ADHD, Anxiety, Destructiveness

We have a 9 yr old son with ADHD and anxiety and he picks everything! All the threads on his clothes and ends up ripping holes in them, picks feathers out of pillows, picks bottom of table during his zoom calls, picks texturized paint lumps off walls, used to pick cuticles but has gotten better. He takes Adderall 10 mg XR and lexapro 10mg. We tried 20mg lexapro but it almost made him more impulsive and anxious (backfired on us). He is very impulsive almost all the time and hyper, loud, destructive and so curious that it gets him in trouble. He touches anything and everything and most of the time ends up destroying his or his siblings’ things (LEGO instruction books, toys, etc). It is intense being around him and I just wish I could help him calm down.

It’s hard to keep him on topic- he goes on tangents and gets stuck talking about one thing (I.e. going to the pumpkin patch) and you cannot get him to drop it and focus for anything. He repeats himself a lot even if we answer his question. It seems like reassurance anxiety.

Without structure, he is listless. He does enjoy his IPAD and that is the only time he’s quiet. When there is Freetime, he just ends up getting himself into trouble. We have to constantly monitor him and cannot trust him to leave him alone in a room or he will destroy or touch something he isn’t supposed to.

He has an IEP for reading and math at school and behavior goals due to interruptions. He is currently doing online schooling at home due to pandemic and it’s very hard for him to pay attention. He picks at everything during his zoom calls and fidgets.

Any advice appreciated, on all fronts.

[Onthemove1971]

Thank you for posting and sharing your son with us.

I am curious if he is seeing a child psychiatrist? If I were in your shoes I would try a different medication. Of course medication doesn't stop all negative behavior, but it should help with at least %60 of negative behavior. It took us at least 4 different medications before finding what worked best for our son. I can't tell from your post if his anxiety is better with taking the medication. Again, I am not a doctor, but I would ask to try a different medication to help the with the impulsive behavior.

Also have you tried thearpy? Or behavior specialist?

It sounds like you have already done a lot. I really feel he could help from a different medication.

Good luck, let us know what you end up doing.

[christelferrer in reply to Onthemove1971]

I have to agree with you. It seems that the medication combo may not be the best suited. We also have had to try and fail 5 times before finding what worked the best. I recognize your son's behavior and can tell that for us, a stimulant never worked. It made the problem worse with a pattern of highly destructive behavior and anger issue. My son is also 9 and takes Sertralin at 37.5mg and guanfacine at 2mg. This has improved by a lot his behavior. Guanfacine is the med I see the most prescribed to control rages and outbursts. Of course a SSRI is needed as the unwanted behavior is often driven by high anxiety. We also coupled the treatment with therapy and we have seen tremendous progress. Good luck, and hang in there, there are solutions. Not always perfect but the right combo will help.

[Hidden in reply to Onthemove1971]

Thanks for your response. see my response at bottom.

[MeadowLane5]

Hi- our daughter age 10 adhd/odd has a very hard time sitting still during her zooms as well. We have benefited from mAking sure she has something tangible to fidget with or move to help her focus. We sat with her and made a list of little fidgets that she thinks would be fun to hold and reach for during class. We put it in a small pouch by her desk and She can reach out for it whenever she feels the need. We put a small plastic spiky massage ball on the floor for her to roll during lessons.. (it’s not visible to the zoom class). We invested in an outdoor swing that can carry her weight til adulthood. We bought it from a special needs school supply site. Something about swinging relaxes her and helps her focus on the next zoom. For lunch if there is enough of a break time she prepares her own meal. She has so much energy and focusing on the cutting and preparing is not only relaxing but a great positive way to release all that energy!

Our daughter has difficulty with riding a traditional bike so we bought her an adult tricycle. She loves it and it serves as a great reward to ride after a “ great” school day. We try to focus on rewarding rather than punishment. It’s definitely not easy. For our daughter remote school has worked better than traditional school. The stress of BIP comments and calls from the dean were overwhelming. It wasn’t good for the parents or our child’s self esteem.

Your not alone- sending you a hug

[anirush in reply to MeadowLane5]

We also have had good luck adding guanfacine to a non stimulant. Did not do well on Guanfacine over 2 mg. Made things worse for both grandsons.

It is so hard getting meds just right. But yours do not sound like they are quite there. Hope you can find a happy medium

[Hidden in reply to MeadowLane5]

we definitely should try some fidget toys- thanks for suggestion.

[MeadowLane5 in reply to Hidden]

We let our daughter choose 3 fidgets from schoolspecialty.com -they have quite an extensive amount of products ..

[Lindsay3411 in reply to Hidden]

We also have a weighted lap pad and weighted soft stuffed animals. My son will put them on his lap when he feels himself not being able to slow his mind down.

[Aspen797]

Many very good suggestions here. I agree that if you haven't already, you might consider a psychiatrist for more specialized medication advice. We've also had the best success with guanfacine--as was mentioned by several posters. As another mom here noted, it helps lessen the fight or flight response, tones down the anxiety. We noticed that before we added guanfacine, our son would pick his cuticles and scabs. I think the stimulant precipitated that behavior. It went very away with the addition of guanfacine.

