Bathroom night-training with 4.5 yr old adhd son

[SunshineF]

my son was diagnosed w adhd about 3 months ago. Due to his impulsivity and sometimes unsafe behavior we started him on a low dose of guanfacine. Over the past few months we’ve increased the dosage for guanfacine to 1.5mg total ( 1 mg taken in am and .5mg in afternoon) and about a week ago we added 2.5mg of adderall.

his behavior has been up and down and we’re having a hard time discerning what’s working, what’s not etc. there’s also been the holidays, sickness, changes to routine, etc. to complicate things.

One other variable to add to the mix about a month ago is he started having dry pull ups at night so he’s been waking up on his own to use the bathroom. Big milestone right!? Well he’s also stopped sleeping through the night (sleep has never been an issue for him) he’s now up exploring the house or getting changed/making bed and starting his day even if it’s 2 am or 4 am. Every once awhile he might sleep till 6 and use the bathroom then but it’s rare these days.

My question is does anyone have any experience with this? Could this be a normal, temporary regression that any kid would go through? Or is this ADHD driven or medicine side effects?

Thank you,

One exhausted and very pregnant mama

[kdali]

I don't know about fixing sleep, but I trained mine to stay in her room when she had a sleep disruption by using a little cloud clock (Amazon) that turns green and plays music when it's time to get up. Now she looks out the window and sees it's dark and will go back to bed herself, sometimes after playing for an hour. Before the cloud she would wake up her baby sister to play at 4am 🤦‍♀️

[SunshineF in reply to kdali]

thank you. We have the hatch that does the same but he’s completely ignoring it. And he’s doing the same and waking his baby sister in the next room because he’s so loud. How long did it take her to use the light and recognizing it’s still dark and she needs to go back to bed? Also was she always tough with waking up early or was it only when night training happened?

[kdali in reply to SunshineF]

Oh no! The cloud worked when she was 3, and now she is 5. The window trick took some reminding, but I think rotating in some busy toys helps her stay in her room. She also began to understand why we don't wake people up, when the now toddler started having sleep regressions and we had both issues going on at once 😵‍💫Headphones helped!

She was never tough to wake up before her school career started, and was usually up playing quietly around 630am. Now I know she's either sick or was up partying, if she's still dead asleep at 645am...and that it's going to be a rough wake up/sometimes a rough whole day. When this happens, I will dress her, find a meal she can slurp down, and brush her teeth and hair, in addition to trying to cheer her mood by being extra silly. I'm sure all that sounds absolutely crazy, but I'm too over morning misery at this point for constant "we gotta go!" nagging, resulting meltdowns and setting her up to have a crap day.

One thing I was able to do a few months ago was change their rooms away from each other. If one is screaming over teeth at 2am, or having a cat tea party at 4am, the other stays asleep. We have not made it to medications yet, but I have taken a few notes from parents here who shared what add on meds helped their kiddos with sleep disruption.

I hope you find some helpful replies here and will report back on what has worked for you!

[MMoore86]

Hello, I'm actually the one with ADHD, but I think my 4.5 yr old son has it too, and my 16 yr old son. From experience with Adderall myself, the sleep issue maybe because of that or both meds. I'm on Vyvanse right now, but was on Adderall before.... I'm still new to this as well being diagnosed as an adult although I had it all my life but finding the right medication can take a while if you're lucky you may get it on the 1st or second try or dosing but unfortunately it can take time because even if the medicine works right it's all about the milligrams as well... But I wish you luck and I hope that whatever he has works for him and also works for you guys as a family ❤️👍☺️

[Hidden]

So sorry for you and your little man. My son stopped sleeping and also started day wetting (yes, at 8 he started day wetting - a child who was easily toilet trained by 3 and has had no night nor day accidents ever since) when he started taking Methylpenidate. Also a range of other negative behavioural changes- all got worse on Methylphenidate.

So of course I am subject to bias of my nightmare experience and I’d say- yes medication is not doing any justice to your little man.

May I ask why you added Adderal? Stimulants stop children from sleeping. Also if there was any impulsive and aggressive etc behaviour- stimulants often make it worse… You can now go the slippery slope and start adding more meds to counteract the bad effects of Adderal or you may start from the beginning. Ask yourself what you want to achieve having your child on medication. Have you achieved it on Guanfacine? Is there any other non stimulant that your son can try instead? Some are off licence, some are sedating and you could ask doctor if there is a medication you can give him before bed so he sleeps better. Don’t panic. You will get it right for him.

[SunshineF in reply to Hidden]

shouldn’t such a low dose of short acting adderrall given at 7 am be out of his system by 2-3 am when he’s waking up?

[Hidden in reply to SunshineF]

I am sorry, I really don’t know the answer to it. I know that my son who has been on a different stimulant, which also was given to him early in the morning (about 7.30am) stoped being able to fall asleep at his normal time. When we stopped stimulant and started him on Atomoxetine he started having his good pattern of sleep again.

