Gifted Issues Discussion homepage Forums Twice Exceptional Advice for starting Ritalin

Hi everyone

My little boy started Ritalin this week. They have not given him a diagnosis (gifted with possible ADHD - not all symptoms but very impulsive), but the issues that we have experienced are so significant, and given we have tried every other possible intervention, it was an absolute last resort. I know this may shock people, but my son is 4.5 years old. In your responses, please do not criticise our decision to look at medication at this age. I am not interested in criticism. My son needs some OT and SLP intervention, and basically he needs medication to be able to get him to a point where we can look at these therapies. Without medication and the ability to sit and concentrate, therapy cannot even begin. Also, he is in a very supportive kindy situation where they know him well, so it made sense to start medication in a safe environment, before he moves to school next year with teachers who do not know him (in fact he is at risk of being excluded from school before he even starts school). Finally, when your child runs out on the road with younger children and therefore puts himself and other children at risk, you have to put your personal opinions about medication aside in order to potentially save your own and other people's children. There we go. I said I wasn't going to justify my decision, but it just came out!!

To the point of my post. We have started on a 1/4 tablet (10mg) for this week. Next week we trial 1/2 a table, and the week after a full tablet. If he responds well we will then move to Concerta.

So far it has had a small benefit (e.g. he has been siting still at mat time which is amazing). He has been more emotional than normal, which is, from what I understand, a common side effect. His appetite has increased (which was interesting). He seems marginally calmer and easier to reason with at night, even when the medication wore off 8 hours earlier.

I am just really asking people to let me know their experiences? Did you start gradually. What changes did you notice as the dosage increased? What was the response when you went from Ritalin to Concerta etc? What should I be concerned about? Any information will be really appreciated.

Thanking you in advance

AB

Hello AB,

Sorry for a rather long post. I felt compelled to delurk by your post. Just wanted to share a bit of my experience with ADHD and medication. My daughter has ADHD and is now 23 years old. My sister's son also has it and he is now 11 years old.

My daughter was prescribed Ritalin at age 6 but at the time because of pressure from various people, I ended up resisting giving her the medication till she was 8. One of the biggest regrets of our life. In hindsight, I would have wholeheartedly started at age 4 or 3 even, knowing what I know now.

She was prescribed 20 mg and I started her on 1/2 of a 10mg tablet till we got her on about 15mg - 1 and 1/2 tablets within the first week. Had to give her this before school and the school nurse would administer the other dose after lunch/before class. Ended up with the 15 mg till she grew a bit bigger then it was obvious her body was metabolizing faster. Essentially we monitored her very carefully to find the right balance of how she felt internally and how she behaved outwardly.

We went through Ritalin, Strattera (caused stomach problems), Adderall (as she got older) and the XR versions. Concerta was great for her. She was on 18 mg until about age 13 at which point we titrated upwards till 52 mg (I think). We had a lower dose for normal school days and we gave her a bump for exams or attention intensive activities.

May I suggest that you ask to be given a prescription for a smaller dose and the regular dose so you can do these "bumps" as needed, rather than increasing the dose permanently, if you know what I mean.

We always took weekends off unless we had a special activity that she needed extra help for. Although at first we tried going off the meds during summer vacations, it proved not viable as her symptoms really interfered with daily life, not just school.

Basically, the change in her was night and day. She became so happy and blossomed with the medication. She went from constant frustration to confidence and learning, etc. etc.

Yes, we went through counseling, behavior management, various therapy lessons, training software, etc. but none worked like her medication. For her, it was the right thing to do.

We are very thankful for the wonderful change in our child and I am a proponent of ADHD medication for this reason. Our daughter who is also gifted/2e will tell you herself that this was life changing for her.

My nephew was 3 years old when he was prescribed Concerta 18mg. Again, also a very gifted child who suffered very much as he literally could not even sit still for 1 MINUTE. Yes, the age was concerning at the time and yes the whole family gave my sister input and yes, her son had therapy and everything.

He is 11 now and is at the top of his class, couldn't be happier, etc. Everyone was amazed at all the positive effects it had on him. My sister and brother in law are also very thankful for the medication. Again, for them, it was the right choice.

I do have an aunt who has criticized our decision and would not let up on me at every occasion, until my daughter herself told her, Auntie E, please stop, it has been great for me and I'm happy. She finally got the message. Btw, she only saw my daughter at family gatherings so she really did not know our struggles.

