Gifted Issues Discussion homepage Forums Twice Exceptional ADHD-Vyvanse vs. Concerta

Our son (6 years old) was supposed to start Concerta-18 mg tomorrow to treat ADHD. Our insurance will not cover Concerta until we try Vyvanse. I didn't realize an insurance company could override a doctor's order! Luckily the doctor sent a Rx for both (in case ds couldn't swallow a pill-Vyvanse can be broken open and dissolved in water). So it looks like we're starting out on Vyvanse instead. Our doctor didn't seem to have a preference between these two medications.

Anyone else have children on either of these medications? If so, what has been your experience. Do you have any advice for us during the "observation" stage of starting meds? Thanks!

i'm sure others will chime in but i have some experience as an adult with Vyvanese. I decided to try out going on meds for my own ADD to see how it would feel if we made the decision for my son. Vyvanese was the best (i also tried adderal and another i forget the name of). I felt very organized and had no more trouble with concentration, but did not feel like i was on "speed", like adderal. The problem for me was that my insurance would not cover it and it was very very expensive. We ended up putting off doing meds for my DS.
irene

We tried Concerta with ds, but when they increased the dose his stomach started to hurt. He's been on Vyvanse for a couple of weeks and is not experiencing the same pain.

With all the amphetamines you need to watch for the emotional reaction. I've been told that if they are emotional the dose isn't correct, but in our experience the higher doses just brought on more side effects. Weight loss due to loss of appetite and trouble sleeping are the others. We have opted to leave both off meds for now. One DD was an emotional wreck and the other quit gaining weight no matter what we tried, when she fell 20 lbs behind her twin we took her off meds.

I hope you find a drug that works for your DS, it can be a trying time to find the "right" one. It is trial and error really depending on your specific child.

Today we started the Vyvanse. About an hour after taking it, we noticed he seemed more subdued and relaxed but no personality change or anything like that. Then he became very clingy and affectionate, very very syrupy sweet. Then about 3 hours after taking the medication, he had a MAJOR meltdown/tantrum over having to turn off his DSi. It was an extreme over reaction. He even kicked his door repeatedly and make his leg bleed. It took quite a while to calm him down and he complained that his head never works right, that his conscience should be telling him the right thing to do but his tells him to keep behaving badly. Once I got him calmed down, he thanked me for making him feel better and has been very clingy ever since. Now he's just moody and irritable and cries very easily. Everything is bothering him. We finally had to tell him to not talk if he was going to complain. It's almost like he's imagining things to complain about. Overall, he's definitely calmer but I'm not noticing that he's any more focused, and he's certainly NOT happier. He's very needy.

I know it's just the first day. Is this normal though? Does he need a higher dose, or is this an indication that it's the wrong medication? The doctor said the medication should start working on the first day but to observe for 3-7 days at the current dosage before increasing the dose. I can't imagine him going to school on Tuesday like this.

I've been to some ADHD forums, but they scare the hell out of me, to tell you the truth. You get such mixed information. I will continue to check them out, but I have come to really trust the information and advice I get on this site. I know anything I hear here is going to be well-thought out and provided based on the experience of other very caring, dedicated parents.

This is similar to the reaction my older DD had, for her it only became worse as we increased the dosage. But again, I caution that every child reacts differently. I imagine the doctor would tell you to stick it out for a few more days. For us it came to a point where my DD had to be physically restrained during her outbreaks. She said the medicine made her calmer overall, aside from the emotional outbursts. The problem was that they didn't really help with her concentration and although she could sit and work longer she actual did worse on achievement tests with the meds. As annoying as it may sound it's like she needs the movement to help her do well.

My younger DD didn't have the outburst and overall did well, she just could/would not eat, no matter what we tried. She was even on Pediasure supplements to no avail. Two different children, two different reactions. It is so individual. <<<hugs>>>

Has your doctor mentioned working with a behavior therapist while on meds to learn new coping behaviors, the ultimate goal being to then be able to take them off the meds and have then better able to function? We worked on behaviors with my younger DD while she was on meds and she is actually doing pretty well off meds.

Yes, we are also working on controlling the outbursts. The thing is, the outbursts are the least of our concerns. They are inappropriate to say the least, but they are not frequent. It's the inattention (even more than the hyperactivity, although he has both) that is so debilitating for our son. Even when he's allowed to move around during a lesson or while doing schoolwork, he's not able to focus long enough to complete tasks. He can't even eat a meal without being up at least 15 times with frequent reminders to come back to the table and eat. When he takes a shower or gets dressed, he simply cannot follow through without reminders, even with visual cues, charts, etc. It's affecting his self esteem, and he wonders what is wrong with him. I wish we could manage without the meds, but we've tried all the behavior mod techniques and home/school interventions. They help, but at this point it's not enough. His inattention is getting worse instead of better. We've had the same problems for years, and feel that the medication is a necessary next step. My goal, and our doctor's goal, is to eventually come off the meds. In the meantime, he needs to learn coping strategies.

