Impulsiveness/saying inappropriate things

[akafred]

This has been a HUGE problem in the past (huge), but had gotten mostly better with just a minor incident here or there. But now I am hearing regular teacher comments. There is a new boy (started the last couple few months) and he and C play off each other terribly. Example: He said he was going to take a picture of C in the shower and she said she was going to take a picture of grown ups smooching in the shower. I have no reason to think she has seen grown ups smooching in the shower, but she is interested in grown ups smooching lately (she told me after I took her to "Hidden Figures" that the reason she wanted to see it was the scene in the previews where there was a kiss, she asked a coworker who was getting married if she was going to smooch, etc).

She is on Strattera and it seems like she needs a dose adjustment but is on the high end of dose for weight so we can't. I'm going to set up an appt with a new doc (psych) that her bio brother sees if they will accept C as a new patient.

Any other suggestions? I don't want to go through what we did before. Being vague, but it was bad. Impulsivity seems so hard to deal with, especially with an instigator/exacerbate.

[Deleted]

The only thing I could think of off the top of my head was a counselor. Helping with social skills and what is appropriate things to say or not.

I know kids move around in Montessori but you could let the teachers know they play off each other and the teachers kind of separate them when possible without telling the kids what they are doing. Not sure if that is possible. Since it seems to be more happening at school maybe then ask them if they have any suggestions.

[akafred]

I trust the teachers are dealing with it appropriately. I just need it to stop.

She was in counseling for 18 months and it did more harm than good IMO. I know a different counselor might be more helpful, but quite frankly I do not have the bandwidth right now. I am barely treading water on weeknights as it is with going to chiro 2x per week after the accident plus Char's extracurricular etc. I barely get one weeknight a week at home and it is quite literally killing me. Ok probably not literally but it is very painful.

[URMySunshine77]

Can you find a social story about inappropriate topics? We got some good ones from Free Spirit publishing. Another option would be to find a way to draft your own. I have heard that there are some Web Sites that walk through their creation.

[akafred]

Feb 9, 2017 21:54:59 GMT -5 URMySunshine77 said:

Can you find a social story about inappropriate topics? We got some good ones from Free Spirit publishing. Another option would be to find a way to draft your own. I have heard that there are some Web Sites that walk through their creation.

Correct me if I am wrong, but social stories are good for teaching children what is and isn't appropriate. In this case, she knows it isn't appropriate, but she is impulsive and says it anyway. She tends to "one up" in conversation, so while she probably wouldn't bring up the inappropriate thing (shower, taking pictures in the shower), she will "one up" the kid who does bring it up and take it to the next level. She thinks it is funny and loves to make others laugh. Anything that is borderline or over the line is desirable. She also likes scaring children by telling them stories like about Bloody Mary coming out of the mirror.

[URMySunshine77]

I understand what you mean. Is there any type of play therapy that can make these ideas less taboo and enticing? I was just thinking about finding a way to make the topics mundane for her.

[Deleted]

How did you handle it before?

Can you talk to her about one upping and tell her instead she should change the subject and role play it.

Otherwise I might go with a complete shut it down technique.

I just don't know how it all works with the impulsivity.

[akafred]

Feb 9, 2017 23:18:42 GMT -5 URMySunshine77 said:

I understand what you mean. Is there any type of play therapy that can make these ideas less taboo and enticing? I was just thinking about finding a way to make the topics mundane for her.

IDK. I tried telling her she can talk about anything at home. She did an uptick in that stuff at home but since I don't play off of her and give her that "class clown" feedback, she isn't *really* getting what she really wants and thus continues at home.

My *very* amateur psych hypothesis is she has an underlying issue with norepinephrine, like an imbalance. She seems to crave it (sensory seeker, daredevil, class clown, debater). I know there is a difference between norepinephrine as a neurotransmitter and norepinephrine as a hormone in the body, but that is where my lack of medical or psych degree betrays me. Strattera is in part a norepinephrine reuptake inhibitor, leaving her with more in the brain and possible body, satisfying that underlying need for stimulus input. But it isn't working as well so she's falling back in her old ways.

