My older son who just turned 9 today has ADHD and does well at school, but can often times during the week at home can say some terrible things to my wife and I and even his 7 year old younger brother.. We started him on Guanfacine and thought it was having a good effect but as we upped his dosage we felt like the emotional outbursts at times were worse. We think it also may be impacting his sleep at night too and when he has poor sleep the outbursts generally seem to be worse. We brought this to the attention of our doctor and they are recommending switching to Concerta. Anyone have experience with their child taking this vs taking Guanfacine? He also does some group therapy but it's more geared towards us on parenting strategies and how to manage "big emotions."
I'm glad I found this group because sometimes it is a daily struggle at home and mentally/emotionally exhausting for both my wife and I to manage/help our son.
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acfowlie
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As a mother with ADD who has raised 3 adult children with ADHD and who is now raising my 8 yr old, grandson with ADD, I applaud you for asking the question. First, I am sorry you are having difficulty with your son and his angry outbursts. I pray over time he will learn how to control his behavior with compassion from you and his meds working optimally.
Concerta works well for my 8 year old and his outburst are at a minimum. If he is acting out it’s because he needs his Concerta or it’s time for bed. To help him sleep, which has always been a problem, his pediatrician prescribes Clonidine 0.2 mg., and it works great for him. If he doesn’t take it he will never go to sleep. Melatonin doesn’t work at all. To offset my feelings I was given antidepressants. Vyvanse works best for my ADD.
Please know that if your child’s brain doesn’t respond to the Concerta, don’t give up. What works for one person may not work for another. I hope this helps.
Thank you very much for your response. With your 8 year old grandson has he encountered any major side effects with Concerta. Our concerns with Concentra are potential loss of appetite and disruption to sleep since he is already thin and doesn't sleep well right now.
Just remember that every kiddo can be different. What works for one 9y/o may not work for the next. My son tried Concerta and it was not a good fit but my friends son does great on it. Keep a log whenever you start a new med to monitor any new behaviors that pop up. We had to try several before we landed on the right combo and timing for my 9 y/o.
The great thing with stimulants is you will know very quickly if it's working or not. If it's not a good fit, don't wait until you have an appointment. Call the doctor and let them know/what to do next. My son needs 2 long acting stimulants plus a booster dose in the afternoon just to make it until 6:30! He also needs the guanfacine and without it he wouldn't be calm enough to sleep. We give this at 4pm so it's up and working for bedtime
I also recommend checking out Adhd dude. He has a parenting course, podcast, youtube channel you can check out. Following his advice along with medication and an IEP has been essential for us.
I’m sorry to hear you’re going through this and that your son has to experience such emotional dysregulation. It’s so hard for everybody. I get your exhaustion.
I’m a single parent to a teen with adhd. He has always struggled with emotional outbursts at home only. It’s his safe space. But unfortunately I take the brunt of it. That said he has significantly better emotional regulation as a teenager. Thankfully! The big stuff has mostly gone away with age, support and medication.
Have you thought about putting him on a concerta and guanfacine combo? Many people do that. We started with concerta but switched to guanfacine because the sleep and eating impacts were too much and his emotional regulation became worse in the evening. These are common side effects. Guanfacine was a miracle for us for the outbursts and big feels. Once he was stabilized on that we added a small dose of concerta for the help with focus and the side effects were much less this way. It works really well for him. I check in with him regularly to see how they’re making him feel to see if we need to change anything.
It is interesting it’s making his emotional outbursts worse because guanfacine usually causes sleepiness and helps with the outbursts. But neurochemistry is unique for everyone so there is definitely no one size fits all. It takes awhile to figure out the right fit each person. But also frustrating and tough as you try to figure it out and have to deal with the side effects! Maybe you might want to consider lowering the guanfacine and add a small dose of a stimulant? You have to titrate off of guanfacine anyways so might be worth trying as you lower the dose.
There’s lots of other options as well. Just thought I’d share that as an option. Hope you get it all figured out. This is definitely not an easy journey. But worth it too support our kiddos and ourselves.
Yes, others have had to stop Guanfacine for these reasons. Depends on each individual"s profile, but Vyvanse is another option. Start low and monitor the side effects. Lots of protein, hydration and exercise as well as supplements like magnesium and melatonin can be helpful too.
Sorry your family is going through this. My family goes through it daily as well. My almost 10 yr old is on guanfacine and Prozac as well as some others but can't seem to control her impulsiveness/dysregulation at home when she doesn't get what she wants and all of us end up yelling. We have a psychiatrist to manage medication and meet with Dr about once a month for adjustments as needed. Thankfully school is pretty good. I guess it just depends on the kid and how the med or combination of meds work for them...each kid is different plus they are still growing. Good luck but wanted to share that you're not only one going through this...although it feels like that constantly.
You are not alone. This group was a huge help for me when I was in the thick of it. Check out past posts which are jam-packed with helpful advice as you can see just from this post.
Guanfacine has reduced but not eliminated my son's emotional outbursts. However, when we mentioned to his psychiatrist that he was having trouble sleeping, she said that the medication takes 6-8 hours to make you sleepy. We'd been taking it at bedtime! We switched to taking it after school and now he sleeps great.
