Meds only somewhat effective

[Adhdmomof2]

Hi All, my son has been on concerta ER 18 mg and guanfacine 1mg for a few months now and we’ve seen some improvement in symptoms but he still struggles with emotional regulation. His teacher says he needs less breaks and his focus and attention have improved a little but he still has issues with task completion and still gets frustrated frequently. I discussed this with his pedi and also the possibility of trying the Genesight test to get more information and he said he’s heard of that kind of testing but has never ordered it before so not sure how to interpret the results. Overall I kind of got the impression maybe he’s a little out of his element and it might be time to find a psychiatrist. We also have a full neuropsychological eval scheduled for July bc we suspect he may also have an anxiety disorder. Do you think it would be best to wait for the results of that test and then try to get a psychiatrist? Or is it typical to see only some improvement and we should continue on his current regimen? Any insight would be greatly appreciated! Thanks!

[Onthemove1971]

If I were in your shoes I would establish with a psychiatrist asap. It is great that he has shown some improvement this means the medication is working.

Having a child with ADHD is a life long journey and medications will get "more" stable then he will out grow.the dose and need an adjustment.

A psychiatrist will be able to make suggestions about dose and timing of taking medication. This type of adjustment really needs someone who specializes in knowing about how the medication is impacting his body.

Our son take guanfacine 2x a day before school and at bed.

We can not make suggestions about increasing the amount or increase the dose.

I was told medication takes care of 60% of behaviors. Right now he is not there.

It may take a few months to see a psychiatrist.

I would also suggest a 504 plan so everything can be put in place so year after year you don't have to go over everything again and again. You can place something in the plan about getting help with task completion, time management, late assignments, extra time for tests, etc.

Hope you get everything taken care of over the summer so he can have a wondering school year..

Just wait until high school.. so much work.

[Adhdmomof2 in reply to Onthemove1971]

Thank you for your reply- getting an appointment with a psychiatrist was what my intuition was telling me too, especially since like you said it will prob take a few months to actually get in. We’re also working with the school to get a 504 or possibly IEP in place but like everything else that also is taking a long time!

[Knitting20projects]

How old is your son and what’s his weight? Asking because 18 mg of Concerta can be a starting dose in some kids. He may have room to go up.

[Adhdmomof2 in reply to Knitting20projects]

He is 9 yrs old and 68 lbs.

[Knitting20projects in reply to Adhdmomof2]

Everyone is different in how they respond, but usually at that age & weight he could try the next dose up of Concerta (27 mg). I’m actually a pediatrician & we typically don’t go above 1 mg/kg with Concerta, which would be 30 mg (68 lbs = 30 kg). Of course, it depends on if your family & doctor are interested in and comfortable with that. I try hard to avoid outing myself on this board as a pediatrician but I have 2 kids with ADHD 💕

[Adhdmomof2 in reply to Knitting20projects]

Thanks for your reply! I will follow up with his doctor!

[Knitting20projects in reply to Adhdmomof2]

Best wishes! I have learned more as a mom of 2 with ADHD than what I got in my training as a pediatrician. I'm sure most parents in this group can understand, when they compare the med management skills of psychiatrists vs pediatricians :). ADHD is a much more complex and nuanced "syndrome" IMHO than what most people think, and I feel it impacts so many areas of life for kids and families. I also believe the medication management (not to mention the parenting/behavior skills you need at home) is nuanced and requires lots of experience. Every patient can be different. But actually, diagnosing and treating ADHD and seeing kids feel better about themselves is among the most satisfying things I have done

[Elijah1]

It is likely that the Concerta dose is too low. I agree that trying 27 mg and, if needed, 36 mg would be OK.

Pharmacogenomic testing is a prediction of how the body will get rid of certain medications based on the gene profile of the enzymes that break down the medications (normal, rapid or slow breakdown). It is a calculation whose accuracy depends on the drug that is being assessed (it can help with certain anti-clotting medication and pain medication and with atomoxetine, an ADHD nonstimulant medication). This test is not likely to help with the choice of a stimulant medication for ADHD and is not recommended by the AAP.

[Adhdmomof2 in reply to Elijah1]

Thank you for your reply! I appreciate it!

[marinecyan]

We found the Genesight testing helpful for our son but only because our psychiatrist knows how to glean the important information from it.

We’ve gone a non-medication route but I still recommend finding a knowledgeable psychiatrist. We had to wait a year to see ours - hopefully you are able to get in sooner!