[akafred]

Feb 10, 2017 7:34:08 GMT -5 @clarypax said:

How did you handle it before?

Can you talk to her about one upping and tell her instead she should change the subject and role play it.

Otherwise I might go with a complete shut it down technique.

I just don't know how it all works with the impulsivity.

What is a complete "shut it down" technique? 'Cause I got nothing. It seems cruel to punish her for something she can't fully control, and doing it several hours after the incident won't be very effective anyway. Her teacher has taken a drastic approach which is to threaten to take away her toddler. If that doesn't work then IDK what will!

[mrsbuttinski]

She trended toward similar topics in the past as I recall. I suspect it's for the reaction. A couple of random thoughts if it were me.

I agree that a Social Story is beneath Char's social and emotional bandwidth, but I don't know if she truly gets the consequences of her behavior. The best Social Stories lay out a plan for behavior in a more "this is what is going to happen" training scenario as opposed to a more Social Thinking curriculum that teaches consequences- that her peers and teachers might think less of her and her family when she escalates these topics even if they are laughing.

She's a bright kid, you could certainly talk about norms of appropriate topics for humor. You could also explore the reasons people laugh- out of discomfort, for instance or because they are laughing at you not with you. She's old enough.

Another avenue for dealing with this is to point out that she is ceding her "power" to this other kid by letting him set the agenda for their interactions. She's feistry enough that seeing this from a power perspective might dial it back.

My sister was a lot like this at that age, she enjoyed the "shock value" of such topics and because she was more accepted by the boys in her classes than girls, she was later to outgrow "bathroom" and sexual references. I know that you, like me, are a strong proponent of positive discipline and natural consequences, but this may be a situation that would be more effectively addressed with <gasp> an actual punishment. You may find it's what works for this particular set of behaviors.

One thing that helped DS was to teach him 1) that it wasn't his job to be funny and 2) to help him develop better material. He has a gift for mimicry which he developed; it gained him attention without bathroom talk which is largely outgrown by well developing kids by 2nd grade. Although he got pretty raunchy by high school which is sort of age appropriate so long as he was entertaining like-minded peers. (I confess I once got a phone call from BSA National Jamboree because his scoutmaster wanted to needle me about a collection of jokes I call "The Trilogy of the Dog" DS told his friends at campfire. When he asked DS where he learned the jokes, he threw me under the bus. Yeah, I'm the cool mom.)

I might explore medications again. It doesn't seem Strattera is giving her the relief she needs from symptoms at this point. I appreciate that it's a lot easier as a parent to be "one and done" with psychoactive medications, but sometimes polypharmacy can lead to more effective treatment. Adding an SSRI to a stimulant helped DS dial back the anxiety that drove a lot of his impulsivity- adding the stimulant to the anxiety meds gave him a 5 second tape delay in which to reconsider his next actions which also helped dial back the anxiety knowing he had a tool that would help him avoid the consequences of saying or doing something bone-headed.

I'm sorry you are still dealing with the injuries from your accident.

[akafred]

lol I am not against a punishment if it will help in this sotuation, but I think it would just make her anxiety worse and add insult to injury. If she is worried all day about what mom is going to say, her behavior is likely to be particularly challenging the rest of the day. The school's threatened punishment is really the nuclear option for Char, and if any threat will straighten her out, this will be it. She LIVES for her responsibilities helping with the toddlers and has her particular toddler that is like her surrogate child. The teacher said she can't have Char teaching inappropriate things to the toddlers and if she can't control her words and actions (also defiance is increasing) then she isn't showing she is able to handle the responsibility of helping with the toddlers. Of course I foresee anxiety around whether she will be allowed or, when it is taken away, anxiety over when she will again be able to care for toddlers. Which is why I need a meds change. Sigh.