My 12 yo son tried stimulants, like Concerta, first but was more irritable so we had to switch to non-stimulants, including Intuniv. One thing to consider is that he may have underlying anxiety that stimulants and non-stimulants do not address. Our pediatrician was concerned about anxiety when my son was not tolerating stimulants. We were referred to a child psychiatrist who started him on Zoloft and then a few months later we started intuniv. That combination has worked well and his outburst at home significantly improved. Like your child, my son rarely have ever had behavioral issues at school.
my son takes Concerta and Guanfacine. We added Guanfacine about 9 days ago. We have seen a great improvement with his ability to control his emotions. That being said two of those days he did have outbursts. I have come to the realization that even with a med comp that has definitely helped, it will never completely cure all issues all days
Thank you for the feedback. We had my son taking 2mgs of Guanfacine 1mg in AM and 1mg in PM. We noticed more regular elevated outbursts and told our doctor and we brought him down to 1mg total for the day and seems to be less outbursts with less severity. Haven't started taking Concerta yet. I tend to agree that outbursts will still happen but if we can continue to help lessen the # and severity I'll take that as a win
are you working with a psychiatrist or a pediatrician. While I love the pediatrician if I am giving my child these kinds of meds I want it to come from someone who specializes in it. My daughter started with ADHD/ODD diagnosis at 6 then it escalated to DMDD when she was about 7 1/2. Her emotional dysregulation would turn into 1-2 hour fits of violent rage against me and anything she could get her hands on. She has tried so many meds and so many therapies. Her Psychiatrist has been very open and honest with me about medications, what can help and what wont and the risk vs reward to each. It is very comforting to have someone with so much experience.
Yes we are working with a pediatrician who prescribed the guanfacine and concerta (which we haven't started yet). He also is in I guess you can say group therapy with his mom and i but the person is not a psychiatrist
Yes it is usually 2 spearate people. We check in with the Psychiatrist monthly just to confirm things are going okay and no adjustments need to be made. I think for us it is a little more often due to the violence and the amount of medication she has to take. Before when it was ADHD I think it was quarterly. You can ask the therapist if there is a psychiatrist associated with them or you can ask the pediatrician to refer you.
Hi, do you mind sharing what your daughter is currently on? And is it helping? Does she do any therapy?
I have an 11yo son, and we are just at a loss. He too has tried so many meds over the years, and therapy. We are seeing a new psychiatrist Friday, so hoping for some help. He’s just miserable, at home, at school, etc.
Guanfacine was not good for us. It is initially a blood pressure med, and we got light headed and my stepkid even feinted. It is a non-stimulant. Concerta is a stimulant. They are quite different. Grumpiness definitely happens with sleep deprivation, and adhd is big about this. If he continues with this, ask for a sleep aid like trazodone.
Medication is always such a difficult decision to make. Here are a few things that made it easier for me and for a lot of parents I’ve talked to over the years to understand.
1. It is appropriate because this is a neurogenic disorder and it responds to a neurogenic treatment, much as one thinks of Diabetes responds to insulin medication.
2. Stimulant medications, unlike there names, do not stimulate the child, but the production of neurotransmitters like dopamine etc… of which the ADHD anatomy is not using effectively, has smaller areas to work, sometimes activates areas of the brain’s not supposed to and has a slower maturational timeline it’s on the correct trajectory but can be 2-5 years slower to develop.
3. Stimulants are a small molecules and are in and out of the body very quickly. They do not impact the liver and as we know need to be replenished every day. They are not like illicit drugs that bear similar names. They are often abused by adults, but not by teens or adults with ADHD. In some studies, ADHD medications normalizing effects have been considered protective as the child doesn’t become traumatized over and over again, not being able to do things or behave a certain way. This is an important consideration. ADHD is a a performance disorder. That means that the child cannot do what they know. It’s not a knowledge problem. This is where the frustration comes in the shortness to anger comes in because ADHD. Also causes executive function problems such as emotional regulation, memory, inhibition, planning problems solving my napping and self talk problems, my son didn’t have the vocabulary because he couldn’t read well and so it took a long time for him to be able to express how he felt and the whole time trying to express his feelings.He would give up and just have a meltdown. Kids can develop good grit. But very differently then we learn that I’d say
4. My son has been taking a stimulant for 24 of his 30yrs and is 6’6” about 240 lbs. The study that looked at growth rate concerns of children taking a stimulant and appetite loss, found that there was a 1/4 in. difference in overall height in the cohort study. I found over the years that the impact was mitigated by eating when hungry. When they become teenagers they eat everything no matter what. Lol
5. As far as the meltdowns, this is not uncommon and definitely should be looked into. It’s hard talking to our kids about this stuff but there is a good model to follow that gives you the chance to hear his concern, share your concern, and empower to your child to be good problem solvers. Getting to the root of what is going on and triggering the meltdown is important. He isn’t handling it as well as chronological age should be able to, and that is because his developmental age is lower. This is a complication of ADHD. They can have up to 30% delay in emotional and social growth, making them developmentally much younger and having demands that are out stripping their skills for that developmental age.
The model is called collaborative and para solutions by Dr. Ross Greene. It can be found on livesinthebalance.org. His website it gives you the language and the scaffolding of how to handle the emotional part proactively, which as you already know, doesn’t work when they are in the thick of it.
I hope some of this helps, I just want you to know that they do get better as they older. Just hang in there. There is light at the end of the tunnel and it isn’t the train heading for you!! lol ❤️
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He also needs the guanfacine and without it he wouldn't be calm enough to sleep. We give this at 4pm so it's up and working for bedtime
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