Morning Behavior

[dadwithquestions456]

My daughter is generally at her best in the morning. She is pretty calm and cool and pleasant. And this is before medication. It's in the evening when she will be rocking while she sits if she isn't already doing 2 things. It also seems she is more irritable in the evening. Is this normal? I've been reading and from what I found most adhd children are difficult in the morning before medication.

[LAJ12345]

natural dopamine levels rise in the evening which might make her over stimulated? Especially on top of meds. (Just a guess)

[510Wins]

I’m no Licensed Doctor. I’m a Mom.

She may be having a reaction to what she’s eating or drinking. My son experienced the same thing and I stopped feeding him Processed food that are made with chemicals. Read the labels and you’ll see that these “foods” are not food. The kids are having neurological reactions that manifest like ADHD. It takes time for the chemicals to leave their bodies once they stop eating and drinking Artificial colors and Preservatives. Most of the chemicals in the processed pretty foods are Petroleum based products (Metal). Once they stop consuming that stuff the behavior goes away, the aggressiveness goes away, those manic episodes go away. They become healthy and are able to control their thoughts and behavior.

feingold.org

(Watch the video part 1 and find part 2 on YouTube)

[dadwithquestions456 in reply to 510Wins]

Thank you. I'll search around and see if there is stuff she should avoid that she's eating now. I really sort of think her medication is why she is like that in the evening. Previous to medication she would fidget a little, but never rocking. She also has teeth grinding with the medication at night. It's very loud and she will randomly sit up at night. We have seen this on vacations. Magnesium helps it, but I worry about her sleep. Her Dr when informed decided not to make a change. Said to talk to the dentist. But she has braces so not much help there. When she was in 4k she got her tonsils and adnoids removed and became a new kid afterward. Previously she was a snorer and I think she slept better afterward. So I worry she doesn't sleep well now.

[MomOfSuperheroes]

Maybe it's the whole am fresh slate thing? My 9yo son wakes up enthusiastic about his upcoming day, so even though he hasn't had his meds yet, he's engaged and that helps him a bit. When I pick him up from school, he's been having to calm his body all day and is ready to let loose.Having said that, without our well-practiced morning routine, my son would be lost. Sometimes in the morning he's so inattentive he forgets to take his pill with it in his hand halfway to his mouth. It's funny and frustrating at the same time!

Anyway, maybe by the end of the day your child is just "tired" from self-regulating/calming her body all day? I wouldn't blame her. It's a lot of work!

[Hidden]

it depends what medication your child is on- if she is on non stimulant then mornings should be okay because medications stays in the system 24/7 however maybe she suffers slightly from side effect - non stimulants have on side effects leaflet listed side effect of ‘manic’.

Equally ‘stimulants’ also have on side effect list ‘manic’ or ‘rebound effect’. So here we go- it seems all these meds can cause what you are describing. I’d say don’t ‘accept’ that ‘this is how it is’. Try some other medication and see if she will be having ‘symptoms control’ all day long.

[dadwithquestions456 in reply to Hidden]

She is on a stimulant. So you are saying the side effect is that she seems better in the morning before she takes the medication? That sounds very odd.

[Hidden in reply to dadwithquestions456]

There is no such side effect of the stimulant where someone feels better (more focused, more in control and more compliant) in the morning before taking it. I’d say if she is on a stimulant and she seems better in the morning before she takes it (so when medication is not in the system) then maybe the stimulant medication is just not a right medication for her? Look at the side effects list- maybe she has ‘irritability’ , feeling on the edge etc side effect when medication is in the system.

My son had a rebound when on stimulant- so he was much much worse both in the morning and when medication was out of his system, but equally he was having a range of side effects whilst it was in the system (irritability, hyper focused, in his own world, pressured speech, tics). Your daughter clearly doesn’t have a rebound effect because she is much better in the morning when there is no medication in her system.

[Hidden in reply to dadwithquestions456]

Just read about what ‘rebound effect’ on stimulants. My messages might have confused it😄 In my son’s case rebound in the after school time meant he couldn’t do well any after school clubs - he was a mess, well what can I say, he was ‘suffering with a come down’ like after drugs. That’s why we switched to non stimulants which stays in the system 24/7 and then there is no suffering when every day child is facing rebound after school - it just can’t be nice for a child…

[dadwithquestions456 in reply to Hidden]

Oh, yes that is probably why she is so strange in the evenings. I sorta think a different medication would be better for her, but doctor didn't make a change when I brought some of this up. The thing that scares me is that she was put on it shortly after she started having her period, it's been a few years. She started getting very difficult and eventually would have these long anger fits. Like she'd lose her mind for a couple hours, afterward she'd be sorry and say she couldn't control it. Her regular doctor put her on prozac which she is still on, but it didn't help. Then we saw a specialist who put her on the stimulant which has made those fits go away. So I'm scared to push too hard for a medication change because I'm scared the fits will come back. But I hate seeing her in the evening rocking and just not being herself. The teeth grinding in the middle of the night scares me too. She also has little interest in being social and is very private with everything she does now. But in the morning when I hangout with her she is pleasant and often wants to do stuff together. In the evening she mostly wants to be alone.

