Gifted Issues Discussion homepage Forums Twice Exceptional ADHD medication trial during the summer?

Hello all,

My DS11 recently had a full neuro-psychological exam, to follow up on a questionable NVLD diagnosis.

He has now got a new diagnosis that I am more comfortable with: ADHD-primarily inattentive, mild depression and "yellow flags" for oppositional behavior. The neuro-psych. thinks that his attention difficulties are significant enough to warrant a medication trial with a stimulant.

My problem is that there are only two weeks left at school (and in fact they seem to be winding down already). Our paediatrician thinks we should wait until fall to try, once he's back in school, but I'm not so sure. The fall is an important time for him (standardized tests for HS admission) so I don't want to be fooling around with his mood and attention during that time.

Have any of you tried medication trials over the summer? Should I/he be able to tell if its helping when he's not at school? He does have a lot of attention issues at home (tooth brushing, leaving doors open and such), so my feeling is that we should be able to see the difference, but I'm not sure.

We were at the same point in the school year when we decided to embark upon a medication trial. I would attempt to get it going immediately, so that the teachers that are familiar with him can give you feedback on any changes. If there are negative side effects, it won't matter since grades are winding down.

If this is not a possibility, I would try the medication in the summer as you suggested. Sometimes it can be a relatively long process to find the appropriate medication (brand, time release) and correct dosage. I agree with you that while he is dealing with transition and testing at the beginning of the school year, this could add an unnecessary level of complexity.

As far as a dramatic behavior change - my son is also inattentive, so the behavioral changes are not so dramatic compared to a hyperactive/impulsive child. I do see a change with his self help, staying on task, even staying on topic of conversation. But, the major change is with school work - which you wouldn't be able to assess during the summer. You might see a "change" but it might be hard to discern if the dosage is optimal.

What you would know immediately is whether that drug is unsuitable. Our DS could not tolerate stimulant ADHD meds; took four trials to find the right med and dosage, with some unpleasant effects in the trial phase. Because of this experience, I agree with you about not wanting to start during a high-stakes testing time-- Mich is right, now is a good time, when all else is stable and you can see what he does at school.

DeeDee

Hi Verona, I am so glad you got a diagnosis that makes more sense to you! Your son is my DD's "IQ Doppelganger" so it seems encouraging that they got similar diagnosis-es.

I agree with starting immediately so you can get feedback from teachers that are used to dealing with him. We are still in the trial phase and it's tough making DD get up early to take her meds when she has no other reason to be up. I think the borderline ODD makes her resent what she perceives as me trying to control her schedule, but she can be reasoned with and she is making an effort to be more compliant.

I also agree that you will notice some changes at home right away - especially like staying on topic in conversation which in our case is no small thing! It is actually pleasurable to have conversations with my DD now. In my case, I immediately saw a less depressed demeanor and DD found she could immediately write essays, songs, poems etc with ease. And she was thrilled to report that her ability to play the Sims improved drastically (for what that's worth!!!).

We are struggling to know if this dosage is as good as it gets or if more would be better since we have no structured benchmarks like school performance to measure improvement against.

We are also still trying to work through major sleep issues, it is hard for me to be task master and remind her to take melatonin at night as I go to bed first and she likes having the quiet house to herself at night so she isn't really too motivated to work on that. Maybe if your DS has summer activities lined up like swim lessons or sports or whatever, it may be easier.

Good luck!

My DS9 just received his diagnosis of ADHD-inattentive type a few weeks ago. We saw the child psych about meds the week before school ended. We ended up deciding to do a trial of a non-stimulant, so our situation is a little bit different. DS is at summer camp until next week, but we will start the meds as soon as he gets back. The non-stimulants can take 6 weeks to work, but our goal is to find a medication that works before school starts again in the fall. Our psych said that the change on medication should be dramatic if it is the right medication, so we should be able to tell a difference at home. I agree with Nik that if DS has some structured activities planned for the summer, it may be easier to tell if the medication is working. I also agree that it will give you a chance to tell if there are bad side effects without it impacting his performance at school.

My son always found those last few weeks of school the most difficult to stay focused, because he was using the 'come on team, lets meet this challenge' spirit of school to help him focus, and so when everyone else got less focused, he really had a hard time.

So if the pead is willing, I would encourage him to start 'medications merry-go round' now.

From my perspective, most of what you are trying to do isn't to find one that works (they mostly all work if you do a high enough dose) but to find one that works without causing moodiness, or other side effect issues - and that's very variable one kid to another. So summertime is a fine time to at least get a general idea of which ones your child 'feels like himself' on. You will need to tweak along the way, possibly when school starts, or growth spurts, or major changes in physical activity level.

You can always pick up a summer activity that would help you see if the med is working, such as starting a musical instrument. My son's ability to practice without parental supervision changed dramatically with medication.

Best Wishes,
Grinity

Thanks everyone for your input. We are seeing the paediatrician this afternoon, and I am going to try to push for a trial before the end of school, or if not, during the summer. Your comments are all very helpful.

Perplexed -- is there a specific reason you are starting with the non-stimulants? I thought most doctors started with stimulants first. I'll ask our doctor about this too.

I guess I should be feeling good that I finally have a diagnosis that fits, and a plan to go forward, but right now I simply feel worn down by worry and sad for my son.

Verona, I was told that they wont give stimulants if there is a family history of heart problems (which I thought we had but turned out I was wrong). I was told the Straterra (non stimulant) was more likely to cause/increase depression and suicidal thoughts.

I am sorry it is causing you grief. How is your son taking it? My DD was happy and relieved when she got her dx

Hugs!

