Behavior change

[Campos03]

So my kiddo is 5 yrs old he got diagnosed with adhd 3 years ago exactly. We are going to the doctor tomorrow to see about putting him on meds. Due to his behavior, he is cussing at everyone, hitting, throwing stuff, being very demanding ang siblings are afraid of him and they are older. We have tried every way possible to calm him like we used to and it just doesn't work. At school he is a whole different person but here at home idk anymore at times. Nothing we are trying to do is helping. So my question is what kind of meds would they give him due to the behavior now?

[Onthemove1971]

I highly recommend trying medication. If it doesn't work for him you can stop. If you start with a stimulant medication it will only stay in his system as long as it is dosed for. For example if it is short acting the medication will stay in his system for 4-6 hours. If he is given an extended release it will last most of the day. When he first starts it takes a while to get the type of medication, dose of medication and timing all correct but when you do they can get such relief from the symptoms.

This is a journey and we are here to support you. Many of us have been in your shoes with frustrating behavior. Kids with ADHD don't "want" to misbehave.

[Campos03 in reply to Onthemove1971]

I appreciate the response. It makes me feel so much better because I know its hard for him and us all at the same time. It's a challenge but I will always be here and try to fix what I can.

[Onthemove1971 in reply to Campos03]

You sound like such a great mom.. the road ahead will have ups and downs but loving him and continuing to help him reduce the symptoms will help him so much.Trust your gut.. it will get better for you guys.

Big virtual hug..

We are always here for you.

[Akoara]

I second the medication suggestion. I tried many many things before I went to medication and I wish I hadn't. My 14 year old son has combined ADHD and although he was always a happy little guy he had terrible tantrums and as he got older he was aggressive and had huge uncontrollable meltdowns (only at home) - similar to what your describing. I was so concerned. The stimulant medication helped with many things but it didn't necessarily help with the emotional disregulation - sometimes I think it made it worse. Once we added extended release guanfacine to the mix everything improved. He was more able to verbalize his feelings and the physical and intense verbal aggression went away. He still has his moments but he's able to stop himself and recognizes that he doesn't want to take it to the next level. Different medications work for different kids but for us - Guanfacine was the real winner. Other things helped too - maturity, better social connections, consistent limit setting, lots of parent education, etc.

You are doing a great job and just know - so many of us have been there and survived what you and your dear child are going through. It does get better and with the right tools and supports - your son and your family will too. My son still has his difficulties but he has come so far and is thriving in many areas.

[Campos03 in reply to Akoara]

I appreciate that thank you. Basically it's trial and error trying meds. We are very hopeful for his future cause he is so smart but sometimes his aggression gets in the way. And at times I tell him calm down and he always tells me mommy I can't idk how. That breaks me but I know I need to stay strong and help him as much as I can. I'm a stay at home mom for him specifically. I got told by his developmental doctor to never put him in daycare cause they don't care about kids like him and it would not do him good. So since then it's been me and him you know. We have 2 older kids 10 & 8 they will help as much as he will let them. I'm his only security that he runs too. Hubby works in oilfield. He tries to help when he is home but little one won't accept it idk why. He yells at him right away everytime.

[BTV65]

I will add myself to the chorus recommending medication. I take it (adult diagnosed add) and so does my son. Most days, within a few minutes of interacting with my son I can tell with 90% accuracy if he took his medication yet or not, based purely on his behavior.

The way it was described to me: the medication can act like a censor button. Giving the brain a bit of extra time to hear that inner voice before acting impulsively. My brother had ADHD growing up. There was no diagnoses or medication back then. He made a lot of bad choices in his youth and I asked him to describe the moment to me. He said it was like your entire world narrowed into a tunnel. The bad choice felt like the only choice available. He couldn't see any other options. It didn't even occur to him at the moment that were other options.

A friend of ours had a child who also used to suffer terrible meltdowns after school. They said that kids with behavior issues will often spend 6 hours at school "holding it all in". Trying to keep a tight control on those impulses and behaviors. It must be exhausting. After school, they are finally able to relax and it all comes rushing out in an explosion.

