not that good for her education. The more you can get her to actually work on these things and improve, the better.

    Best,
    DeeDee


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    Originally Posted by Nik
    Originally Posted by Grinity
    Will she accept a writing/organizational skills tutor? Nowadays coaching can be done over the Internet or in person. Was she at all impressed that the school almost didn't let her return?

    No and, no! She seemed very calm about it, said she believed she would be fine...I think that may be due to the Aspie in her. (I am the one getting panic-inducing correspondence from the school). Her roommate didn't fair so well so hopefully DD realizes now that they clearly mean business there.

    Originally Posted by Grinity
    I love the book 'Transforming the Difficult Child Workbook' by Lisa Bravo to help parent these tough to motivate kids.

    Love it! Good for you! I am not sure if my DD would pick up on those subtle gestures though...I may have to
    bring that book back out for the summer.

    very small discussion based classes, writing labs and tutors are available at no charge (but she has to ask for the help, and there is still the anxiety). I really wouldn't know what else to ask for. I am hopeful that she might have less anxiety about asking for and accepting help now that she has gotten to know her tutors (teachers) and fellow students over the last semester (they will all be the same for next semester).

    Get the book out now. If those letters seem panic inducing then you have plenty to practice on. Stress anxiety and flexibility seem to be themes that could become key life lossons. I can promise that her life will be full of ups and downs. If you panic over the downs you won't be able to savor her or provide the calm positive reference she needs.

    I had faith that she will face her challenges and grow.

    Grinity


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    Read this very interesting book called Anatomy of an epidemic by Robert Whitaker. It's about mental illness in the USA and our love affair with medications. Read the chapter on ADHD- it's really eye-opening.

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