Perplexed, we found that the non-stimulant meds have much less of a sudden "Wow, different kid" effect than the stimulant meds do. But that's what works for our kid-- at the right dose, it's quite tremendous.

Verona, kids with sleep issues or who are already underweight sometimes don't do well on the stimulant meds (which can change sleep and eating patterns). A kid with aggression issues (toward self or others) may not do well on the stimulants, either-- this is highly variable and our doc tries hard to look at the whole kid very closely before deciding on a drug. We use a developmental pediatrician, not our regular ped-- I like having a prescribing doc who really, really knows these meds inside and out.

HTH
DeeDee

Well, my son has sleep issues (greatly helped by melatonin) and borders on underweight. He also has oppositional issues (but not so much physical aggression, more not being able to handle frustration and saying hurtful things, or not being able to "let go" of an argument).

We saw our paediatrician, who appears to have quite alot of experience with these medications. We didn't take DS along, but DH and I went to discuss the neuropsych. report and possible medication. We got a very long lecture about the downside of meds, that she thinks they are being overprescribed, and that in her opinion his profile (mainly inattentive and with oppositional character) would have a low chance of being helped by meds. He has about a B+ average at school, so she thinks that there is not a strong need for medication and that he will start enjoying school more during highschool, when he can take more interesting classes. She also said that the medication would not help self-esteem, social issues or behavioural problems. I didn't completely agree with a lot of what she said.

At the end, she did say that since we have an official dx, she would do a trial but that we shouldn't get our hopes up. She said she generally starts with the stimulants, but if there are sleep problems, loss of appetite, etc, she'd try the non-stimulants. We would start the trial at the end of June (after school ends), as she is away for two weeks and needs to see him before prescribing.

Thanks Nik for the hugs! DS has an appt. with the neuro-psych. next week to hear about the results of the testing. I did give him the short version (because he asked me directly and seemed worried). I wouldn't say he is happy and relieved like your DD; I think he is processing the information, and at least didn't deny that he might have a problem with attention (which wouldn't have been out of character). I'm trying to give him information a little bit at a time, so he's not overwhelmed and I think its going OK so far. I'm planning to give him a book about ADHD called "My Brain Needs Glasses". Its pitched a bit young for him, but I like the way its written.

We are also persuing other avenues for the low mood and behaviour issues: some family therapy probably, and some school accomodations for next year.

In the end, I think we are on the right path. And I'm trying to remember that life is a journey. Thanks everyone for your help with this.

PS I could look around for a developmental paediatrician, but not sure if that is common here. Also, seeing some specialists in Canada can involve a very long wait time (like 6 months to a year). Anyway, thanks for the tip DeeDee, I will at least check into the possibility.

Hi Verona-- When you see the neuropsych, ask him for names of good people who can help you with various facets of treatment, including serving as the person to monitor meds.

Your ped is right that meds are probably over-prescribed-- and yet, to not recognize that depression and ADHD cause real suffering that should be treated seems inhumane to me. People can be unnecessarily dogmatic about the issue of medication; nobody is wildly enthusiastic about medicating a child in theory; but if it helps ease suffering, it may be worth a try IMHO.

FWIW-- Cognitive-behavior therapy also works well for anxiety, depression, and compliance issues; it's not fast, but its effects are lasting and profound.

HTH
DeeDee

Hi DeeDee,

I did ask the neuropsych. who he recommended for prescribing meds and he said our regular paediatrician was fine, and that he didn't think a developmental paediatrician or a paediatric psychiatrist was needed. Plus, my quick internet search showed that there seems to be shortage of these specialists in my area.

Although I didn't agree with everything she said, I think our paediatrician is very careful and experienced, so we'll probably stick with her for the meds. trial, at least to start out with. DH tells me I just need to develop a thicker skin when dealing with her.

I am also getting names for therapists from the neuropsych. - we are thinking that we'd get a better buy-in from DS with a family intervention. The neuropsych. (who I really like alot) describes himself as a "behaviorist" so I guess that's the kind of therapy he has in mind.

Thanks for your insight.

Verona, agreed-- we got the most bang for our buck out of behavior therapy when we changed our parenting in targeted ways as well as getting help for DS. If you can find someone who can do that whole job, that's tremendous!

It gets better once the right help is in place. Really.

Best wishes,
DeeDee

We discussed the risks/benefits of both stimulants and non-stimulants with the psych. There is no one right way to do it. He said most people start with the stimulants because most people have waited until they are in dire need of medication before they decide to start meds, then they want the meds to work right away. The reason we chose non-stimulants is that we have the summer to wait for it to start working and if it works, it will work 24 hours a day. Also, DS has a little bit of compulsive behavior that should be helped with the non-stimulants. The down side is that it only works in 50% of kids and sometimes it doesn't work as well as the stimulants even when it does work. Really, it is the potential of having 24 hour control of focus that motivated me to try the non-stimulant first. The child psych said that is what he did for his own child. HTH!

I get this response a lot and it is frustrating to me. A B+ average is great for an average kid, but when you are dealing with a gifted kid who knows he is smart and is frustrated by the fact that his grades don't reflect his intellect, then I think it is a problem. Also, my understanding of ADHD is that it actually gets worse in high school when the classes become more demanding. Your pediatrician needs to understand that a child with inattentive ADHD is not going to be much better at focusing on an "interesting" class than an uninteresting one. Now, if his inattentiveness is due to is giftedness and boredom in the classroom, she may have a point, but then he would not have ADHD, he would just be a gifted, unchallenged student.

Perplexed,

Thanks for the medication info. and the kind words!

I was pretty upset after the appointment with the paediatrician. Just trying to focus on the way forward now.

Best of luck with your DS's medication trial over the summer.