Gifted Issues Discussion homepage Forums Twice Exceptional Advice for starting Ritalin

He definitely has a full belly of food, but I might need to watch the water. Thanks for the advice.

And, while I am here, I never knew about the meltdowns as the tablet wears off. Wow! They are pretty extreme. My son was hyperventilating whilst telling me his heart was broken because he missed out on a ride at the xmas party. I dont think I have seen him so upset before! It only lasted 10 to 15 minutes, but it was pretty extreme.

the come down tantrums/rages were why we had to go to a non-stimulant. they are not fun!

We find that we had a tendency to moodiness and crying coming off short acting ritalin. And a tendency to extreme moodiness in the afternoons on too low a dose of concerta. A higher dose of concerta generally results in even mood all day (more even than off medication), behaviour and performance improvements across the board (all versions we have tried have appreciably improved focus, and all general functioning) - and radically suppressed appetite.

I'd talk to your prescriber about the meltdowns ASAP. They can be both terribly upsetting and wearing for the child, and as disabling as the attention issues, especially if the child has any evening activities.

We had to try several meds and dosages before figuring out what would work for DS. I'm not sure what the prescriber's rationale is in starting with Ritalin and moving to Concerta, but each med works differently and affects a particular person differently.

I know I say it often here, but: make sure you are using a prescriber who is expert, who sees hundreds of kids a week, who takes the time to understand your child's symptoms precisely and listens when you tell them about effects. I would not let a general pediatrician do this job for my kid; we use a developmental pediatrician. A psychiatrist who specializes in attention issues would also be an appropriate choice.

DeeDee

When dd was on Focalin LA (the extended release stuff)she did have the rebound anxiety/crankiness, which we circumvented (mostly) with a small dose of short acting Focalin. Sort of a tapering off effect, IOW. FWIW, if you do need to consider a different stimulant at some point in the future, Focalin tends to cause overall fewer adverse side effects because of the way it's manufactured.

Also, I'll heartily second DeeDee's comments about specialists vs. generalists. Many pediatricians insist on referring out to specialists for behavioral medicine issues. I wish they all did.

Deedee I have no idea where the OP is located but if they are in Australia like I am, then it is a legal requirement to prove Ritalin SA works before you can trial Ritalin LA or concerta. And all stimulants are far more tightly controlled here, only specialists can prescribe and they have to call a government agency for authorization when starting or changing a prescription.

Spot on MumOfThree. We are in Australia.

Interestingly we had no rebound issues at all today. Today could only be described as AWESOME!! We felt like one of those 'normal' families that you see on TV and you read about in books He only had a 1/2 tablet this morning, but 8 hours later his behaviour was amazing when we went to a resturant. Our friends were absolutely shocked. There were some minor issues (he did throw a toy that hit another child), but I put him in time-out and he agreed without any objection. That is HUGE for us! He also put his pyjamas on without being asked. He and my husband are sitting down doing a puzzle as we speak. I am really happy . I know that tomorrow may not be perfect, and we are going to have hippcups along the way, but I am ecstatic at the moment!!

Astroboy the RPA hospital elimination diet has done more for one of our kids than medication, and I see both diet and medication as being critical for the other. It's hard work but really worth considering giving it a go. It was the variability of response you are seeing that made me think of it.

Hi,

On the rebound tantrums, sometimes just knowing that time will be a fragile one is enough to act preventatively. A well timed snack, cartoons on TV, or some low pressure outdoor time is sometimes enough (not a time for crowds or perfectionistic hobbies). Or as said above even sometimes a tiny chip of a pill if timed right can avert the trough.

ADHD runs in my family and I've noticed one family member goes to sleep most easily if they drink a lot of coffee about 1/2 hour before bed. Otherwise they think about all sorts of things and can't fall asleep. Really is a differently wired brain than most. On that note if you do have ritalin in the evening bedtime is best not 3.5 hours later (well I guess it varies a little kid to kid but what I mean is bedtime will be rough if it's in the rebound).

On good behavior 8 hours after a pill -- that is not the pill, that's the kid managing to keep it all together all on their own as regular ritalin doesn't last nearly that long. Wonderful news they have that in them. Of course, having a day going well does predispose to continue that successful feeling. Kudos to you also for managing the rebound so they didn't lose that momentum.

I know you don't want criticism of the decision to medicate, and I am not meaning this that way but rather as an anecdote with how a pretty badly ADHD boy can turn out. There's a very noticeably ADHD member of my family who's gotten through life with every measure of success met without medication (the parents were against the idea). College, sports cars, address, career, family, all just how he wanted. He uses large amounts of exercise and a lot of caffeine and goes from dawn to dusk with boundless energy. As a young child there was no activity he could really excel at due to his impaired attention, and he was pretty hard to be around. But he is incredibly successful as an adult in the fast paced world he chose for himself. Just so you know that down the road it may be possible.

In a similar vein to carefully planning what will be attempted in the rebound timeframe, we also now carefully prune our expectations while off medication or waiting for it to kick in. Pick your battles.

We have given up on the idea that our 6.5yr old might be able to eat her breakfast unassisted or dress herself - a girl who could dress herself beautifully at 2yrs old (back when it was interesting to learn how to put clothes on the right way around and learn all the kinds of fastenings). We highly supervise or do for her until she takes her medication in the mornings and try very hard to not get impatient and angry at what she simply cannot do (ie actually look at the clothes she's putting on and do it correctly). Then she takes her medication and turns into a different child and it's much more reasonable to expect her to what she's been asked or to self manage.