ADHD/Impulse Control Help

[BlueRose7]

My son is 9...diagnosed when he was 6. Have tried a bunch of meds and landed on a combo of Straterra and Concerta that work well for his ADHD. However his impulse control has been non existent lately and hes being really hurtful and disrespectful. I am picking him up from daycare and receiving multiple incident reports. He hits other kids, talks back to the adults, is always over policing other kids and how they play, hates being told no and gets physical, and has meltdown temper tantrums. He really has no idea how to play and socialize. He has also now moved on to saying some very inappropriate comments to other kids. He says he doesn't want to go to daycare everyday, but I can't just stay home with him because I work. Nothing seems to help to change his behaviour. I have tried every consequence you could think of and nothing works. We have tried books and inspirational videos to inspire better behavior. We have taken away his privaleges after multiple incidents...I don't have anything left to take away. I have tried all of the positive parenting/safe space stuff too. I feel so defeated by this boy and have no idea what to do. Its really embarrassing...I feel like I need to quit my job because child care situations are awful. I have gone for help to our Pediatrician but it seems like we just try to change his meds and then we are on this never ending med trial while everything else falls apart. Anyone have any experience with this? Open to all suggestions.

[Knitting20projects]

I obviously don’t know everything about him. Please take my advice with some skepticism because I’m only hearing what you’re saying in this post. I’m wondering if he has significant social skills difficulties? From what you’ve said? The over-policing other kids’ behavior is actually a common behavior seen in autism. Those kids have rigid beliefs about rules and no sense that it’s inappropriate and socially unpopular to be the “little policeman” when his peers break the rules. Wanting to control how his peers play? That is classic autism behavior. At least, that’s my first impression hearing this. He sounds rigid and like he can’t “read the room” and modify his own behavior to fit situations? I would be wondering how his friendships have been to date. “No idea how to play and socialize”? I have a son initially diagnosed with ADHD but ultimately found to have autism also. The behavior you’re describing sounds very familiar. I would be making an appointment with your pediatrician and asking for a referral for a diagnostic evaluation for autism. As soon as possible. Don’t let your pediatrician say he makes too good eye contact or his speech is too good to have it (Ie he doesn’t need an evaluation). If he doesn’t ultimately get diagnosed with autism, a child psychologist could use whatever information they obtain from the evaluation to determine what other resources could help. And I would ask for a child psychiatrist referral to optimize his ADHD medication and be sure he doesn’t have depression or anxiety that hasn’t been identified (in addition to an autism evaluation referral). Sending you big hugs and apologies for the long response.

[Lovey23]

hi there, I’m new to this but I can completely understand the overwhelming difficulties your going through also my son who is only 3 and had all the same symptoms as what your saying, I feel like I’ve tried everything too! In my mind I’m thinking about how and what to say to make sure my parent g is positive and yet constructive.. etc it’s a hard road with kids who have highly emotional and behavioural needs more than others. My daughter has manic episodes so it seems very high emotions then after the episode she’s very down and flat polar opposite (we’re undiagnosed) but we are seeing patterns now more prominent now she is older (nearly 7) it’s really heartbreaking not knowing how she is coping and speaking to her teacher she’s has confirmed behavioural issues and learning difficulties (behind in class) I’m at a loss, I just wanna hug my babies and say everything is gunna be okay 🥹 hopefully we get some answers soon. Hope you do too *hugs to you*

[BVBV]

How is your son’s mood overall? We actually had to stop meds due to side effects and my son is so much happier. Stimulants especially made him more irritable, agitated, and affected friendships.

[Trying1978]

I hear you. My son (7) doesn't have the defiance issues as much at school or camp, but he does at home. The game-playing and social stuff, too. He did a social skills group at school that really helped 2 years ago. We have also been on the medication merry go round. My only suggestion would be to find a child psychiatrist to help with meds. When we moved from our pediatrician to ours, it helped.

I feel the despair, though. I only work part time, and it seems like I spend every free moment dealing with the 2 of my 3 kiddos who have ADHD, and it often just feels impossible. Hang in there!

[Juniper52]

Our pediatric psychiatrist suggested Guanfacine (Intuitiv) specifically for impulse control for our son (then 12). He’s been taking a combo of that and Vyvanse pretty much ever since (he’s 14 now), and although for us it’s hard to parse out what specifically has helped with impulse control, I will say that he is MUCH more able to think before he acts and make decisions that don’t tend to create havoc in our lives. Worth an ask anyway!! Best of luck to you!!

