Gifted Issues Discussion homepage Forums Twice Exceptional We started the meds...

So after a lot of deliberation and a few months of counseling, we decided to take our ped's and our psychologist's advice and do a trial of Vyvanse.
Started on 20mg on Saturday... Noticed a HUGE difference during swim lessons that morning, but the rest of the day was "business as usual".
Sunday (yesterday) the big difference is that he sat and colored almost ALL day.
Both days he was VERY talkative (way more than usual) and he had problems napping.
Today he's at school, so I'm half tempted to email his teacher to see how he did today. Or should I leave it alone for a week and see how it goes then?

How long did it take for you to notice a change in behavior when you started your kids on meds? Was it a BIG change or just little things?

I can't remember - and after the medication Merry-go-round who could remember?

I would say that the prescribing doctor will probably want to increase the dose until it's 'too much' and then back off a step. 20mg is quite small. I wonder if it's wearing off at naptime?

Talking to the teachers is ok if it will help pass the time. I read that giving a child medicine tends to make parents and teachers behave better.

Hugs -
Grinity

We recently went through the Merry-Go-Round to which Grinity is referring! We also started on Vyvanse. Our doctor recommends giving a new medication or dosage a 3 day trial. She initially told us one week, but then she said usually you can tell by 3 days. You just don't want to make a judgment based on one day in case there are other factors involved. You are looking for a pattern. Because today is the first day of school, I'd probably give it at least one or two more days at school, and then see if the behavior, focus, etc is consistent. If so, then you can tell the doctor specific times he seems to be focused and other times when he is not. This might let you know how long the medication is working for you. You'll also be able to look for side effects.

That said, you should be able to tell a difference in one day. It's not the type of medication that has to build up or anything. It works for the day you take it and is gone by evening.

Also, these medications works so differently for each kid, so keep that in mind when hearing about others' experiences with specific medications. For example, Vyvanse didn't work for us b/c dh became very weepy and sad. Concerta works pretty well for him but doesn't change his personality. Conversely, I know others have had the opposite experience.

I'd be very interested to hear how it goes, so please let us know how his day went. Good luck; I know it's hard to make the medication decision, but it's definitely been the right choice for my ds. It's not a cure-all, and we still have our share of issues, but it definitely helps him so much. Prior to medication, just writing his name was torture. I think this was due to working memory deficits related ADHD. The week he started medication, he came home, pulled out a blank notebook, and announced that he was writing a book. And he's still working on it! Voluntarily!

Will be thinking of you! I was there not long ago! Good luck and best wishes to your family.

Hi KD,

Vyvanse and most of the stimulant ADHD meds work fast (that day) and wear off fast (that day). I'd say you'll notice it right away, but it may take a few days for you to see enough evidence of the up and down sides to know whether it's right for your child.

That particular med ramped up my kid too far (it was like several cups of coffee-- really fantastically focused, but also on a hair trigger and tipping over into overemotional some of the time). After trying several stimulant meds we ended up using a non-stimulant one which he tolerated better.

DeeDee

Vyvanse - which worked so much better than the other stims for my DS14 - does have a really long half-life. So it might be the exception to the rule that stims don't build up in the system. I'm sure that this is different for each kid and each does as well.

Best Wishes,
Grinity

That was him on Sunday. He was totally focused on drawing/coloring/writing in his new calendar ALL DAY LONG. It was crazy. But then I made something for dinner that he didn't want and he absolutely broke down and sobbed... BUT he's done that before (broken down) but the focused thing all day was new.

I haven't really been able to see how it's affected him during school, but he says his days are good. And they just started their NWEA testing this week, so I guess it was (hopefully) a good week to start the meds?? My friend that brings them home from school said he's been really good on the rides home this week, whew.

We have a follow-up appointment with the psychologist on Friday morning, so we'll see how that goes.

Thanks again for all of your input. I know each kid is different, but it's still nice to hear other's experiences.

Good luck kd! It's so hard to wait it out. Will the NWEA tests help with advocacy?
Grinity

Hi, KD--

As you accumulate more days, you'll start to have a good sense of whether the upsides of a given med are worth the downsides (side effects). Our longest trial that ended unsuccessfully was I think close to three weeks (it ALMOST worked...) and the shortest was three days (simply could not stand it). The three-week one was really close to working, but the emotional volatility started to outweigh the focus.

You'll know.

Best wishes--
DeeDee

edited to add: find out when they expect it to wear off. Some kids get more weepy when the dose is at peak effectiveness, some as it wears off (that has to feel funny...). That's worth noticing, it helps the doc decide what to try next if there has to be a next.

He got all sad and bent out of shape when one of the babies my friends watches grabbed one of his coloring pages.

It seems as if he's been over-excitable right after his bath/shower time. Which would be at about hour 13. Is that normal?

I got a snotty email from his principal today when I asked about the MDT/IEP. Kind of pissed me off, actually. I don't think his needs are being met - the reason I say that is because he FLIES through his homework and tells me that everything is "super easy" and that he "needs a challenge" in class. So needless to say, I need to meet with her, ASAP...