I’d say talking with adults taking prescription amphetamines for ADHD -it does affect sleep pattern and eating even in adults, it’s just they are adults and they are aware of it and they know why this is happening and surely they have strategies to cope with these adverse effects. Adults don’t need to grow and develop brain anymore, also blood brain barrier is closed in adults.

For example how many big scale medication studies and follow ups into adulthood have been done on 4 year olds taking stimulants to manage ADHD? For what I have been researching- it just haven’t been done on such young children on a large scale.

I am not an expert, just a parent who has been extensively reading medical journals, nice.org.uk research publications and BNF which basically tells about every mediation licensed in the UK and what dose, what side effects etc there are- everyone has access to it online or a paper copy at the library (it’s updated yearly with a new edition).

I know that people metabolise medications differently and that there are even specific tests available in the US to determine this. Maybe worth doing such tests for your child?

However you did say that your child slept well before starting stimulant. He’s very little and medications have different effects and different side effects in young children and even if you look at the lists of side effects there are often 2 separate lists for children and for adults.

For example in the UK no doctor would prescribe such a young child (under 5) stimulant ADHD medication at this young age. We have a strict rule that ADHD medication can be prescribed earliest when child turns 5 (meds are licensed from 6 but at psychiatrist’s discretion they can be prescribed also from 5). I am not saying that this is a better approach- this conservative and cautious approach in the UK when it comes to medicating young children with psychotropic medications; at the end of the day it’s US being a driving force in inventing new treatments, new medications and basically the most forward thinking in the world in terms of medical treatment.

[Lanego]

My 10 year old is on Guanfacine. I would suspect the early morning wake up is due to Adderall since it's a stimulant. We started at 1mg guanfacine and went up to 2mg but his blood pressure dropped too much, and he was very tired and sleepy. We've backed down to 1mg but that means his impulsivity and backtalking is worse. Agree with Pattimum, what were your goals when starting medication and did guanfacine achieve that or does he need the additional Aderall. Best of luck!

[SunshineF in reply to Lanego]

we started low dose of meds to help w his impulsivity and hyperactivity because it was beginning to become unsafe. He’s been receiving services at pre-K for a year and he knows all the strategies but can’t implement them in the moment. The goal was for the low doses to slow him down just enough to help him think before he does things. Sometimes I think the meds are working and other times I don’t. And now this sleep issue is really rocking his world (and ours). Just feeling lost.

[SunshineF in reply to SunshineF]

also he kinda plateaued w the guanfacine so she added 2.5mg of adderall to see if they might work together and help.

[123adhd]

Personally, I think it sounds like a meds are interfering with his sleep. My son is on 2 x 5mg of Ritalin and we noticed a difference with sleeping. Nothing major, just maybe once or twice every few weeks he will take while to settle and perhaps night waken. We take breaks from meds at weekends but I do wonder if he was on it all the time would it disrupt his sleep more often. May be worth getting in touch with your doctor as this is something they usually like to hear about with regards to sleep. For me, sleep trumps how his behaviour is through the day as a good nights sleep is so important for their growing brains! However, equally happy children threw the day is important. My friends little one is affected by Ritalin, but it’s the only meds that helps him so the doctor has prescribed melatonin to combat the sleep issues. Hope you manage to get something sorted and wishing you the very best in your pregnancy xx

[SunshineF in reply to 123adhd]

thanks for this.we are in touch with his dev ped who is prescribing and she doesn’t think the meds should be causing the wake ups as they would be out of his system by then…but I’ll bring it up again bc he had no sleep issues until now. I’ll also ask about melatonin too.

[123adhd in reply to SunshineF]

wishing you all the best - and I hope my comment in no way sounded condescending or patrionising. Us mum with children with adhd face enough of that. That what brought me to this online platofrom xx

[Aspen797 in reply to SunshineF]

Guanfacine can interfere with REM sleep. Our son takes 2mg (very helpful!) but adding the second milligram took an entire year because initially adding the first additional .5 to the then current 1 mg caused night waking. We had to start with added 1/4 tabs and very, very, very gradually increase. Your son might be sensitive to the increase as our was.

Here is a link to a study about sleep and Guanfacine: pubmed.ncbi.nlm.nih.gov/253...

[SunshineF in reply to Aspen797]

Oh wow ok I didn’t realize it could take that long and could have that effect. How old is your son and do you mind sharing if he works with a psychiatrist for his medicine?

[Aspen797 in reply to SunshineF]

Our son is 13 now. He began it when he started experiencing tics. It helps moderate them. It also helps more with the anxious/irritable/impulsive side of ADHD than stimulants do. We actually took him off stimulants for a while because we were so floored at how well the guanfacine worked, but we restarted when he had trouble focusing for school tasks. Yes, we consulted a child psychiatrist for medication management when he began having tics and it was this very experienced doctor who guided us in the super gradual increase.

[SunshineF]

also, how did you know he needed to increase the dose? After some time did it seem like his current dose wasn’t doing anything anymore?

[Kkoelle]

yes the adderall will keep him up. My son can’t sleep without melatonin. Maybe give it a try