DS12 has taken stimulant medication at low-to-moderate dose since third grade and it worked reasonably well until it wasn't "enough" and dose increases/med-class-change made things worse (bc of side-effects).
I'm trying to get a handle on which behavioral components have caused the most trouble at school. His profile has always been difficult for me to understand, because he didn't nicely fit into any of the ADHD sub-types. He would most closely fit the inattentive type because he does not have any "hyperactivity," whatsoever and is really unusually slow, physically. In fact, as my mother pointed out, in some ways it seems a lack of impulse seems to be a greater issue than too much. I think what she was really describing is a large deficit in task-initiation (but that is another subject).
Except. He does blurt out in class, interrupts instruction, and doesn't have any awareness of when to put on the brakes, verbally. He doesn't do this when stimulant med is pushed high enough, but then the side effects are unbearable for him.
He doesn't have a big issue with sustained attention, once it's initiated, much more trouble switching gears (hyper focus?)
I think he becomes easily overstimulated, experiences physiological reactions to the social demands of the classroom, and what existing self-inhibitory skills exist (not a lot) are hijacked. Add to that a moderate lack of social savvy and he becomes a hot mess. No brakes.
Additionally, he is the kid who is not in tune with non-verbals and implicit social expectations. So while his classmates are savvy enough not to get "caught," that's not even on his radar.
Because he seem unable to tolerate stimulant medication at high enough doses to be useful, I'm considering asking for a trial of extended-release guanafacine (Intuniv), minus stimulant, for the next few weeks before school starts. It is thought to be helpful with impulsivity. It may or may not have additional benefit of reducing anxiety and improving appetite, sleep. According to my research, some doctors prescribe in tandem with stimulant.
I know you are not doctors, so am not asking for medical advice, but am asking if anyone can help me pinpoint the excessive talking issue in terms of EF. If it's an impulsivity issue, it seems reasonable that treating that might be beneficial.
We do not have a developmental pediatrician in our area and also have very few pediatric psychiatrists. Part of last school year's difficulty was that even though we had a psychiatrist on board, he could not see DS for what were (to me) emergent problems, since the first priority is children in psychiatric crises. Getting kicked out of your gifted program doesn't meet that criterion.
He has a new pediatrician who feels comfortable prescribing front-line ADHD medications but said he didn't think he'd want to go much beyond that, although he might go as far as SSRI/SNRI under certain circumstances. I am relatively certain he'd be willing to give the Intuniv a go, since it's not a controlled substance or anything with a terrifying SE profile.
So--what is excessive talking? Besides something that causes a lot of trouble in school...I know that part already. I know a lot of gifted children are chatterboxes, but his problem is well beyond norms.