[Deleted]

Shut down approach is just that anytime she starts to talk about the subject she is shut down. Like she talks about kissing, and you instantly say that is not appropriate for kids to talk about in a firm voice followed up by a punishment if she continues.

I know it is controversial, but I do punish for things that happen at school.  If DS physically hurts another child at school, I take away his TV in the evening.  I know some people think what happens at school is handled by school and the several hours later argument.

1. I believe by age 6 he can grasp the punishment coming several hours later.
2. I believe it is my job to back up what the school has done, and if they need my help or have asked for my help (which they have before), then I will do it.

I probably am a bit more strict than you, but I am still in the authoritative parenting style not authoritarian.  Its shades on a scale. 

I like the teacher approach and maybe that will solve it so you don't have to do anything at home.

[akafred]

Again, it isn't that I am against punishment. There are times it is appropriate and I do. However, in this case her disability is driving the behavior. She has ADHD. She is impulsive. But more than that, if I punish her for it, her anxiety will spike. When her anxiety spikes, her behavior gets worse. So punishing her would make it much worse. I'm sure she is worried as it is about the toddlers. I can't give her more to worry about or it will just backfire and spiral.

I am not sure how I feel about a complete censure any time she mentions kissing or anything in that realm. My gut tells me that it would be hypocritical as I have always had a "you can talk about anything with me" approach to these things. Also kissing isn't bad... It's more that there is a shades of gray thing (no pun intended on the book!) and she needs to learn when the gray becomes too dark. She doesn't see where the line is when she goes over it.

I do like mrsbuttinski suggestion about teaching her other ways to make kids laugh, and explaining to her that she is giving her power away to that other little boy. On day 1 he was in frenemy camp. He is pretty clearly cut from the same cloth as Char.

[spooko]

There are several kids that I KNOW DS feeds off of negatively. Starting already in about 1st grade we've pointed out that these aren't the best friend choices for him. As time went on and gentle observations weren't cutting it, we've gotten to the point of just laying down the law that he's not to play with A, B, and M. That they can't handle themselves around each other and that it's not a good situation to put yourself in. So just stay away. I think it could be helpful to start the observation process with Char. Hmm, looks like when you play with X you seem to find yourself in more trouble. It may be a better experience to play with so-and-so-good-example-friend.

You know I have an escalator child myself so I empathize!

[mrsbuttinski]

Feb 10, 2017 10:49:08 GMT -5 akafred said:

Again, it isn't that I am against punishment. There are times it is appropriate and I do. However, in this case her disability is driving the behavior. She has ADHD. She is impulsive. But more than that, if I punish her for it, her anxiety will spike. When her anxiety spikes, her behavior gets worse. So punishing her would make it much worse. I'm sure she is worried as it is about the toddlers. I can't give her more to worry about or it will just backfire and spiral.

At this point, I would agree that you have to weigh the anxiety piece in this. But at some point I personally found it necessary to move away from the "you can't help it" to the "it sucks that you have to work harder at this because of your AS/ADHD". To hold her to a lower standard will eventually become the soft discrimination of lowered expectations. YMMV.

I am not sure how I feel about a complete censure any time she mentions kissing or anything in that realm. My gut tells me that it would be hypocritical as I have always had a "you can talk about anything with me" approach to these things. Also kissing isn't bad... It's more that there is a shades of gray thing (no pun intended on the book!) and she needs to learn when the gray becomes too dark. She doesn't see where the line is when she goes over it.


I think your instincts are spot on here. You need to keep the communication channel between you and your impulsive DD open around all manner of topics that may not be appropriately discussed with other people. 

Plus it's really hard when a child is trying to understand relationships and sexuality, to put boundaries in place because they shift as the child gets older. 

[Deleted]

Feb 10, 2017 10:49:08 GMT -5 akafred said:

Again, it isn't that I am against punishment. There are times it is appropriate and I do. However, in this case her disability is driving the behavior. She has ADHD. She is impulsive. But more than that, if I punish her for it, her anxiety will spike. When her anxiety spikes, her behavior gets worse. So punishing her would make it much worse. I'm sure she is worried as it is about the toddlers. I can't give her more to worry about or it will just backfire and spiral.