[Campos03 in reply to BTV65]

I completely agree with the school thing. He went to school in a program for kids with disabilities called PPCD since he got diagnosed and he would go for 4 hrs a day. When he first got diagnosed he was 3 and this recent school year he was barely turning 5 and when he would get home it was like a whole different kid. The meltdowns would happen significantly more and more. We bought him a weighted blanket it used to help tons, take him outside to breath it out it worked and many other things but we noticed recently it got more aggressive to hitting, cussing, and other stuff. Me and my husband have been so afraid of medication cause we are worried about him being zombie like but I've heard from the doctor that it wouldn't happen. It's scary for anyone I know. He is only 5 that's why we are worried you know. He did do therapy for 1 year, Occupational therapy & Speech therapy which he completed. So Now this next school year he is gonna start kindergarten and we are just like wow he is gonna be there for 8 hrs a day now. I hope he doesn't meltdown. But at some point he will I know that. Also when he first got diagnosed 1 or 1 1/2 year prior he had brain surgery so we thought thats how the ADHD came along but we got told no it was already there just waiting to show. It just showed early in his case due to the surgery. His life has been so hard for him only being 5 now but all of our family members know to not pressure him, they talk to him calmy, they dont take his meltdowns up the butt. I feel bad when he does his meltdowns on his grandparents but they always say thats our baby we love him he is fine it will get better. And we are beyond thankful for that. Not having a support system i can only imagine it being extremely difficult. So our appointment is this morning at 11 hopefully fingers crossed it goes well and discuss medication.

[BTV65 in reply to Campos03]

Yeah, stimulants can calm kids down *too* much. I think it's about dosage though. It's a marathon. Keep that in mind. If one thing doesn't work, try another. Give each med a chance.

I was a teacher in 8th grade. I had identical twins in class. Both had ADHD, but one was the alpha and had it worse (not horrible, just 10% more than the other, in regard to behavior). One day he came in. Very calmly, quietly, didn't say a word to anyone, sat down, took out his book, notebook, pencil, and looked up, ready to start class. Yeah. That was twilight-zone weird. The teachers who all had him that day called him in for a group meeting to find out what was wrong. Turns out he had just started medication, and I think they started with the dosage a bit high. It all worked out. Within a few weeks of trial/error, they found a better dosage balance and he returned to more typical personality, while retaining enough focus to help him improve his school academics.

Keep in mind, all of these meds are relatively short term. Within a couple days of stopping, they are out of their system. So nothing you do will alter your child long term.

[Campos03 in reply to BTV65]

I will definitely keep that in mind about the medication. I'm starting to feel better and not guilty about introducing meds for him. I know its a good thing for him to calm down.

[Onthemove1971 in reply to Campos03]

Please keep us posted and let us know how it goes.

There will be more recommendations on you can get the medication on board that will also help him.

It is great you will have all summer to work on this so the start to school should be much better.

[Nats2005]

Our 6-year old son was on Guanfacine for a bit, now on Clonidine. Both similar, primarily target the impulsivity (whereas Adderall and other stimulants work on focus) which theoretically can help with the aggression. Clonidine is a smaller dose (0.1mg/pill) than Guanfacine (1mg/pill) but apparently more concentrated and targeted at the parts of the brain that drive the impulsivity and aggression. Still not a perfect solution though.

We see similar behavior patterns, he seems to be "rockin' it" at school (private special need school + Adderall XR + morning dose of Clonidine) but falls apart in the afternoon and evening at home. Even on the weekends morning/early afternoon can be decent but we have problems later in the afternoon or bedtime.

[Peerandparent]

2yo is quite young to be diagnosed with ADHD. Since I have ADHD, we knew my son was at high risk for it, but my son didn't get diagnosed until he was 5, and now he's 7.5 and still awaiting a full assessment. Who did the diagnosis? There are a lot of things that have a similar profile to ADHD, soaking sure he's properly assessed by someone who knows what they're doing is essential.