KD, I don't remember how long the Vyvanse lasts in the system, but I do remember that some kids find that "wearing off" feeling really tough to deal with (like coming down off your caffeine buzz). It's a question to bring back to the prescribing doctor for sure. A good doc pays attention to these details if they form a pattern.

Hang in there with the negotiations. Have you ever brought in an outside expert or advocate to talk directly with the school? At some moments this has been key for us.

Thinking of you,
DeeDee

No, but I have a friend that works at Cooperative Education Services here that knows some advocates, so I might ask her for some help.

Went to the psychologist today... He wants to try to up the meds to 30mg and try another med that's short acting since the Vyvanse seems to be wearing off early. I'm not sold on that one, but I'll try the 30mg... He said that the Vyvanse probably wears off around the time we get home and that's probably why he's so whiny around that time.

I also talked to my friend at CES and she gave me some good advice. So I sent an email to his teacher and will go from there.

KD, I hope it works out well!

DeeDee

KD,
Just wanted to check in and see how the medication is going. Did the increased dose of Vyvanse work?

I did want to mention also that we were giving my son a lower dose of Concerta for a while and felt that it worked pretty well. His focus was good, but it just didn't last long enough. Then, when it would wear off, right about the time we got home from school, he'd be a mess for a couple of hours. Very irritable, grumpy, and highly emotional. What helped was to give him a short acting low dose booster in the afternoon before the rebound effect reared it's ugly head. It did work fairly well, but the focus wasn't as good after school during homework time.

Now that we've increased his dose, we do not need the booster. The morning dose lasts long enough, and we really don't see the rebound stuff anymore. Around the 10 hour mark I make sure we are involved in a non-stressful activity. Usually I read to him. Then, he eats dinner, has a shower, we read some more, and then he goes to bed. I guess my point is, I wish we'd increased the dose of the extended release med (Concerta) sooner. I thought we were on the right dose, but evidently not.

I don't think it's a bad idea to try to increased dose sooner than later. You probably have already done that at this point. As you now know, you can usually tell pretty quickly, and you already have a basis for comparison with the lower dose. If the emotional stuff gets worse with the increased dose, maybe a methylphenidate drug like Concerta or Ritalin will be better.
That was our experience, but it is different for everyone.

Keep us posted, and good luck. Thinking of you guys.

Thanks for checking in. I haven't done the increased dose yet just due to scheduling difficulties. I need to give his psychologist a form that his teacher filled out (that looks like a "normal" kid). So I'm not sure what he'll suggest after. He had also suggested the booster, but wanted to check a higher dose first. The only "issue" I have is, at $40 a prescription for a 30-day dose, I feel like it's a waste not to finish it. KWIM? I know that's petty, but, it's $80 in a matter of a few weeks. I wish we could just get a trial to test it and see where it goes.

Thanks again for everyone's input!

Vyvanse is advertised to last 14 hours, but most parents tell me it does not last that long. If given prior to school, the effectiveness has often worn off by the time children begin homework.

Several clients reported symptoms of severe depression after taking Vyvanse, which included suicide ideation.

Most of the psychiatrists that I work with do not feel Vyvanse is better than Adderall. However, they often prescribe Vyvanse to teens because it can not be abused. Snorting Vyvanse will not result in a feeling of being high. Unfortunately, Adderall is sometimes abused by teens. They crush it and snort it to get high. My college clients who take Adderall have to keep it locked in a safe (to prevent theft).

I know what you mean about the cost of the medication. It's crazy expensive! I don't know about the cost of a booster to go along with Vyvanse, but when my son took the methyphenidate (Ritalin) booster, it was super cheap.

I can't tell you how much we spent on meds during the first few months. It was crazy. I have so many leftover medications here it looks like a pharmacy. I hate to throw them away just in case he has to switch back to one of those meds in the future.

Good luck with everything.

We had our follow up with the ped, she prescribed the 30mg of Vyvanse. Luckily, we went through the whole Rx of the 20mg before changing. I refuse to waste those things...

His psychologist suggested the booster, but his ped did not. She said to just give it to him later than we usually do and he would be fine. We give it to him between 6:15-6:45 now, so just do it later and see what happens.

I also asked her about the emotional outbursts and she said that those should get better with the higher dosage. So hopefully she's right about that. Other than that, we haven't had any more of the "side effects" and he hasn't lost any weight and his eating habits haven't changed luckily.

KD, the outbursts could get better OR worse with the higher dosage. Some kids find the stimulant ADHD meds ramp them up. Our kid on Vyvanse was a guy on the edge-- think 3-4 cups of coffee, revved to breaking point. He had many more outbursts than usual, to the point where we had to discontinue it-- the focus wasn't worth the emotional volatility to us at this point. YMMV.

We found the nonstimulant Strattera worked well for attention without giving us extra outbursts.

Personally, I also wouldn't use just a pediatrician to prescribe these drugs-- I'm more comfortable with a specialist who sees hundreds of kids with the same diagnosis mine has, and has lots of experience with each med. Again YMMV.

DeeDee

So far, so good. The outbursts haven't been worse - not necessarily better, but definitely not worse.

I've seen a difference on the higher dosage, and the psychologist said that, as long as we don't have any new problems, we don't have to see him as often anymore.