Eloping son with ADHD

[Stefanyc1]

Hello everyone. My son is 7 years old diagnosed with ADHD as well as behavioral challenges and probably ODD. He takes Focalin XR 15 mg in the morning and Intuniv 2mg at 4pm. He does great on the Focalin XR until about noon and then he crashes and become angry. He cannot possibly being burning through the extended release that quickly because he gets a 2nd wind of focused energy at about 3pm. When he crashes he will elope from class and take off out of the main building, toss chairs and hide under his desk if prompted to do work he doesn’t want to do. Has anyone heard of the “peaks and valleys” of Focalin XR? I read about Metadate CR and how it has a supposedly smooth metabolism? Any thought?

[Onthemove1971]

Of course every body is different, but if he takes the medication at 7am and he is good until 12pm ( if my math is correct about , 5 hours? ) that is about the same as out son. He takes his medication at 6:30-7am and we give a "booster" dose, which is the same medication with a smaller amount, at 1pm that last until bed. Yes, I agree there is a 3pm time where they hype up again.

Some people think this is to much medication, but with ADHD medications they are stable and then when it wears off they still need to be in school, do homework and sports. There is not way our son could function without his afternoon dose.

I would speak to the doctor ( hopeful a good psychiatrist) for advice.

Good luck!

[ADHD_DAD]

My son also takes an afternoon booster. That one wears off, too, but gets him home and through homework. Then my wife checks out for the evening and I try to exercise his legs off. He talks constantly on our walks and during workouts, but I just shut it out. It's like white noise to me. Crickets chirping or ocean waves in the background. He knows. He doesn't care. He gets my attention if it's important. I don't think there are peaks and valleys with the meds, but rather, a return to his "baseline"when the meds wear off. I usually laugh to myself and think "looks like he still has ADHD "

[Stefanyc1 in reply to ADHD_DAD]

Thank you for your reply. It makes sense to do a booster, I just find it so odd that a medication that is supposed to last 10-12 hrs only lasts about 5hrs. He takes his Focalin XR at 7am and by 12 noon he is starting to get agitated and irritated by what he feels are outrageous requests to work. I referred to the medication data and a graph shows that Focalin XR has a biphasic metabolism so is supposed to peak at 4 hours and then it declines until about 8 hours when it peaks again: I’m just wondering if this way of metabolizing the medication is the cause of the agitation or if he in fact is burning through extended release form in 5 hours and needs a booster.

[ADHD_DAD in reply to Stefanyc1]

I think it is quite common for them to wear off. Both my son and a friend's daughter take Concerta which is supposed to last 8-12 hours. Both need a booster in about 5-7 hours. I don't have a handle on the science behind it, I just witness that it wears off. Maybe your son has an issue metabolizing it (you could try a different med) or maybe it wears of like my son's and my friend's daughter. No harm asking questions amd researching, though (in fact, I highly recommend both). Just trying to reassure you based upon our experience. Be well.

[gnpjammer in reply to ADHD_DAD]

Yes, this is similar to what we saw our 9yo son (ADHD, ODD, anxiety) go through. He did much better on the immediate release meds given at intervals. The XR meds didn't work nearly as well for him. And we had the GeneSight test done, which showed he's a slow metabolizer. Our doctor also has us giving him Calm brand magnesium gummies, which seem to help at least a little as he will even ask for them.

[123boys]

My son is 9 and we had similar experience of hiding in class, eloping from the room and school, anger, dark language etc. He was not on the same meds as your son. It may be worth exploring anxiety and if you can afford it get a full neuropsychological eval.The school would not give us an IEP but rather a 504 and BIP.

Things started to improve last year but it is hard to say exactly what caused the improvement. Maybe some maturity, a growing embarrassment in front of peers, medication, BIP.

To me, the behavior is a response to stress. It triggers fight, flight or freeze. You have to figure out what is causing the stress. Is it writing tasks? Transition to non preferred activity? Social interactions?

I know how hard this is. Keep looking for answers. I wish you luck and grace on your journey to help your child.

[Stefanyc1 in reply to 123boys]

Thank you so much for your response! This is exactly what I’m thinking. He goes into flight/fight/freeze for non preferred tasks. He doesn’t know how to cope and give an acceptable response. Just curious if your son tried any medication for the anxiety? My son sees a developmental pediatrician for his meds and I was thinking of asking about an antidepressant as I have read that they can help with anxiety. I had horrible anxiety as a child and at 38 I can can still remember how debilitating it was.

[123boys]

Yes, he takes sertraline. For us, the anxiety is driving the bus and the sertraline helps him more than the clonidine or methylphenidate. It’s hard to even address the ADHD without getting the anxiety out of the driver’s seat.

[Stefanyc1 in reply to 123boys]

Agreed! I have been having those exact thoughts! Thank you for you insight. It has been rough for us and just feeling connected to others is so helpful

[abryans]

Once we started medication (which has been a big help), we started attributing all the ups and downs to the medicine. We eventually figured out that my son suffers mightily from "THANGRY"- tired plus hungry = angry. We try to make sure he gets midmorning and mid afternoon snacks and to stay calm and get some food into him before reacting too much to the "thangry". He is having a big growth spurt and he burns a huge number of calories so he needs a lot of nutrition.

[Stefanyc1 in reply to abryans]

I completely agree with you about the food and sleep. It is so hard when my kiddo takes his stimulant (which has definitely helped) because he has zero appetite so I at least try to have him drink protein milk. My son is also having a growth spurt and when his meds wear off he eats like a grown man. Lol. It’s such a fine line and careful orchestration of meds and environment. One day at a time...