He's much more emotional that usual, however on this medication. I can't help but attribute it to the Vyvanse. Hopefully it'll pass, but if not, we'll have to try something else. On a positive note, he ate lunch without any problem. He hasn't complained of appetite loss or stomach aches at all.

The strange thing about the meltdown today is that he seemed fearful and sad rather than angry and frustrated like usual. Again, I know it's the first day. I need to just see what happens over the next couple of days, but I've been so nervous about this. I just prayed and prayed that it would go smoothly.

The day has gotten much better. DS seems happier than this morning, calm, less energetic (asked to come home when we were on a walk-usually could go walking for hours), and still a little more emotional (gets sad and irritated easily). I have read that for some, these emotional side effects fade or disappear after the first few days or even weeks. I hope that's the case for my little guy. So far, he's not having any physical side effects other than a very slight dry mouth and loss of appetite. He's still eating when I give him food, but he doesn't ask for any snacks like usual.

A friend of our has a DD who is doing great on meds. She just sets out an appropriate portion and encourages her DD to eat it. She has lost weight but not to the extreme of my DD, so giving them food and even drinks when you know they need it is a great way to combat the loss of appetite. The emotional side effects can and does fade for many kids, although it can take a little while, even a few weeks.

Please don't feel the need to explain your reasoning. I definately think that there are kids that needs meds and would never feel that I could put myself in your shoes. I really wish they could have worked better for my kids, especially my older DD. I am also very grateful that our physician had our DD's working with behavior strategies while on meds, from everything I understand it isn't very common. It's more common that the med is the end of treatment, see me again when you need a refill. Therapy definately made a difference with my younger DD. The doctor has also left it open to possible small runs on meds for my younger DD when she really needs to work on specific behavior, which we may need to consider at some point in her future. Again <<<hugs>>>

Thanks Melissa. I'm feeling more encouraged now as the day has progressed. I definitely notice differences in my ds, both good and bad. We'll see where we are in a few days. It's always a tough decision to start medication, and the mixed results people experience make that decision even more difficult. He seems to be coming off the Vyvanse now (wearing off), and he's not irritable at all. He's just a little manic and unfocused (and still not hungry for dinner at 7:30 pm).

I am going to keep the behavior therapy in mind. We haven't done that. We just use very consistent behavior modification techniques at home. Some we've come up with on our own. I'm a speech pathologist, and my husband has a psychology background, although he doesn't work in the field anymore. I feel like we have pretty good insight, but we're certainly no experts. Our developmental behavioral pediatrician has given us some great interventions for home and for school as well. She's very familiar with Montessori, so that's been good. So many of the interventions are meant for a traditional classroom, and they do not apply for our personal situation. We are very lucky to have a school and teacher who is willing to try anything, even traditional classroom strategies if necessary. Hopefully this classroom will continue to be good for ds. He will be there for two more years after this one if all goes well.

I am going to look into the behavior therapy though. DS really needs some coping strategies for dealing with his frustration, anger, and disappointment. We currently have about 4 meltdowns a week at home, and sometimes they are pretty severe. At school, he doesn't have major tantrums, but he cries very easily. They describe him as highly emotional. Luckily the meltdowns and crying fits don't last long, but still, crying over every little thing in the classroom isn't productive and isn't winning him any friends.

Thanks again for the support. I really appreciate it.

Today was great! No side effects other than a little dry mouth. DS drank lots of water for that. He was tired because he was up from 1-5 am this morning (ugh!), but we didn't see any of the emotional side effects today. It's strange that he woke up like that because he had no problem falling asleep and slept soundly from 8pm-1am last night. He thought he'd slept an entire night!

When the medication wears off around dinner time he gets a little hyper, but he's really happy. He had no trouble falling asleep again tonight; I'm hoping he STAYS asleep til morning. He had a low grade fever this afternoon/evening, but the doctor says it's not related. He's probably coming down with something. So, it looks like we'll get another day to observe at home before he goes to school on Wednesday (if he's well).