I am not sure how I feel about a complete censure any time she mentions kissing or anything in that realm. My gut tells me that it would be hypocritical as I have always had a "you can talk about anything with me" approach to these things. Also kissing isn't bad... It's more that there is a shades of gray thing (no pun intended on the book!) and she needs to learn when the gray becomes too dark. She doesn't see where the line is when she goes over it.

I do like mrsbuttinski suggestion about teaching her other ways to make kids laugh, and explaining to her that she is giving her power away to that other little boy. On day 1 he was in frenemy camp. He is pretty clearly cut from the same cloth as Char.

You can go about it in whatever approach like come down really hard and then ease up.  Or you can only say these things to me but not in public.  However, you draw the line.  Kissing is just an example, its not THAT bad or even bad.  Its when she gets into the worst stuff that is a problem. 

Kind of like the potty words- you can only use these words in the bathroom.  Maybe you can only use these words in the home with mom?  These are just examples, and not well thought out ones at that.  I'm just throwing them out there so you can tweak them how you would want to set boundaries.

I guess I am saying set boundaries, but it is up to you how you would set them.  Explicitly show her the line and how not to cross it. 

[Deleted]

Distraction might help too- changing the topic, perhaps a joke book to go along with teaching her how to make kids laugh.

[akafred]

Feb 10, 2017 14:39:56 GMT -5 @clarypax said:

Feb 10, 2017 10:49:08 GMT -5 akafred said:

Again, it isn't that I am against punishment. There are times it is appropriate and I do. However, in this case her disability is driving the behavior. She has ADHD. She is impulsive. But more than that, if I punish her for it, her anxiety will spike. When her anxiety spikes, her behavior gets worse. So punishing her would make it much worse. I'm sure she is worried as it is about the toddlers. I can't give her more to worry about or it will just backfire and spiral.

I am not sure how I feel about a complete censure any time she mentions kissing or anything in that realm. My gut tells me that it would be hypocritical as I have always had a "you can talk about anything with me" approach to these things. Also kissing isn't bad... It's more that there is a shades of gray thing (no pun intended on the book!) and she needs to learn when the gray becomes too dark. She doesn't see where the line is when she goes over it.

I do like mrsbuttinski suggestion about teaching her other ways to make kids laugh, and explaining to her that she is giving her power away to that other little boy. On day 1 he was in frenemy camp. He is pretty clearly cut from the same cloth as Char.

You can go about it in whatever approach like come down really hard and then ease up.  Or you can only say these things to me but not in public.  However, you draw the line.  Kissing is just an example, its not THAT bad or even bad.  Its when she gets into the worst stuff that is a problem. 

Kind of like the potty words- you can only use these words in the bathroom.  Maybe you can only use these words in the home with mom?  These are just examples, and not well thought out ones at that.  I'm just throwing them out there so you can tweak them how you would want to set boundaries.

I guess I am saying set boundaries, but it is up to you how you would set them.  Explicitly show her the line and how not to cross it. 

Grrrr lost my post. I DO set the limit. She KNOWS. Believe me we have discussed it, even role played it (though it is hard to recreate). But there are 2 problems. One is when she is in the moment she isn't even thinking about the rules. She is getting what she "needs", which is positive social feedback in the form of making other kids laugh, all while doing something a little edgy which is her thing. The other problem is she goes over the edge and doesn't recognize it. In general it is a little like expecting a 3 year old to accept, mid bite, that they should not eat that cookie because it has no nutritional value and is empty calories. No, they will keep eating the cookie unless you take it away... and then there will be a tantrum. Char has trouble recognizing that th cookie is bad for her to start with and she sure as heck isn't going to stop eating it. It's some of the same brain actions as addiction. It's going to be extra hard for the alcoholic to put down the drink when he's already drunk half of it.

