Help with focus

[Sassy2019]

Hello,

As a follow up to my post above, I would appreciate suggestions to help with focus.

We have had good results with intuniv when we titrated to 4mg at bedtime. It helped our daughter return to/ near to baseline in term of “removing rough edges” which I think were from use of stimulants.

However, she still struggles with completing assignments and I find that she does not express her needs eg request help completing a homework. Not sure if the latter is a side effect of intuniv.

We decided to try vyvanse again for focus starting about a few days ago, in addition to intuniv.

Now, she is beginning to show rough edges again. Easy irritable, would yell at me, melt downs, refuse to participate in evening Bible study as she used, irritable.

Wondering if anyone has any suggestions to help focus. We would have to discontinue stimulants again.

I appreciate all the responses to my previous post and found them useful.

Thanks

[anirush]

Neither of my grandson's can do stimulants, they both get so angry on them. But they are also both on different combinations of medications. That's what makes it tough every child reacts differently. Both are on intuniv but one combines it with wellbutrin and quetipietine. The other is on Intuniv with Risperidone and Straterra. Both do well with their combinations but it has taken a while to find what works. They are both now young teens.

[Sassy2019 in reply to anirush]

Hello Anirush,

Thanks for sharing.

May I ask why they are also on quetiapine and risperidone.

Do they have any other diagnoses other than ADHD?

We would consider strattera .

Thanks

[anirush in reply to Sassy2019]

They both have social anxiety issues. The older one also suffers from depression. The younger one has sever anger issues. Yesterday the older one was being so mean to his brother, the cats. I finally asked him did you take your meds this morning? He said, oh maybe not. It took 45 minutes for his meds to kick in and for him to settle down. This was early afternoon and I could not believe how awful he was being because he is usually the more stable one.

[Sassy2019 in reply to anirush]

Thanks for sharing.

We will look into strattera.

[pbcharlee]

Its hard to find what works. My son took vyvanse for years. We only gave it to him on school days and took a break on the weekends. Seemed like as the school year went on his dose has to increase a little but would reset itself and start al over again the following school year at the lower dose again due to the break without medication in the summer. From my experience when behaviors you are mentioning above might mean the does isn't high enough. I hate even saying those words because after about 6 years of taking it with the breaks in the summer and all we finally discontinued taking the vyvanse and he was addicted to it. All he wanted to do was sleep. Constantly tired. Very little motivation. Just be careful and keep that in the back of your mind. He quit taking it BC he had a new summer school teacher one summer that told me she cant tell when he is on it versus not on it. I need to get him on something else now just don't know what, My son is 15 now. I am also open to advice.

[Sassy2019 in reply to pbcharlee]

Thanks for sharing

[Elijah1]

Does she have anxiety or worrying (some describe the features as sensory problems)? It can be aggravated by Vyvanse and improved on Intuniv?

[Sassy2019 in reply to Elijah1]

You are right. Intuniv has helped with sensory issues like being irritated by noise and vyvanse/stimulants made it worse

However, I am looking for help with her focus. Any suggestions would be appreciated.

Thanks

[Elijah1 in reply to Sassy2019]

If she has anxiety, stimulant medication may aggravate it. Options are to treat the anxiety and then the ADHD, try a different stimulant (as stated below, methylphenidate products may be less likely to affect anxiety), or try a non-stimulant such as atomoxetine.

[Sassy2019 in reply to Elijah1]

Thanks for the suggestions.

We will look into atomoxetine.

Stimulants not tolerated include methylphenidate (biphentin, concerta).

[Aspen797]

Stimulants help with focus more than non-stimulants. Have you tried non-amphetamine based stimulants yet (Focalin, concerta, Ritalin, etc.)? Vyvanse is in a drug class that some (but not all) kids can react more irritably/ aggressively too, sometimes another class of stimulants does the trick. If your daughter is older and capable of meta cognitive strategies, there are a number of tools and skills to aid with focus. Often maturity and interest are needed though. Some options include the tomodoro technique, using a time timer and setting it repeatedly for 10 minutes or so to act as a reminder to stay focused. Self-monitoring to go with the timer, where you check off whether you were or were not on task and reward yourself for a certain number of on tasks checks. The Revibe watch does this for you and some find it helpful. A lot of apps out there to aid with focus/reducing distraction. Until mature enough to do these, continuing to try to find a good med combo and making sure she has lots of supports (schedule, timers, breaks) and IEP/504 based accommodations (school work/homework) might be the best. Regarding asking for help, sometimes kids need real concrete instruction in how (e.g., put this type of question in chat, put these questions in an email, these type have to be asked aloud) to ask for help. Relatedly, many of our kids have poor working memory and processing speed. When teachers move quickly between topics, ours can get behind and not even know what to ask to get caught up. Accommodations can be made to address this problem in the 594/IEP

[Sassy2019 in reply to Aspen797]

Thanks for the suggestions.

Stimulants not tolerated include methylphenidate (biphentin, concerta).