[Hidden in reply to dadwithquestions456]

I can only talk form as perspective of a parent who has a child with ADHD and also as a woman who used to be a girl and also I have ADHD (never diagnosed and as an adult I cope without medication but it’s only because I have sort of an easy life without much demand on me).

I can see how you are scared to twig and change medications for her. Did you consider trying Qelbree for her? It is licensed for ADHD but initially it was licensed as an antidepressant so maybe you could achieve 2in 1 effect helping her for both with mood and with ADHD. Also then she wouldn’t need Prozac, you could reduce to 1 medication. You could also try Atomoxetine as it’s also sort of 2in1 helping with anxiety etc but Atomoxetine in females may have a side effect of abdominal pain especially during the period. So I suppose she would have to try and see if this would affect her (she well may be one of whose who don’t get tummy cramps form Atomoxetine). I was worried about the tummy side effects onnAtomoxetine with my son and actually he has been totally fine- no tummy aches, no other side effects.

So basically stuff with the period- it’s probably Premenstrual syndrome (PMS) has a wide variety of signs and symptoms, including mood swings, food cravings, fatigue, irritability and depression. It's estimated that as many as 3 of every 4 menstruating women have experienced some form of premenstrual syndrome. Taking a pill (from gynaecologist) can help with this. Basically even I, even though I am Roman Catholic from a very religious family- for this reason (purely medical reason) I could be taking it as a young girl. Worth discussing with doctor as it may help with PMS.

PMS is very severe in some females - for example statistics show that majority of crimes committed by females are due to PMS (or coincide with this time in the month).

Hope these thoughts help! Basically you need to be like a detective, thinking of many things and being assertive with the doctors.

[dadwithquestions456 in reply to Hidden]

Thank you for the suggestions. I've thought there may be better options out there, but I guess I need her doctor to feel that way? It's just so crazy because I would feel awful if I pushed for a change and then it ended up being worse. I wish I had a better idea that she was going to have trouble in school this year because the summer would have been a good time to try things. I guess this is why I'm trying to find a second doctor to get another opinion on what might be right for her. The non-stimulant medications sound better to me, but they do take time to work right? I'd hate for her to have worse days in school waiting for something to work. I'm sort of terrified of her going back to the anger fits. The Prozac I'm not sure she really needs. When she was first put on it I remember it seemed like she was better for like 2 days. Then she just went back to the way she was, so I don't know it does anything for her.

[Hidden in reply to dadwithquestions456]

I totally understand your thought process. Maybe try to introduce non stimulant over the Christmas break or any school break that is coming.

For me maybe it was a bit easier to just be assertive and wanting meds change for my son as in the past I had a moment in life when I had to take some psychotropic meds (Zoloft and something else which I funnily enough don’t remember what it was but it was 20 years ago). Also probably it was easier as already one other mum in my son’s class was sharing her experience with medicating her son and her son already was tried on Methylpenidate (bad for him- in himself, not playing with other kids and so on- range of side effects) and he moved on to Atomoxetine successfully. Our kids have the same psychiatrist as well so it helps to share opinions for us mums and also we can see our kids playing and we can kind of share how we find their behaviour.

I feel that psychiatrists are like authoritarians and I suppose they do it because they deal with all weird people and they- as doctors- have to take a position ‘I am a doctor and I know best’.

The thing is how do you know that this stimulant that your daughter is now taking is giving her best functioning that she can have if you don’t try something else? My son 2nd day on Atomoxetine told my husband ‘Daddy I am so happy.’ I feel it kicked in for him within 2 weeks but his psychiatrist was very slow in increasing dose and only when he got to the right dose for his weight (like in medication leaflet- it specifically says how much it needs to be) which is why whilst he was kept on too low dose we couldn’t see the full benefit. Once he started receiving the right daily dose - it’s pretty much immediate effect. It’s just because it works gently and all the time- it’s almost like you may wonder ‘does it work’. Then look at your child’s functioning - for me that’s very much measurable as my son is less oppositional towards me, he is more with it in social situations, he stopped suffering anxiety, he is happier, he can eat well and sleep well, he can focus at school, he can do after school clubs and sports until late and goes to sleep at 8pm without meltdowns or problems sleeping. And this all is from 1 medication. 1 capsule a day - easy.

Methylphenidate in individuals who have tendency to anxiety - increases anxiety. So I suppose then Prozac was added to counter balance this and other stuff you described. But why be on 2 medications? And still not right. When hopefully trying out one of the non stimulants she could be just on 1 medication.

Do you think that let’s say 2-3 weeks when medication is tried out but still not at the proper high maintenance dose could mess her so much at school? Surely this wouldn’t impact on her school performance so much, unless you know she has some important exams planned. Of course don’t change medication when she has soon exams etc- it’s too risky then.

[dadwithquestions456 in reply to Hidden]

Thank you for your response. One problem I have is that I can't talk to my wife about this stuff very well. It's not that she doesn't care, but she seems uncomfortable with it all and wants to not think about it. I can't stop thinking about it.

