Switched 8yo medication from Concerta XR to Focalin XR concerns

[Boymom0408]

My 8 yo son has ADHD and was diagnosed at 5 years old. He was on adderall 5mg; then 5 mg with a 2.5mg mid day for the first year and then put on Concerta 18 XR middle of first grade at 6 YO. He was on the concerta 18 until October of 2022 when they upped his dose to 27 XR due to some behavioral/focusing problems at school. Within a month or so he started complaining of stomach aches that progressed into pretty debilitating stomach pains throughout the day as well as his emotional state seemed to be effected and he was very weepy especially in the evenings. He ended up being extremely constipated which we discovered via xray and they assumed the medication was contributing to that. We made the mutual decision to go a different route beginning of January and they put him on Focalin XR 5mg and miralax for 5 days to clear him out. Fast forward to now, the stomach aches have disappeared, but the behavioral issues have increased as well as his anger and irritability. He is extremely smart and was making straight A's and now he is telling his teacher the work is stupid and he just doesn't want to do it. He screams at his younger sibling almost daily and has screamed at me telling me he hates me.(Which he has never done). He is being more deceptive; sneaking his ipad after bedtime and staying up unless I catch him in the act. Throwing tantrums at karate practice and basically anytime he has to do something he doesn't want to do. Did we make a mistake? Should we revisit the concerta and just keep and eye on his diet and making sure he is using the bathroom more often and not backed up? I just want to help him as best as possible. Is there a different medicine anyone recommends? I have left 2 voicemails with his pediatrician to give them this feedback. We are just lost. He is a great kid and I just want to do whats best for him.

[Hidden]

I can only say from my son’s experience- he was 8 months on a stimulant medication (extended release but by 3/4pm he was really suffering when it was coming out of his system). He was on Mathylpenidate and he just had a range of side effects, neurological and weird ones even like excessive sweating, just would have to basically rewrite the whole side effects chart to explain… And they were slowly adding on and creeping in more and more but his psychiatrist was saying that it wasn’t side effects and that my son ‘is like this’. He was getting worse and worse…

We changed psychiatrist and then eventually after a few costly visits (we are self paying) he changed my son to Atomoxetine. Once my son reached therapeutic dose of 1.2mg per 1 kg body weight, we just never looked back! He is happy, he can sleep, he can eat, he can focus, he can attend after school clubs and even have maths tuition at 5pm (he hates maths yet now he made such a progress with the tutor that he starts saying he likes it!). None of this would be possible on a stimulant… He is more stable on a medication that works 24/7 and doesn’t have to daily come out of the system. He is not irritable or anxious anymore (I noticed on stimulants anxiety and irritability were getting worse and worse).

Also ask your child’s doctor about Cyproheptadine - it helps children with functional dyspepsia, with functional nausea, with poor appetite, it also helps with stomach emptying. Because it stops tummy aches and improves appetite my son now can eat loads of fruits and vegetables and constipation just has no chance to happen. I give him prunes, dry apricots and various other dry fruit that he likes- organic so it doesn’t have added sulphates. Also Weetabix cereal (but the types with loads of sugar so he also actually likes it)- Weetabix protein crunch or Weetabix chocolate melts (13g fibre per 100g cereal). And make sure he drinks enough fluids- dehydration also causes constipation. I never give my son any medicine for constipation because fibre from food works for him but I also give him a capsule with organic ginger daily (it’s got well evidenced safety even used by pregnant ladies for nausea so I feel it can’t harm my son even though it is a herbal remedy😉Supposedly ginger does help with transit, stomach emptying etc….).

[Boymom0408 in reply to Hidden]

Thank you so much for this feedback and information!!!!!