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.

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.

Hi Polly

I know exactly what you are saying. I am a Senior Manager in a government department, and two of my most recent Directors would definitely meet the criteria for ADHD. Interestingly, their impulsivity, and inability to sit still, etc are characteristics that are really needed in their roles. If they surround themselves with those who are more focused on details, can plan for the future, etc, then they are often quite successful in their role.

I am keen to give Ritalin a good go, and then in the future see if we can reduce it. I would really like to manage his overexcitability through more natural ways. I know a very successful doctor who admitted to me that he uses Diet Coke to manage his attention and concentration difficulties. He would have litres of it per day! Seems to work well for him (mind you, I havent had an opportunity to look closely at his teeth!).

MumOfThree - I have wondered about the RPA elimination diet. We tried Sue Dengates 'Fed Up' diet, but little change. My son has a range of intolereance (soy, dairy, egg, gluten, lentils, peas, oats), and we have followed a very strict diet for 2 years. I might have a look at the RP diet. Thanks for that suggestion

Astroboy if you've got known food issues there might not be more to find, but my advice is if you are going to do the RPA diet then bite the bullet and go all out from the start - their "strict" option plus dairy and gluten (which is already out I see). They have plans in their book for eliminatig all of these at once. Dairy should be the first on you try to get back, then salicylates, then amines, then the various smaller chemicals. You really want to find a dietician who knows the diet well. If you are in Adelaide or Sydney send me a message and I can suggest dieticians.

It's also worth considering fructose and other sugars as a potential issue, which are not covered by the RPA or fed up diets. You can get breath tests for sugar absorption issues (fructose, sucrose and lactose).

Thanks for the info. Most appreciated