And mrsbuttinski, I hear you. I do not want to lower the bar forever. Right now though I feel like it would be cruel to keep it where it is when she can barely see the bar much less reach it. It's disheartening for her and not helping her improve. At this stage I really think she needs the help of pharma to even be able to process the situation. She just isn't there yet. I have a pedi appt for Tuesday. Not sure what to do. The neuro isn't working out. Don't really want ped Rxing but have to go there to go anywhere. Sigh. I just want something that works for the long haul.

[Deleted]

Hopefully you will find some help with the pedi etc and adjusting meds fingers crossed. Perhaps in speaking to the teacher and camps part of it could be them keeping a close eye on her and intervening before it's out of control and talking to the other kids that they should ignore it. That is hard to do definitely and I am not sure on success rate, but as a former counselor I would have appreciated a parent sharing with me a diagnosis and ways I can help.

I don't get the impression she seeks out adults but perhaps if there is one at a good quality and stable camp for summer you can use their bond to build on that. It would be easier for them to keep a close eye and just generally be staying aware. And it sounds like her teacher is on top of it.

I don't mean to be dense or make you explain in length I just don't know her that well.

[akafred]

@clarypax, it's cool. It's just really frustrating because advice like "set the limit" makes it sound like I haven't tried. I have tried but it isn't helping, which is why I am reaching out asking for help.

Anyone have experience with BuSpar for ADHD?

[mrsbuttinski]

Why BuSpar?

Geez, I know next to no one who takes this drug these days.

Was this to be an addition to Strattera or instead? BuSpar is one of those old line meds that is sometimes added to a cocktail of things. I don't know anyone who takes it alone.

One teen I know who took it was a teen and had issues with priapism as a side effect; TBF he also had that with most atypical antipsychotics. Another teen I know had sexual side effects which made him very interested/horny; he also had this problem with Wellbutrin.

As I recall, it needs to be taken several times a day- maybe 3 doses during the day because it has a short half life. And studies have not demonstrated efficacy in children.

From the FDA prescribing information:

Pediatric Use

The safety and effectiveness of buspirone were evaluated in two placebo-controlled 6-week trials involving a total of 559 pediatric patients (ranging from 6 to 17 years of age) with GAD. Doses studied were 7.5 mg to 30 mg b.i.d. (15–60 mg/day). There were no significant differences between buspirone and placebo with regard to the symptoms of GAD following doses recommended for the treatment of GAD in adults. Pharmacokinetic studies have shown that, for identical doses, plasma exposure to buspirone and its active metabolite, 1-PP, are equal to or higher in pediatric patients than adults. No unexpected safety findings were associated with buspirone in these trials. There are no long-term safety or efficacy data in this population

Is there some reason you have ruled out an SSRI? These are generally the go to for GAD these days. Does she have a strong family medical hx of bipolar that would make a subclinical dose of an antipsychotic a better/safer choice?

DS continues to do well on an SSRI and a stimulant. He also has years of CBT to rely on for situational anxiety at his disposal.

My niece did pretty well on a combination similar to DS's, but her psychiatrist (DS's as well) added a miniscule dose of Abilify to the mix- so 3 psychoactive meds- but the difference is incredible in how she feels and how she functions. Niece has a strong family hx of bipolar- her mom (potentially borderline or psychotic) and he dad's family (strong bipolar) so the antipsychotic as a kicker is safer than bumping up another med for the sake of taking two. The difference is striking to my eye. She also sees a therapist, but I don't think she's a particularly good fit. JMHO, I think it's more of a play date than someone challenging new thinking. 

I wonder what Char would look like if you took the tx of ADHD  off the table and managed the anxiety piece first. I've talked about my mother being the font of all ADHD in the family. I finally got her in to see a psychiatrist for meds management- finding a psychiatrist for someone over 70 is harder than finding one for someone under 18 FWIW. Mom's been on Prozac for years via her PCP for anxiety- there's a lot of OCD and anxiety in her large family. The new psych bumped up her up to a higher dose and then added a kicker of Trintellix which has really helped dial back her background anxiety and deal with the situational stuff. It's like the intensity of her ADHD has been lessened by taking most of the anxiety off the table.