I do want to try a non-stimulant. I am very worried the methylphenidate could be making anxiety worse. One thing weird is that she has been on this for about 3 years. First year it was a blessing because she stopped getting in trouble in school and the long anger fits went away. Last year seemed ok, but I think school anxiety was building up. She didn't really get in trouble so I didn't realize it was hapening to the degree it has. Now this year is the worst, so why is she getting worse? The Prozac was added first by her regular doctor. Other than the first few days it never seemed to do anything, but the psychiatrist has not suggested dropping it. When I gave my concerns last appointment she stuck with the methylphenidate, but added something for anxiety that is take as needed. I don't remember what its called at the moment, but it's not really an anxiety drug first, It has maybe helped the last couple weeks as she hasn't gotten in trouble.

In my mind a non-stimulant should eliminate he being so odd late at night. Would hopefully eliminate the teeth grinding and odd sitting up in the middle of the night. This could help her sleep. Maybe her anxiety would get better if the methylphenidate is making anxiety worse...

Her fits were crazy bad like I would not want one happening in school, it would be terrible. She would really lose her mind. So I'm still scared.

[Hidden in reply to dadwithquestions456]

Do you know why she was getting those fits at school? For example my son has been bullied at school and this also impacted in his behaviour and his mood both at school and then after school.

It would be worth doing- if you can find on internet reviews from people let’s say who are taking Qelbree (or other non stimulant) - I’d hope that not all of these positive reviews would be fake😄You know, like the big pharma employees churning positive reviews in the net 😉. I have read some very good reviews for Qelbree and specifically people were saying that they were previously on stimulants and how on Qelbree they feel better, not as anxious and easily sleeping, more happy and still able to focus well. I can’t comment because this medication is not yet licensed in the UK. US is always more advanced with meds.

Because quite frankly speaking - the way it looks now for your daughter - she is already on 2+ meds. And it’s a common sense that the fewer meds taken daily is better.

Statistically there has always been a big drop up rate for compliance with medication in people with ADHD - because if all the side effects and the impact on physical health, growth, making people more anxious and depressed… That’s why new meds keep being invented… Your daughter’s doctor might be a creature of habit or maybe Ben have some other unknown incentives for prescribing what she likes prescribing - knows what she knows and prescribes what she knows. But you could ask if she had any patients on Qelbree and how they are doing etc. I think once you show calm, smiley confidence and ‘no fear’ attitude with the doctors, they are often more likely to do what you want.

As you say your daughter has been on this for so long… I’d say go with your gut feeling about your child- you see her daily, not the doctor. So you are the expert in knowing your child.

[dadwithquestions456 in reply to Hidden]

It's strange but as I think about it now, I don't know she got any better other than losing the long anger fits. Those came with puberty. Before that she had a best friend and scored like the best in her class on the testing at the end of the year. Then with puberty her anger lost her best friend I think and then she started getting in trouble. ADHD treatment has eliminated those, but nothing else has really been better. The first year on medication she had a friend she would talk to all the time and he would come over. Last year that dropped off and this year she's pretty content by herself. I wish I could understand the cause of those fits better. She still get angry now and then, but it goes away pretty fast now.

[Hidden in reply to dadwithquestions456]

I’d say puberty is the clue here. She might also be low on iron (often happens to young girls following puberty, so if you can have blood count done, this would be good). Definitely also look into PMS.

[dadwithquestions456 in reply to Hidden]

It's funny you would mention that. Earlier this year when she had a super great week, I started giving her iron regularly again. It's been sort of an on and off thing that we did more for sleep. But I started giving it to her again and then we had this week that felt like a miracle, but she went back to normal when she had her period and it hasn't come back except short periods like a more good morning here and there. But yes I've always looked at puberty as a key. She was doing pretty good till puberty and thats when the crazy anger fits hit.

One thing I have not been able to get my head around is the methylphenidate stopped the fits like completely. But she has some time before taking the medication in the morning and it is supposed to run out before the end of the day. So I can't figure why she never has still had a morning or evening fit. Before the medication they would happen at those times.

[Hidden in reply to dadwithquestions456]

Explain please more about these fits.

In young girls in puberty hormonal changes cause havoc in the brain, then often the hormones stabilise, it could be that?

Also no one says that Methylphenidate is useless all together. Yes, it does pose a risk of addiction, yes it does stunt growth in children, yes it does exacerbate anxiety but also it does control symptoms of ADHD such as impulsivity (in some people it does, some get even more impulsive and aggressive). However it doesn’t work on neurotransmitters in the brain in the stable and constant way the way the non stimulants do. If the neurotransmitters need help (and in ADHD they do) then the better way is to do it constantly and in a stable way with non stimulants- my opinion as a parent who watched my child on Methylphenidate and it was very bad for him and now on Atomoxetine - and I can see overall improvement in his physical health (better sleep pattern and enjoying his food), better coping strategies, focus, improvement in mood and in impulse control etc in every part of his life- school and leisure and social interactions. That’s what I am looking at when I think how my child is functioning- wider view how he functions in the society plus his physical health.

[momlife7]

Mine is in a good mood most of the day even before meds but usually after 5 its like rolling the dice what youre going to get so try and be done with activities by then and just “chill” at home