My 6 year old has ADHD, ASD, and DMDD, he’s also gifted. He was on Vyvanse and we switched as it was causing major emotional meltdowns. He’s now been on Quillavant for a week and he’s so grumpy and sassy literally all the time. I can’t take it anymore. When he’s not on stimulants his hyperactivity and impulsivity is through the roof; he will literally not sit down and constantly does bad/dangerous things. He also gets irritable and has meltdowns when not medicated too. He’s been on Guanfacine for about a year and it helped a lot with the emotional issues but not enough and not at all with the hyperactivity.
Any suggestions? I’m out of ideas but we can’t live like this. I love him so much but he’s such a difficult kid.
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redmama2
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Yes, it sounds about right the stimulant controls the impulsive behavior.
The non-stimulant controls the mood, focus and eliminates the explosive/silly/rude behavior.
We were told when everything ( type, dose and timing) are all dialed in 60% of the negative behaviors should be controlled.
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What worked best for us was to work with a Child Psychiatrist closely, thsy should manage ( this is for years) the medication together. They should be skilled at increasing doses or like us, giving Gufancine 2x a day with the stimulant. In fact our Guanfacine dose was a 24 hour dose. Our Child Psychiatrist was amazing, she would call me on the phone to help us. I am so Thankful for having amazing support.
Also, as children like ours grow and mature there need for medication could change.
Let me tell you 60 % is amazing when life was miserable before.
I have been in that same position with my son when he was 6. He's 8 now and still is regulated by a Focalin XR and 24hr Guanfacine combination. He would wake up in the morning completely out of character, being hurtful both verbally and physically, and provoke situations. As soon as his Focalin kicked in, he was fine and calm. The goal was for him to wake up without being unhinged. He now takes guanfacine in the evening and he wakes up more calm. Then he takes his Focalin when we start the day. One dose of each per day (Focalin XR in the morning, guanfacine in the evening). As far as the dosage, you will have to work with your doctor to get it just right.
I feel for you! Prozac has made a huge difference for my daughter, who is 8 and has ADHD and autism. She is also on 2mg of guanfacine. While she is still herself, her symptoms are less severe. We are still trying to figure out the right stimulant (or if they even help her?) but her psych said that if something from the Ritalin /methylphenidate family didn't work we should try Adderall, which we are starting this morning. You're not alone on this journey!
I'm sorry to hear about your son's issues. I definitely recommend working with a psychiatrist that can help with different meds and dosages. We tried a number of different things and while Foculin in the morning and Guanfacine in the evening had the best results for focus, he still had anxiety and anger issues that would get out of hand. We determined it was the stimulant medication. We changed to Straterra which is a non-stimulant and it made a huge difference. No more anxiety or anger. It may not work quite as well on the focus but still helped with impulse control. It was worth the trade off. He is now in high school and doing great on the Straterra. It's probably a combination of the meds and his natural maturing but we are in a really good place now. Hang in there and keep trying different things!
My son uses Guanfacine 2mg every evening. We give it around 5 PM and it makes him a little sleepy, which is great! He is such a better sleeper with Guanfacine. We think that this medication is the best thing that he has ever used. He doesn’t feel like it’s a medicine. The methylphenidate wa awful and the focalin tirned him into a beast! He hated the way the stimulants made him feel. Guanfacine is a lifesaver for our family and I hope you try it out with your child.
My grandson is on Focalin XR 10 mg. he tried the Guanfacine for the hyperactivity, but he passed out sleeping all the time, so we only took it for a couple days? He just had neurological testing done and they are requesting that his neurologist increase his meds. still problem focusing and sitting still for any length of time. Focalin is the only one we found that didn't have a lot of side effects.
My son is 8 but was in a similar position a couple of years ago, your description resonates a lot. He also has an ADHD diagnosis and likely DMDD, also tested gifted. He is now on guanfacine ER 2mg and atomoxetine and doing well.
Hi - Similar situation with my 10 yo. Its been a rollercoaster for past 5 years since shes growing sso a constant change in meds to get right combinationand dosage. We have a great psychiatrist though who does all changes slowly. We just started with Jornay PM which is given at bed and kicks in by AM. Also taking Guanfacine (don't think Guanfacine helps) with some others. Besides outbursts and tantrums at times, sleeping is difficult throughout night but believe that's more from anxiety. It looks like things will have to be tweaked occasionally as they grow but a good psychiatrist will help. Also, group therapy can help with the social emotional stuff. Good luck to you all who are trying to help their lived ones.
Usually either an Amphetamine based stimulant, or a Methylphenidate will work but not both he should react better to one of the two. I can only take amphetamine based, they never figured out as a child that Ritalin made me so much worse, and it is like that to this day. Maybe starting plain Ritalin and Zenzedi dextroamphetamine would be good so you could observe which type of stimulant he reacts the best to in its purest form. The problem is meds only go so far; The key is figuring out which works best. It sounds like his doctor tried a Methylphenidate based med, since Vyvanse is dextroamphetamine wasn’t working. A lot of exercise like swimming lessons, pee-wee baseball, soccer getting that energy out of him can help a lot. My parents used to try to exhaust me with activities. It can have as large of an impact as the right med. Good Luck.
great ideas above regarding medications. If you haven’t already, you may want to consider looking more into micronutrients and probiotics to help gut-brain axis. Pediatric neurologists specializing in ASD (larger children’s hospitals) can best advise.
Question. Are you taking the brand name Vyvanse or the generic? It's known that not all of the generic Vyvanses work as well if at all for some people. There are threads on Reddit in r/ADHD about it. I've noticed it with my kid when he gets generics sometimes.
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non stimulant trial with guanfacine
Progressively worse stimulant side effects
Not extended release stimulant
stimulants causing anger/mood issues
Switching from stimulant to non-stimulant