[akafred]

I mentioned BuSpar because recent trials have shown that it is good for anxiety and also that significantly reduces ADHD symptoms. Someone mentioned their child taking it and doing well on another forum, but it is the first time I have heard of it being used this way, so I thought I would ask here.

I'm not taking an SSRI off the table. I am just a little uncomfortable with it for 2 reasons. 1 is we literally know nothing about family history except one 9 year old brother who got dx with ADHD and anxiety last fall, so I can't answer the question about bipolar, and the other is it would most likely require 2 or more meds, which may very well be the way to go but I don't love it. Multipharma seems like such a complex road and I am not really comfortable navigating the single pharma road given our limited resources in the area of providers.

I think I have mentioned before that I have a friend/former coworker who has a daughter about 6 or 7 years older than Char. She is actually the youngest of 4 and they nicknamed her "The Devastator." Charlotte has always reminded me so much of the Devastator's antics. And The Devastator got a bipolar dx a couple years ago. I'm not concluding that C has or will develop BP, but she has some early signs. With the lack of family history other than knowing they self medicated for something or things, it makes me a little reticent to try an SSRI. She is only 7.5 years old and 45 pounds. It's a big step.

But moreso than anything, I am frustrated with the apparent lack of skilled providers to help me through it. The neuro just doesn't really listen. I think we suffer from a bit of provider bias where they see DD is on Medicaid and assume her parents are uneducated. I can see that we will get back into that 6 month vortex. We have the possibility of the psychiatrist practice that her bio brother goes to (to accept DD even though they don't take new patients because she is family) but it is in a very inconvenient part of the city for weekday appointments and the psychiatrist relies on nurse practitioners so we wouldn't really be seeing a psychiatrist. There are no other psychiatrists. None. Hopefully the pedi appt will be enlightening. But I don't have a lot of comfort around it.

Meanwhile DD failed an eye screening from when the Lions came to school. They took a picture of the eyes so it wasn't her intentionally failing which I would not put past her. She has in the past been borderline farsighted (as in, age appropriate, so no glasses needed) and now is nearsighted. So that appt is Monday. Part of me hopes that if she does need glasses that will help with her attention etc. But the impulsiveness is really what needs the most help.

[akafred]

Eye doctor appointment went fine except she was a wiggle worm of course. She is NOT nearsighted. Still a tiny bit farsighted but that is still expected for her age and is decreasing vs last year.

[akafred]

Per pedi we are going to taper down and stop Strattera and begin the lowest dose of Concerta (generic). She did one of the genetic tests for med metabolism and that will tell how well different SSRIs and non-stimulant ADHD meds will work for C as well as MTHFR. By the time we have the results we should know how Concerta alone is working and whether we need an SSRI or other additional med too. I think DH was pretty unhappy with that possibility but I am almost resigned to it. We have her cell number and can reach out with any concerns or updates.

I know many don't like pediatricians Rx'ing, but I was very unhappy with the neurologist who wore funny pants but didn't listen, and the area is extremely underserved in psychiatrists. Even if we got in with a psychiatrist office, most likely we would be turfed to a nurse practitioner anyway. At least pedi is an MD, and I trust her. We were already sort of social acquaintances before our old pedi quit practice to be a SAHM, and I know her to be very well educated, experienced, and like minded. I met one of my good friends locally on the Bump and she had already met and became friends with pedi as they lived near each other, so I have seen pedi at my friend's son's birthday parties and a few outings. Worst case if this gets too complex I trust her enough to make a referral or to ask her for one.