Have you had your son evaluated by a developmental pediatrician/neuropsychologist? Sometimes when you get a really thorough assessment you can find underlying causes--apart from ADHD-- that are contributing. OT and SLP therapy can help tremendously with anxiety in those cases as it addresses the underlying deficit that is causing difficulty. This may or may not be the case here, but important not to overlook. Best to you!

[Hidden in reply to Aspen797]

yes he has been evaluated by developmental pediatrician and also neuropsychologist. thank-you. what stimulant has worked well for you in conjunction with guanfacine?

[Aspen797 in reply to Hidden]

👍. Our son takes Focalin XR on school days. In our case the low dose guanfacine made the stimulant workable (no change in affect or personality but improved emotional regulation and executive functioning and took the intensity/edge off the stimulant). BTW, if you're looking for fidget ideas, here are some favorites

walmart.com/ip/BrainSpark-D...

amazon.com/SHASHIBO-Shiftin...

Popping small bubble wrap bubbles might satisfy that urge to pick while still looking at zoom

[Hidden in reply to Aspen797]

he does love to pop the bubble wrap if we ever get it! thanks so much for the ideas. i've already ordered the brainspark digit dots and am looking at other shashibo shape shifter too.

[danqatsi]

Looking at this through the POV of someone learning to be a Sped teacher I suggest working with or around the "problem" rather than against it. You seem to have a kinetically interested child and that's great. What if you gave him some things that are his and ok to pick at or even utterly destroy? Like hand them over with the very clear understanding that you may never see it intact again. So at the very least he is destroying things that you are ok with. Clearly, this will need to be directed over time towards less destructive things. Maybe even channeled into creative acts like origami. I'd wager that it is the sensational discovery as well as the discovery of what a thing is made of. So maybe give him some hands on things where he can work this sensation backwards and he gets to make something rather than unmaking it. This will be a slow transition since the "unmaking things" part of this behavior is probably pretty well in place but understand the energy behind the behavior rather than the behavior. What is it doing for him? How can that be met in a way that is more acceptable? Remember that while it might seem like he's trying to upset you, he is not and work from there.

I'd also add physical breaks where he can channel some of that energy into something active. Again, don't look for "the" answer, just find *an* answer and follow his interests towards something that feels right. For now. Part of this game is adopting the approach of "for now." A lot of parents, naturally, forget that this is a long game and once you can find something that takes hold you can adapt it towards a goal. Then another one. This is totally doable but you need to believe that and believe in your kid. And tell him you do. Sincerely. Having a learning disability myself I can tell you that I am painfully aware of the frustrations that people have had with me. I guarantee that he is too. Let him know he's worth it.

Another practical thing I'd add is a consideration of his seating situation. Is he seated during these times? Have you considered a balance ball or one of those wobbly seats where you have to maintain constant effort to stay upright. Have you tried standing? Pacing? Dancing while in class? This is all ok. Your kid is ok. Really. Look at it scientifically. Try documenting this behavior for a week or so and keep track of when it occurs. Is it a time of day? Before or after a meal? A certain subject? A certain activity or type of activity? You'll see patterns that you might not otherwise see if you were focused purely on changing the behavior. Try letting the behavior happen and seeing if there are patterns. There will be. But really, your kid is ok. Just different. And that's cool. He'll very likely use this thing that you see as a problem or a quirk to do something awesome and unique in the world. And how sad would it be if that didn't happen because it was looked at as a problem and not a gift?

[Hidden in reply to danqatsi]

I appreciate your response so much. It is spot on- it's like you know him Yes, he definitely knows we get frustrated and I wish it wasn't that way. Adding the pandemic to the list and having my husband caring and doing schooling for 3 kids at home while trying to work full-time does not help the scenario. There just isn't enough patience and time to go around. It makes home life more stressful for the kids definitely because it's a lot to manage. We do need to keep track of the times the behavior occurs as well- a journal is a great idea. Just need to hold ourselves accountable. Thank you for your empathy and understanding and words of acceptance.

[Hidden]

I appreciate all the feedback so much!

Some additional information: our son has had developmental delays from birth- he has had speech, OT, PT almost his whole life. We did a bit of therapy to overcome some fears (dogs, balloons). He's been seeing a child psychiatrist for nearly 3 years now. He has tried countless different meds for ADHD (stimulants- diff varieties of both amphetamine and methylphenidates) and also all 3 non-stimulants. Adderall is the medication that is the best tolerated for him so far but may not be the most effective. He takes the lowest dose of atomoxetine (Strattera). Guanfacine seemed to help some but made him a zombie (stared off in distance, non-responsive).

He also loves to swing so we got a swing set during pandemic but I think the swing maybe doesn’t let him use all his power to go as high as he wants. He does enjoy riding his bike (recently switched from balance bike to training wheels bike).

[Onthemove1971 in reply to Hidden]

I know many people use the trampoline.. just a thought.

Sometimes it is getting stable and living life until maturity takes place.

Glad we all could help.