The doctor did say that if the emotional side effects do not subside in a day or two, she wants us to half the dose. We're already on the lowest dose of Vyvanse. Today ds was calm and focused on a school project we were working on. We did a painting activity as well for about an hour and a half, and he was really concentrating. He says he feels like his brain is working better and is more focused. For the first time ever, he sat and read a book silently to himself! I hope tomorrow is another good day, but I'm remaining cautious. Thanks again for the support!

I'm really glad to hear things appear to be going well. I'm keeping my fingers crossed for your little guy. It's great when he feels the difference, not just you seeing the difference.

Thanks Melissa! He slept all night last night and is doing well so far this morning (day 3). I'm keeping my fingers crossed too that it continues to go well.

Woohoo! Hope it keeps getting better. Thanks for the update Jen.

FYI - I just recently stopped taking Vyvanse. I was more prone to UTIs, which caused me to get thrush while on antibiotics (I am allergic to penicillin), and then I had other issues, all related to the bladder. I was on 50mg.

It worked for me, other than the physical side effects. Though, as with most ADHD meds, I did experience a "crash" around 2-3pm. It did not affect my normal "emotions" (you could say that I am part of that Gifted with Overexcitabilities crowd). So I wouldn't be quick to blame a tantrum as a side effect.

I personally miss it though - says the mom who is slowly gaining a few pounds back.

JJsMom,
Thanks for sharing that info. It was really helpful. We actually haven't had any tantrums over the past couple of days, not even little tiny ones. DS is doing exceptionally well. At first (day 1-2) he seemed different, even a little zoned out and not more focused. Now he's just himself, only calmer and more focused. I was really worried about him losing his personality, but that hasn't happened. No more sleep issues either. Of course, we're only on day 4, but I'm so happy things are going better than on day 1. Does Vyvanse take a few days to balance out? It seems like he had s/e at the beginning, but they are all gone now except the dry mouth and occasional "dizziness." I don't think he's actually dizzy; he just feels different. Did you feel different on it the first day vs. a week later? Thanks again!

My son had major emotional breakdowns in the afternoon when on Concerta. Vyvanse made him feel tired. He started cracking his knuckles like crazy and had a very dull affect. He is currently not on anything and we are searching for a new dr who specializes in ADHD in high ability children.

If I don't eat, I feel dizzy... it's jittery moreso than dizzy (like a caffiene high without the immediate crash). I think that's just the way the ADHD meds work, being a stimulant. I did feel different a week later. More used to the way it worked. I personally did feel a "crash" around 2-3pm (took it at 8am), BUT it wasn't as extreme as a caffiene crash. And it was not too bad since, for me, most of the stuff I needed to stay really focused on was already done for the day. I started with the lowest dose and was upped after about 2 months. 50 mg was definitely the perfect fit for me. But I'm not sure what they recommend for kids if there becomes a point where it seems not to work anymore.

And I can totally tell a difference now when I take it vs not taking it (I have a "stash" for those days that I do need it - my last refill). The one thing I did love about Vyvanse is that even though they say you can become dependent due to it being stimulant and not to forget your dose, etc, I didn't/don't suffer withdrawals when I don't take it. I rarely took it on the weekends when I was taking it regularly. There was no "oh my God, I have to have my meds now" feel, which I hear happens with the likes of adderall.

Oh, and DH says he likes me more when I take it (I really wish I didn't have the UTI/Bladder issues, which I am personally prone to anyway) because I have MORE of a personality.

My cousin (who is in her late 40s) takes Concerta. She has been on and off all types of ADHD meds and says so far Concerta has been the best fit for her.

Good luck!

Oh, and I know you don't have to worry about this with your DS, but I am a smoker (throw stones NOW), who is on/off again quitting. When taking the Vyvanse, I feel the need to smoke more. Thankfully for my health and those around me, I don't smoke at home, in front of DC, or at work, etc... but the craving is more. So if there is a "habit" that your DS has, don't be surprised if the desire to do so intensifies, if that makes sense (like 4evercropn saying her son cracked his knuckles more).

At first vyvanese worked wonders on my son then the tics began. Started as a throat clearing consistantly, moved to heavy breathing and motor tics. Began our diagnosis of tourettes . At first the doctor said its nothing but when the breathing sounds like an asthma attack and scares strangers even though it is all nasal and not from the lungs it was scary. Did seem to be more of an issue for adults than for him.

I think they recommend "testing" for Tourette's before using stimulants b/c stimulants can exacerbate or bring on tics that a child is already predisposed to. I'm not sure if it's true that the stimulants actually CAUSE the Tourette's. It is my understanding that the meds do not cause the tics, they just increase the chance that they will actually manifest. Sounds convenient though, huh? We haven't seen anything like that so far, but it's only been a week.