[wesleycrusher]

Feb 14, 2017 13:00:32 GMT -5 akafred said:

Per pedi we are going to taper down and stop Strattera and begin the lowest dose of Concerta (generic). She did one of the genetic tests for med metabolism and that will tell how well different SSRIs and non-stimulant ADHD meds will work for C as well as MTHFR. By the time we have the results we should know how Concerta alone is working and whether we need an SSRI or other additional med too. I think DH was pretty unhappy with that possibility but I am almost resigned to it. We have her cell number and can reach out with any concerns or updates.

I know many don't like pediatricians Rx'ing, but I was very unhappy with the neurologist who wore funny pants but didn't listen, and the area is extremely underserved in psychiatrists. Even if we got in with a psychiatrist office, most likely we would be turfed to a nurse practitioner anyway. At least pedi is an MD, and I trust her. We were already sort of social acquaintances before our old pedi quit practice to be a SAHM, and I know her to be very well educated, experienced, and like minded. I met one of my good friends locally on the Bump and she had already met and became friends with pedi as they lived near each other, so I have seen pedi at my friend's son's birthday parties and a few outings. Worst case if this gets too complex I trust her enough to make a referral or to ask her for one.

Good luck!

Also don't discount nurse practitioners. Just like docs, there are good and bad but as a psych RN I can tell you that there are some excellent, experienced ones out there.

[akafred]

Feb 15, 2017 15:12:49 GMT -5 wesleycrusher said:

Feb 14, 2017 13:00:32 GMT -5 akafred said:

Per pedi we are going to taper down and stop Strattera and begin the lowest dose of Concerta (generic). She did one of the genetic tests for med metabolism and that will tell how well different SSRIs and non-stimulant ADHD meds will work for C as well as MTHFR. By the time we have the results we should know how Concerta alone is working and whether we need an SSRI or other additional med too. I think DH was pretty unhappy with that possibility but I am almost resigned to it. We have her cell number and can reach out with any concerns or updates.

I know many don't like pediatricians Rx'ing, but I was very unhappy with the neurologist who wore funny pants but didn't listen, and the area is extremely underserved in psychiatrists. Even if we got in with a psychiatrist office, most likely we would be turfed to a nurse practitioner anyway. At least pedi is an MD, and I trust her. We were already sort of social acquaintances before our old pedi quit practice to be a SAHM, and I know her to be very well educated, experienced, and like minded. I met one of my good friends locally on the Bump and she had already met and became friends with pedi as they lived near each other, so I have seen pedi at my friend's son's birthday parties and a few outings. Worst case if this gets too complex I trust her enough to make a referral or to ask her for one.

Good luck!

Also don't discount nurse practitioners. Just like docs, there are good and bad but as a psych RN I can tell you that there are some excellent, experienced ones out there.

I don't mean to discount them. Our beloved first pedi was a NP. I could be off base but I don't know that it would bring a lot more to the table to see a psych NP for meds vs her MD pedi who knows her history. I know a lot of people are not ok with pediatricians Rx'ing psych meds and I am not loving the situation either, but I am faced with 3 choices: 1) Pediatrician who knows DD and has experience with RX'ing for ADHD, 2) Neurologist who doesn't listen to concerns or apparently believe in genetics, or 3) Psychiatric NP who doesn't know DD and might take a long time to get an appt with. I wish there were another option.

[akafred]

Update: Current situation (tapering down Strattera and adding in Focalin) is a bust. Teacher reports that she is MUCH more focused and quiet during the day, but gets very weepy especially in the afternoons. She didn't know about the meds change and thought she might be getting sick. She also said DD has "lost her sparkle."

My observations in the evenings have been pretty decent. No real negatives until last night. More later.

DH reports mornings have been rough. Of course there are no positives from the meds yet, and she is extremely sensitive/negative. He has to push and prod and remind and nag to get her dressed in the morning, but she reacts so negatively as if she is the worst person in the world. And this morning if anything she is more scattered.

And last night it was obvious the anxiety was up again. We went from cuddling on the couch with a couple of warnings that We would need to go up to bed soon (with her lightly protesting) to her screaming at me that she no longer has a mother and all kinds of nasty things. What happened between? I got off the couch and walked up the stairs.