[Onthemove1971]

I encourage a.consultation with a child psychiatrist who specializes in medication management. They will be a key support as your child grows and.needs management of their medication..If they feel other assessments are needed they will suggest them.

They will help you understand about: best type of medication (stimulant, anti-anixeity, etc), best timing (am vs pm), and best dose ( try to increase or decrease).

Medication should stop 60% of symptoms of ADHD and if it doesn't then adjustments need to be made.

[Bookworm365]

hi there! I’m so sorry to hear of the struggles you and your son are having. My husband and I are (full-time working)parents to a 6yo boy diagnosed with ADHD but who also exhibits some of the same socially awkward (or really unacceptable) behaviors like your son. I would echo comments from others to get connected to a child psychiatrist for medication management. While we started with our son’s pediatrician, the Vanderbilt assessment showed results and possible diagnoses greater than just ADHD. At that time, our pediatrician recommended we connect to a psychiatrist. The psychiatrist has also indicated this is not just a cut and dry ADHD situation, and he suspects some presence on the spectrum for our child, too. We have seen good results with a low dosage of Vyvanse and a low dosage of Abilify, which can be used in children with autism to address low frustration tolerance and help reduce agitation. We feel it helps to lower that rigidity you see (and we see too), so he is better (still not great) at accepting no. (We tried a few other stimulants and also guanfacine for several weeks, but we saw more side effects than benefits).

From a behavior modification standpoint, we do see the most progress with a token system. (UGH 😆) and using a calm tone. The rewards for the token system being really incentivizing are key. We’ve watched a lot of Dr. Russell Barkley videos on YouTube and he has a couple of books that are great, too. We do notice our son seems to have extreme reactions to embarrassing situations (tripping, dropping something, etc) and when he can’t do something himself the first go. In these instances, he needs space to calm down on his own. We avoid talking and eye contact, and it seems to help expedite his calming.

Hang in there! You’ve got this!🤞🏼👍🏼👏🏼

[NYCmom2]

I have one child with ADHD and one with ASD. They’re more work than typical kids, that’s a fact.

I agree with the advice from the community to explore your concerns with a child psychiatrist or similar specialist. Have you got a neurological exam for your child?

As a mom that works freelance and is home and available to my kids almost full time, it doesn’t solve all the issues. Quitting your job isn’t the answer. If only it were that simple.

If you have family or a sitter who can pick your child up early from daycare that might alleviate the problem. Especially if you find the incidents are increasing as the day wears on.

Sending you loving prayers and hope for more support!

[Knitting20projects in reply to NYCmom2]

Oh, if only being home would fix everything!!!! Sigh. Nope! I’ve been away from working for 3 years—-my kids are equally challenging. But I do have better skills at figuring them out.

[Fish1fish]

If you haven’t already, get some genetic testing done to see which medications work with his genetic profile. What you explained sounds identical to our situation and we were also at the end of our rope which included a hospital stay along with several stints at the local PHP. My daughter is much better now that she isn't on stimulants, a category of meds her profile said were a bad for for her. We used Genesight for her genetic profile.

[Fiestyfrog]

Mines on Jornay PM and Quellbree for anxiety. My friend started her son on Jornay PM and it's helped him too.

[Knitting20projects in reply to Fiestyfrog]

Interesting—-I have heard great things about Jornay PM too. Wish my insurance covered it.

[MA_CHADD_Dad]

You've gotten a lot of advice on ASD and medications. My son is 15 (ADHD and Anxiety) now and he wasn't diagnosed or on any medication until this year. We experienced many of the challenges you are describing. We used extensive behavioral modification approaches as my wife is a BCBA, but we still struggled. The times he was at his best were when he had a teacher or other adult that took him under their wing, or if we had kids over to our house and kept an eye on how we was interacting with the other kids. He struggled the most when left alone with other kids for long periods of time unsupervised. Being a working parent I know it's really challenging to try and balance your work life and your son's needs. If you can't work with his current daycare provider you might want to look into other daycares or child care options that might be able to work with him more effectively. The defiance can be really stressful, I know first hand. Although in our experience it was far from perfect, kids with ADHD sometimes respond better to positive reinforcement rather than consequences for negative behavior. Reward his good days, give him challenges for when he's at daycare, if you setup play dates give him chances to behave the correct way when you are watching and reinforce it. Medications and doctors are important parts of this puzzle, but that doesn't mean the right behavioral approaches won't make a difference too. Good luck!