I won't even explain what we went through, suffice to say it was extreme symptoms across the board before medication and calmness and happiness once medication began.

You'll know if you're doing the right thing. Just watch and listen to your child and it will be obvious. I always gave her meds AFTER meals and gave extra vitamins. We avoided the meds after 5 pm (you'll have to keep a diary to monitor how to dose). The XR versions were great as she got older, just 1 pill after breakfast, but when she was little I prefferred Ritalin because it lasts only 4 hours at a time and I could adjust it better.

And oh yeah, as she got older, my daughter learned to manage her behaviour herself and knew when she needed meds or not. I now have a 4.5 year old son but he does not have ADHD so I know both sides.

And one last thing, piano/music lessons were helpful for her.

I wish you and your son the best and hope things work out for your family.

Best,

Lucky

Well, I think it is kind of hard to answer. From what I read on forums on ADHD, it really depends on the kid. Some reacts well to Ritalin others do not, but do react positively to concerta ... Some become more irretable when the dose is too strong. I guess that the only way of getting the right medication is tries and errors. But it needs to be patient since it requires a certain time between starting a medication and it reaching its steady state (I guess something like 2 or 3 weeks). In your case, it might be tougher since your son may have some difficulties in expressing by himself how the medication works on him.

Actually, there's no ramp up time in Ritalin. The half life is super short, today's pill is completely out of his system probably by early afternoon.

That said, when you get the right dose I think you'll know. He'll still be him, with all his personality, but with some self control. Personally, as soon as you see that, I would stop, and stay with that med, at that dose.

Ritalin and Concerta, while both stimulants, are completely different drugs. It makes no sense, IMO, to find a working dose of one just to switch to another!

Good luck, btw. Trying to find the right med can be rough, but when it works out its practically magic!

It's ok Medication is what some kids really need. I personally know three kids (from three different families) whose behaviour was so extreme and damaging that drastic measures had to be taken, and meds saved these kids.

Running out into traffic is not something to take lightly. Besides, just because he's on medication now (when he's at risk and needs it) doesn't mean he will be for the rest of his life.

My DS (ADHD combined) did his "traffic running" when he was about three, so I used a wrist strap (what a fantastic thing that was!). I'm not sure if you could use that on a 4.5 year old though. You have my sympathies...

Hang in there... It'll work out, you'll see

Thanks everyone for the support and encouragement

I forgot one thing ... If any of these ADD medications did not work, the reason can be that the problem is not ADD. Some people on this forum may discuss this point better than me, I guess...

Hello AB,

I'm new here, and I just made a comment yesterday but I think it's still being moderated. I wrote about my DD23 with ADHD and her med history. It was rather long but I forgot a very important thing.

If you haven't already, please ask your pediatrician to investigate further by running full lab tests such as Complete Blood Counts and vitamin panels among others. My DS4.5 at age 3 suddenly started acting out, tantrums, extreme irritability, lack of appetite, not growing as expected, etc. and lo and behold, Iron Deficiency Anemia and Thalassemia (a hereditary blood disorder). Anyway, we also ended up discovering he had an enlarged Spleen due to this and it was affecting his food intake (spleen pushing up against stomach making him feel fuller).

Within 2 months of intense vitamin therapy, he slowly reverted back to the sweet and happy boy we knew prior. We now monitor his bloodwork every 60 days to see how he is progressing. His Thalassemia is a lifetime issue but his IDA is now almost resolved.

My suggestion is just be sure to specifically request Iron/TIBC and Serum Ferritin and insist upon and keep copies of all your lab tests.

You never know - it is always best to rule out other health issues that could be in addition to his ADHD.

It's been about a year now and we are very grateful that our pediatrician agreed to dig more deeply into his issues. DS has now grown 3 inches!

Wishing you the best in your situation,

Lucky

After trialing one week on 1/4 tablet, today we went up to 1/2 a tablet. Again, only minor changes noticed - improved focus and attention. A bit more teary than usual, but we were told to expect that. Interestingly it took about an hour to kick in. Maybe we wont notice any major changes until we trial the full tablet???

Is he taking lots of fluid with the tablet? Effects kick in mug faster for our dd if she's had food and plenty to drink with/prior to medication.