It's hard to say how much of it is the stimulant and how much is the loss of the Strattera (she is down to 10mg vs her full dose of 35, so it's probably not helping much), but it is clear it isn't working.

[mrsbuttinski]

Feb 25, 2017 10:33:28 GMT -5 akafred said:

Update: Current situation (tapering down Strattera and adding in Focalin) is a bust.


I'm so sorry. Given that she's done poorly in the past with a stimulant alone and given that she has some significant anxiety, why did the prescribing physician not start with something to dial back the anxiety before adding a stimulant? Or were you still hoping to be successful with a single medication?


Teacher reports that she is MUCH more focused and quiet during the day, but gets very weepy especially in the afternoons. She didn't know about the meds change and thought she might be getting sick. She also said DD has "lost her sparkle."

That could be a side effect of the Focalin. Many people react to one of the classes of stimulants with emotional lability. DS can't take this particular class of stimulant because of this side effect; it rules out Concerta and other Ritalin-like medications as well as Focalin. He does really well on Adderall or Vyvanse. 


Good for you keeping the teacher as part of a blind study. I am curious though, did she come up with the comment about the lost sparkle before or after you let her in on the medication trial. What does that even mean? It sounds like the sort of thing I have heard in the past from the sort of mom who "would never drug my child". 

My observations in the evenings have been pretty decent. No real negatives until last night. More later.

That's good; it suggests that she's not rebounding as the medication wears off. 

DH reports mornings have been rough. Of course there are no positives from the meds yet, and she is extremely sensitive/negative. He has to push and prod and remind and nag to get her dressed in the morning, but she reacts so negatively as if she is the worst person in the world. And this morning if anything she is more scattered.


How soon is she required to get into gear once meds are given? Focalin can take about 30 minutes to kick in. I used to give DS his meds in bed as a littler kid and then come back in 20 minutes to get him ready for school. He had to be in at 8:15 with an hour drive so mornings were early here. 

And last night it was obvious the anxiety was up again. We went from cuddling on the couch with a couple of warnings that We would need to go up to bed soon (with her lightly protesting) to her screaming at me that she no longer has a mother and all kinds of nasty things. What happened between? I got off the couch and walked up the stairs.


So sorry. That must've been so hard for you both. 

It's hard to say how much of it is the stimulant and how much is the loss of the Strattera (she is down to 10mg vs her full dose of 35, so it's probably not helping much), but it is clear it isn't working.

If it was me, I would see about getting the anxiety piece settled and then try to introduce a stimulant back in. I might ask for one with mixed amphetamine salts instead. Good luck; I hope you can get to a happier place soon. 

[spooko]

The emotional piece was extreme for DS for the Adderall family but not with the Ritalin family. I could see trying the Adderall family before trying to sketch out a second medication plan. Aside from that, I wonder if an afternoon bridge dose of something would be more effective for her if she's having a hard drop in the afternoons.

I'm sorry that it's a rough go right now. I know how much this sucks.

[akafred]

Vyvanse is Adderall family and Focalin is Ritalin family as I understand it. Since Vyvanse caused high anxiety and we had some success on short acting Ritalin, dr wanted to try a Ritalin. Actually she Rx'd Concerta but insurance didn't cover it so she Rx'd Focalin.

She mentioned adding in an anti anxiety med if it didn't work. I'm not fully sold. I am concerned about the possibility of a trigger for bipolar and the potential side effect of suicidal thoughts or actions. I think it was kind of a long shot but we were hoping a different class of stimulant would be easier on her anxiety.

Teacher said the "sparkle" comment before she knew about meds, but she may have suspected. And she is kind of a "no meds" mama although when we did let her know about the Vyvanse, she told us she did medicate her son who has ADHD and anxiety after trying not to for a long time. But I really think that comment was more that Charlotte is unhappy and weepy and not an anti-medicine comment.