This is such scary stuff for me, and for many others. I'm scared to death to give ds the meds, but then I feel that I'm not meeting his needs if I withhold it. He was simply not functioning in a classroom despite changes in setting (home-school, Montessori) and increased difficulty level of work. We've tried accommodations at home and interventions in the classroom. It's just gotten to the point that the ADHD is evident, and it's so frustrating that there's no great treatment. I guess it's like that for many families dealing with ASD, depression, anxiety, and other physical and psychiatric disorders as well.

I'm keeping my fingers crossed that the Vyvanse will work for us. I hate the thought of countless medication and dosage changes. Right now, ds seems to be doing well for the most part. He's completing his work at school and is able to focus. The downside is that we have to really push the food intake. He doesn't have much of an appetite. He's starving every morning, so he eats a huge breakfast, but he's still not really hungry by dinner. He eats a decent amount at dinner, but not enough to make up for eating very little lunch and skipping snacks. I think this is why he wakes up between 5-6am every morning. His tummy is empty.

Also, he is still emotional on the meds. Two days this week, he had just two or three emotional moments at school. Yesterday, he cried off and on all day at school. It's like a sadness rather than frustration and anger (his usual M.O.). The teacher said it's like how a child acts when they are really tired. He doesn't seem tired, but stimulants do slow down the brain in people with ADHD.

Speaking of, DS sometimes complains that his brain isn't working right. He actually said, "I wanted my brain to slow down, not stop!" Other times he says he feels great because he's able to shut out all the noise around him and concentrate on what he's doing. On those days, he says he can think "better" than usual. I'm going to give it another week or two and see if things balance out a little more. If not, I guess we'll be reducing the dose (already on the lowest dose, so we'd have half it) or changing meds. Patience is not my strong suit.

Right this minute I am cracking up laughing. DS just walked out here all dressed and ready for the day, bed is made, breakfast dishes are in the sink, teeth brushed, and room clean. He even made his bed and carried his dirty clothes to the laundry room. This is the same kid that I usually have to tell at least 5 times to do just one of those tasks, and I often have to go in and physically help him get started. He's happy and pleased with himself for doing those things. But, in a couple of hours I'm afraid he's going to get sad. : (

What a roller coaster! Thanks for "listing" to me vent. I have rambled on and on here, but sometimes it just helps to get it out, right? Thank you for all of your responses. It helps me to put our situation in perspective when I hear others' experiences. Misery loves company...safety in numbers...something like that.

Definately not rambling. Many of us have been there and completely understand.

You're not kidding, CFK! LOTS to worry about. I'm about to worry myself sick over this whole med issue. While my ds6 is certainly able to complete more work, is more compliant, and is calm most of the day, I feel like there are too many moments that I'm missing the essence of his personality. I am really hoping there's some balance somewhere, some magical medication or dosage that will not only allow him to be himself but also allow him to excel. He still has a period of time during the day when he's sad, a part of the day when he's really tired, and a time of day where he's almost euphorically happy. Then he gets manic when it wears off. These are not drastic mood swings. In fact they are quite subtle, but it's enough that I certainly notice them. When he doesn't have the medicine, he's absolutely unable to focus and concentrate on much of anything these days. But, I do get to see his personality more. I can't decide if it's his personality that's so different or if I'm just not used to him being so calm and unintrusive. I'm used to him being stuck to me every minute we're together, saying, "mom, mom, mom, you know what....listen to this...can I?...." Now, I look around and he's in him room playing alone silently...and it makes me kind of sad. Usually, his mouth doesn't stop. He literally thinks out loud. Well, before Vyvanse. Am I crazy? Am I just mourning the "loss" of my immature, inappropriate boy instead of embracing the mature, motivated, loving young man that I am currently living with? Ahhh...rambling again. Why does this have to be so hard? I know many other people deal with much bigger issues than this, so please don't think I'm feeling sorry for myself. Just want to figure this out and help my little man.

That is what happened with my little man, We didn't know it was tourettes at the time. I have gone natural in the past month wth focus factor for kids and am trying the gummy omega fish oil. something is improving not sure if it is one of these but could be. He is having no side effects from either of them.

Thanks vicam. That's wonderful that you are seeing results! I am going to keep that in mind. We are actually going to try cutting the dose in half to 10 mg. We'll see if he's able to keep the same level of focus without the side effects. I'll post results in a day or two.

I think you probably are mourning a loss here. Ever hear of Stockholm Syndrome? OK, I'm exaggerating for comic effect, but there is a whole kernel of truth to this joke.