Since you mentioned that his behaviour is substantially different at school, that suggests to me that there might be significant differences in strategies and environment at school and home. Maybe see if you can have a conference with the teacher(s) to discuss strategies, and see if there is something you can do to change the dynamic at home. Another (less likely) possibility is to see if you can have the opportunity to observe the class to see if there's something you can spot that will help at home.

Personally, what I need to focus on more than anything is self-regulation. Sometimes my son pushes my buttons something fierce, and if I react rather than choose a response, he can learn less than healthy things from me.

In general, our strategies need to change as the child does. Keep in mind that a child with ADHD can be 20-30% delayed in executive function and emotional regulation, so your 5yo may be as intelligent and as well educated as his peers (or maybe even smarter) while in very specific ways he will still be like a toddler.

As for meds, stimulants absolutely will not turn your kid into a zombie. Most ADHD meds will simply improve his ability to self-regulate and focus. The added bonus of a stimulant med is that they don't stay in the system for long, so not only will you know very quickly if they are effective, but you'll be able to respond quickly to side effects. In my experience taking meds myself, having my son on meds, and also pulling from my work in mental health and information shared by my psychiatrist colleagues, stimulants by their nature will not take anything away from a person with ADHD. They might add side-effects, but their personality, their creativity, and their spark will still be there.

Sometimes when there are severe behaviours they might consider a mood stabilizer, and those can blunt a person's affect (turn them into a zombie) but I've never heard of that being used in ADHD unless stimulants and behavioural interventions have been tried first.

Lastly, in my personal and professional experience working on a mental health unit, telling someone to calm down never works. In the past, when people have told me that, I'd often snap back sarcastically:. "Gee! I wish I'd thought of that!" Or "No thanks, I like exploding!". From my experience, here are some strategies that might work:

1) In the moment, suggest some of the strategies that he has already practiced. Don't suggest unfamiliar strategies or expect him to figure out on the spot what will work, because when the emotions are intense the rational brain is on holiday.

2) when the moment has passed, calmly talk about what happened. Anger is often the result of broken expectations. Ask him what he can do next time, and what you can do next time.

3) make sure (as much as possible) that there are clear and consistent consequences for destructive behaviour. He may not be able to control the emotion, but he can and must learn proper ways to channel it. Being clear and consistent means that the consequence is less likely to add to his response in the situation. This is where finding out the classroom approach is important, because it can be difficult for a neurotypical child to navigate different rules at school and home, and neigh impossible for a child with ADHD. The more rules and routines are consistent, the easier it will be for him to tolerate a lot of things.

4) People with ADHD have a difficult time changing gears (i.e. shifting from play to chore, or even from one type of play to another. For my son, a lot of his most problematic behaviour disappeared when we gave him warnings ahead of a change (e.g. "TV is going off in 5 minutes" or "Do you want to do X now, or in 5min?")

5) when introducing new strategies, practice them with him a lot when he's calm. The more it's easy and familiar, the more likely he'll be able to use it when he needs to. In addition, in my experience relaxation and mindfulness activities are most effective when practices on a regular basis, and not just when it's needed. To use an analogy, if the relaxation exercise is like a sponge, it's much more effective using it to mop up the drips and spills as they come, rather than try to use it only when the house is flooding.

6) There's a lot to be said for slowing down and giving him a chance to self-regulate. With my son, when he's angry or upset I really want to go in there and "fix" it. What he needs in that moment is either validation and/or some space to work through his emotions. Sometimes I feel I'm in a rush (e.g. late for school) and I know from experience that I can argue with him about getting ready for 20min and he'll still be upset,or I can tell him I'm giving him a minute to calm down and it'll often be as quick as 30sec before he's calmed down enough to talk or to do the task.

7) a mantra from my de-escalation training: "It's better to be effective than to be right". In the moment, do what works for him and for you. You can always impart the lesson later when he's calm.

Hope this is helpful! When I'm able to do as I've suggested, it works really well. Now I just need to be able to do it consistently!