I'm just not sure medication is the answer for any of this emotional stuff, at least not a stimulant ADHD med.
The stimulants make lots of anxious kids more anxious. For ours, they were a terrible fit. For some, they work splendidly.
It works quite well for everything EXCEPT the emotional outbursts. In fact, when we tried to tie specifically to a reward system, the meltdowns became more frequent and more severe because he was putting so much pressure on himself. We do have a "behavior" listed on his chart that says, "Managing Frustration Positively". Anytime he feels like he wants to melt down and stops himself from going into full breakdown mode, we give him stars and praise him A LOT. Even if he comes home from school and tells me about an incident where this happened (even if no else observed it) we give him stars because he's extremely honest that way. Once we tried rewarding him for having "no meltdowns" at school on a daily basis, and that was just too much pressure. During that week, he had many, many more outbursts that usual. It seems to be something he simply can not control, no matter how badly he would like to be able to.
That's really important information, and I hope you are conveying all of it, in detail, to your doctor.
At that age, ours always responded this way too-- and it really made him feel terrible about himself because he wanted so badly to behave and earn the reward, but the pressure to succeed made him anxious, and he'd blow up, and then feel worse, which made him more anxious. Vicious circle.
I don't want you to give up on behavior modification strategies-- there are ways of helping a kid this dysregulated get a handle on his own behavior-- but it will be more complex than a star chart, and anti-anxiety meds may be necessary for a while.
An ABA therapist or a CBT therapist may be able to help you design self-regulation tasks that are small enough that he can actually achieve them, gain confidence, and then make bigger gains. Leaving it to him on an all-day basis is too hard right now, and I would find ways to take the pressure off rather than increase it, expressing understanding-- "This is hard for you right now."
asked to have a meeting sometime in the next couple of weeks, and they scheduled it for MONDAY!
I hope it goes well!
DeeDee