It's ok for you to be having feelings right now - you've been through so much. Does he mind the 'sad period?' If not,and if it's no worse than you've described above, then I strongly urge you NOT to play with his medication dose this week. He has a lot to mourn as well, now that he sees how mature he could have been these last few months. For all you know he is still adjusting to the dose he is on, and in another week all these subtle shifts may be gone all by themselves.

Go back to your basic 'Energizing the Positives'
When he is sad say: 'I love the calm wisdom you are showing right now.' or 'I love how you are handling your feelings right now.'
When he is tired, compliment him on how well he is handling himself, even though he is tired.
When he is euphoric celebrate with him how good he feels.

I'm not promising that you won't eventually change drugs or dosages, but I can promise that if you cut his does in half right now, you are sending a message that you aren't sure that you want him to grow up and be this new mature self. Give yourself the gift of a little more time. We don't have to be hypervigilent all the time, yes?

BTW - I'm currently reading Deirdre Lovecky's 'Different Minds' which is about her experiences with Gifted kids of various levels of giftedness who also have ADHD, NVLD or AS. Fascinating!

Love and More Love,
Grinity

Grinity,
Thank you! We actually DID cut the dose in half today based on the doctor's advice. The teacher is saying that he's emotional all day at school (crying, practically hyperventilating with some obsessive compulsive type behaviors). When he's at home, we just see the very subtle changes in mood. At school, apparently, it's pretty drastic. He is getting his work done, though! So, the doctor thinks his dose might be too high. We'll see how it goes over the next day or so. This is not fun, but I actually think he's feeling better about himself in general. You asked if he is bothered by the sad moments, and I honestly don't think he is. He said today, "I hope I'm not so emotional today, but I REALLY hope I can still focus." As for the positive reinforcement, I am praising him when I see him handling things so maturely. He actually came home from school yesterday and spent almost an hour writing in his journal. He's writing a novel about his adventures. If you recall, a few weeks ago we though me might be dyspraxic!
.
Do you really think that we might need more than a week for the medication to "balance out"? I am going in to observe later this week. I want to see the "severe emotionality" for myself.

Now that I hear what the school is saying, and that you have 'doctor supervision' I'm totally comfortable. Without those other pieces of information, I was worried that perfectionism, overfocus and isolation were having their way with you. As a group we tend to be vulnerable to those forces.

It did take a few weeks for my son's 'twichiness' and emotions to balance out. It bothered him slightly for 3 weeks and then totally dissapeared. It took us 4 different medications, each slowly being bumped up to the right dose a week at a time - so when I talk about second guessing myself, I speak from experience.

My prayers are with you and your family that you find the 'happy medium' soon.

Love and More Love,
Grinity

Thank you Grinity. I'm dying to hear how ds did today. I wish I could be more relaxed about this.

Well, the verdict is in, at least for today. DS6 took 10mg of Vyvanse (a half dose) today after being on 20 mg for 9 days. He was just as focused as he was on the higher dose, but he didn't have the emotional side effects! Hoping this continues, but for now I'm trying just to be grateful for each good day as it comes.

Another great day on 10 mg (lower dose)! What a relief!

Thanks Lauren! We are so happy right now. I'm waiting for the other shoe to drop, but just trying to enjoy the moment. : )

I haven't read through everyone else's reply because I'm in a hurry, but I wanted to respond!

DS was diagnosed at 6 years old. His doc started him on Concerta. He showed some improvement in attention, but started losing weight almost immediately. This was compounded by the fact that we seemed to constantly have to up the dosage levels. A few months later after we'd moved cities, DS's new pediatrician recommended we switch to Vyvanse. For my son at least, Vyvanse has been a MUCH better choice. He's gained back some of the weight he lost without sacrificing behavioral improvements. It's a better choice for my son and he's tolerated it well over the last couple of years. We've upped the dosage two or three times, but he has been growing. And he doesn't seem to get worse side effects as we up the dose, either. If a parent were asking me which I thought was better, I would say Vyvanse (and the docs I've talked to seem to agree, as well).

That being said, it would tick me off about the insurance company, too! How disturbing that they can apparently override a doc's order like that!

Alyson,
I know. I was surprised the insurance company could make that decision, but our doctor said it happens all the time. DS6 is doing quite well on 10 mg Vyvanse. I'm sure at some point we'll have to increase his dose, but this is working well for now. On 20 mg we noticed a decreased appetite but not severely so. With the 10 mg, there's no change in appetite at all. We are very pleased. Maybe the insurance issue was a blessing in disguise! Thanks for your response!

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