10yo - unmanagable

[DoBetter]

Hello

My son was diagnosed as ADHD at about 6 years old. Up until this point he had been in and out of a couple play schools as he was always branded as being naughty. Since his diagnosis we have managed to find him a wonderful school who embrace all children and while still give a great education are stringent as most traditional schools. We also got my son onto the generic form of Concerta. The medication definately helps him to concentrate at school though we do find we need to up the dosage every couple of years. He is currently on 27mg. More about that later

Lately though he had become such a handful that it is making life for the whole family at home very difficult. He does not want to do anything you ask him to do like making his bed, bathing, brushing his teeth etc. Everything is a fight which normally results in screaming just to get him to do something and him in return saying we dont love him and him getting very aggressive. His poor younger sister is stuck in the middle of all of this, she tries to be the peace maker but most times just lands up getting hurt either emotionally or physically by her brother

Sleep is another story. It is so difficult to get him to sleep. He refuses to sleep in his own bed always being anxious at night worried about every sound he hears and imagines worse case scenarios. He insists on watching a youtube video before bed too. The thing is at the moment getting him to bed before 10PM is proving impossible. Generally I am not to concerned about 10PM as he still gets a good 8 1/2 hours sleep although being back at school now I am not sure if this is enough sleep

We as a family have gotten into a terrible habit of just letting him be so as to keep the peace in the house. We try to introduce rules like allowing own time to play computer games after school until 4PM, then doing homework, dinner and bath until 6PM. 6PM to 8PM is again own time to do what he wants. 8PM is then generally brush teeth and start to settle with the aim of being in bed by 9PM. I guess I need some advice on the how to settle down part. His idea is getting off the PC and then just watching some videos. I know the PC hypes him up so this is why we try to get him off off this at 8PM. We also try to read books etc

His doctor has prescribed him now 36mg concerta. We will give it a try and see what happens. While he did well academically last year (Stage 4) on his final report card all the teachers commented that he day dreams a lot and rushes through his work. Not sure if this is a result of the medication or a too low dosage of the medication

All I know is that something has to change for the sake of my families sanity

Any advice, thoughts welcome

TIA

[Fish1fish]

You sound like you are describing my house!

So what we discovered through genesight testing was that adhd stimulants and my daughter = bad! Until recently we had her on various stimulants trying to find the right one, vyvanse being the latest. Ends up none of them are compatible (behaviors exactly like you outlined) and we recently switched to non stimulant adhd medication for her adhd. Non stim adhd med may not work as good as the stimulant variety, however I will take a shorter attention span and poor impulse control over violence, nonstop screaming, and aggression any day of the week.

[SecretAgentIEP in reply to Fish1fish]

Can you share which nonstim worked for your daughter?

[Fish1fish in reply to SecretAgentIEP]

We are currently trying guanafcine. There are a few others like strattera which we have yet to try. We are still getting angry outbursts which I believe are learned behavioral responses. We are also reading lots of parenting books and discussing strategies with the therapist to help with these.

[SecretAgentIEP in reply to Fish1fish]

Guanfacine can cause irritability, anger, mood swings, etc. There may also be sensory defensiveness if he has auditory, tactile, or vestibular sensitivities. Perhaps try occupational therapy for them to evaluate and perhaps build frustration tolerance, emotional regulation, executive funtioning, and problem solving skills to reduce emotional or sensory meltdowns. Activity, a sensory diet, and OT have helped with our son, perhaps more than the medicine.

[Hidden]

My son was on extended Methylpuenidate and he was even worse, all side effects, rebound… He was already on 30mg at age 8 and he’s quite a small boy so I wouldn’t say that along makes it better. I’d say for us it made it worse.

After 8 months of a nightmare his doctor agreed to change to Atomoxetine and we never looked back. He can sleep, he can eat, he can do activities until late evening and he won’t have meltdowns. He can focus at school and yesterday (on a Friday!) i asked him to do his homework after school because we have a busy weekend , and you know what, he did it! None of it would be possible on Methylphenidate. And he is not anxious anymore- anxiety was worse month by month on a stimulant. His mood is now stable and cheerful. Yes on occasion he still has poor impulse control and reacts (he’s bullied at school so sometimes eventually he does react), also sometimes he talks rudely to me. But that I think just like any kid…

Also ask your sons doctor about Cyproheptadine. For my son it helps him with functional nausea and functional stomach ache (he doesn’t t have it at all now but even before meds he used to have nausea and feeling full even when not eating much). And it helps with sleep.

[ExhaustedMother]

I feel you! you are also describing my house! I ended up reading: yes, your teen is crazy loving your kid without losing your mind by Michael j. Bradley (recommended by my therapist). My oldest son is 11, but the disobedience did it for me and once I started looking at it from the perspective in the book, his behavior started to change. It’s tons better now - we still have the major blowouts but they are less frequent and the severity is not as intense. We tried generic concerta but he’s not on anything since Fall 2022 so I think how I change my behavior contributed to a change in his.

[Hidden]

Also what I read what other parents on this forum did and it worked for their kids- they give stimulant such as Concerta in the morning but a very low dose and then in the afternoon like 5pm they give non stimulant such as Atomoxetine or Guanfacine. I read in ADDitude magazine about it and I think it said that then stimulant can be as low as 5mg because the non stimulant builds up in the body (it doesn’t t have to daily come out, it works 24/7).

You may want to ask your child’s doctor about it. I know that in the US it’s a widely used practice to mix stimulants at a low dose with non stimulants. When I asked my son’s psychiatrist in the UK he said that since he is in a private practice he could do it but NHS wouldn’t do it because NICE guidelines don’t support this. And then he said that even though he could do it, he would prefer not to do it. It’s just they are very conservative with meds and kids in the UK. Luckily my son is totally fine on Atomoxetine. I think the fewer the meds the better anyway.

[DoBetter]

Thank you for all the responses.

I think I must add that we live in South Africa so not sure if the medications you mention above are available but I will find out.

I did not know about the stimulant vs non-stimulant. I am not sure want Concerta and its generics are (we used to use Neurcon and are now on Mefedinel)

Atomoxetine does sound wonderful compared to what we are dealing with now though

I do agree our behavior as parents do play a part too. A lot of the attitude I get thrown back at me I can see originating from me when he has just pushed too many buttons for too long and I am tired of fighting and I explode

[Elijah1]

His bedtime behavior suggests that anxiety is affecting his ability to go to sleep. You should also check when his upsets occur - during the day or in the evening, the latter suggesting that ADHD is contributing to the behaviors. This should help with any additional treatments (medicine or non-medicine) that need to be implemeneted.

[DoBetter in reply to Elijah1]

Hi. His anxiety is most definately at night. During the day he is fine. Come night he does not want to be alone, always hearing noises, remembering strange things that have upset him in the past like a balloon flying away ( he has a terrible phobia with balloons flying away, lost 2 as a child and its has scarred him for life. Whenever somebody has a balloon he insists they stay indoors and he always wants to keep them even when they deflate etc). He is not very social, rather spend time on his PC than with family. I would not call him introvert though, he is definitely outgoing and loud (complete opposite to me)