My adhd son is struggling. Lots of sensory challenges major reactivity and is dyslexic and a slow processor, but still bright. We had planned to do summer school for summer learning loss, but he essentially went into fight flight at dropoff the two days we attempted. He hid in his sweatshirt and sat in lobby whole day. Major anxiety. Turns out he is terrified abt not knowing anyone. We modified the plan and he's just going in for his weekly OT and three sessions of weekly sped pullouts.
We have tried multiple stimulants that make him more anxious and guanfacine.
We are considering an ssri, prozac. His developmental pediatrician has seen a lot of success with it for kids who look aggressive, but are actually anxious. The psychologist we work with is open to him trying it. We are of course worried abt a med with a Blackbox label and that he'll likely be on for years. Forever?
For those with kids on ssris, have you seen a greater ability to work through the avoidance behaviors connected to the anxiety?
Thoughts and experiences pls
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Chipcookiemom
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Try not to have the on it forever mindset, especially with SSRIs for young kids. Often times using them at such a young age paired with therapy are life changing, break the thoughts patterns, and they only need it for a few years.
That was our experience at least. They were used for a year paired with CBT and his other therapies and helped immensely. We titrate off of them and all has been well. I wouldn't just do the SSRI alone though, I'd do therapy too. If you can get the anxiety under control a little better over the next two years, stimulants should work better around age 9 to help with the focus that will be needed at school at that age.
hi! My son sounds similar to yours. He is 8yo with combined type ADHD, anxiety and dyslexia. We’ve tried several different meds, and stimulants have not worked for him. We started prozac approximately 2 months ago. We definitely still have good days and bad days, but I can say transitions have become MUCH easier and there are more good days then bad.
Previously at school he was refusing to attend any of his specials that were outside of the classroom - gym, art, etc. After starting the meds he started attending without issue. He also seems more outgoing and friendly in situations that previously made him uncomfortable. For example, his dad coaches his brother’s soccer team, in the past he would be very irritable during practice, sulking on the sidelines. He has since been willing to go on the field and “help” his dad. He’s very anti group sports, so this is a really big deal for him.
Kudos to your developmental pediatrician for recognizing kids who present as aggressive but are actually anxious. We’ve seen a lot of professional who couldn’t understand that our son’s anxiety may not be a typical presentation, but he is in fact very anxious. I think a lot of his challenges and behaviors stem from his anxiety and his awareness of his learning challenges.
All this is to say we are seeing a difference with the Prozac. While not perfect, it’s been a better result than we’ve gotten with any other med. I should mention he is also taking 1.5mg of Guanfacine per day which he has been taking for a few years.
I also worry about the black box warning and also if he will need to take this or other meds indefinitely. I try to focus on the improvement we are seeing right now and I hope with maturity and by giving him the right tools and support while his anxiety is under control that he would some day be able to manage without the meds. Whether that is naive or not I don’t know.
Never tried that but added Sertraline , generic Zoloft, to my aggressive grandson's medication and what a difference. Kind of wished we had added an antidepressant years ago. Let us know if it helps.
my stepkid is 15 and has been on ssti for 7 years. It’s been a blessing. So watch initially (for the first couple months), since some can have the opposite effect with different body chemistries. If concerning symptoms (like my suicidal ideations), see doc immediately and get off it. I’ve been on citalopram, ecitalopram and trintellix. I did have a hard time getting off trintellix (withdrawal), but not from citalopram family ones.
If you’re concerned, try getting a gene sight test. It is low evasiveness (swab in the mouth), and will tel you which psychiatric meds have adverse side effects with his particular chemistry.
My 8 year old with similar symptoms started Prozac in January and it has made a huge difference. She has more ability to regulate herself and a lot of what I thought was aggressive probably stemmed from anxiety, as she rarely is like that now. She still has her struggles and some of it is because her maturity is a bit behind her age. She is also on guanfacine, and both are very helpful. Personally, we are having a hard time finding a stimulant to help with focus and I'm starting to think some of this just happens when they are ready.
I wasn't diagnosed with ADHD until university, but I had anxiety attacks at age 6-7 that were bad enough that I was throwing up every day at school, and had my first thoughts of suicide at 8.
Right now, balance the risks of the med against the risks of the status quo. I'm not the person on the spot, so I can't make the decision for you. A couple things to keep in mind, though:
1) If a medication is helpful, he can rack up some successes and that will do a lot for his anxiety in the long term.
2) Withdrawing from everything obviously isn't a long-term strategy, but neither is a constant state of overwhelm. Try and find a set of tasks or an environment that is a 4-5 on the freakometer. Once he gets adjusted to that, it will become a 2-3, then a 1-2. As he adjusts, there will be other things that are a 4-5 that he can try. If he's totally freaking out, that just reinforces the fear, but if he's in his comfort zone, nothing is changing. Also figuring out his endurance for those environments is key. The main thing is to keep him in the 4-5 environment until his body realizes it's not under threat and calms down. If you can't find anything that's a 4-5, then maybe even having him imagine situations or talk about them will be enough. My son had a major phobia of needles. He needed vaccines, and he needed bloodwork. So we got a pretend syringe (it's one meant for crafts - glue, I think) and had him first handle the syringe, then talk about it, then show him what they would do in the office, then practicing with actually poking him with it (not to the point of breaking the skin), then doing the whole procedure. He's still nervous about needles, but he can do it.
3) Try not to worry too much about the long term picture, because there's no real predicting what that will be. Yes, he might be on the meds for a long time. Given the alternative, which is better? If he needed to be on insulin, or blood pressure medication, or antihistamines, would you have the same reaction?
4) Personally I haven't had much luck with SSRIs. If Prozac doesn't work, see if their doc is willing to prescribe a medication that acts on dopamine rather than serotonin, since that's more frequently the issue.
5) Despite the scenario I described at the beginning, I hold two university degrees, have been in the same job for 12.5 years, and have been happily married with two kids (9 and 5). Have hope that his current situation isn't permanent; that he will figure out what he needs to thrive. It won't be easy, but that's why you draw on every support, resource and tool you have at your disposal.
6) Barkley describes ADHD as "not a disorder of knowing, but a disorder of doing" We know the skills, we often know exactly what would help. If your son says he doesn't know how to do something, feel free to help him learn, but don't assume that if he's not using the skill that he doesn't know it. For decades I had people trying to teach me tools and skills I already knew like the back of my hand. My problem was that in the moment, I had a hard time actually doing the thing. Help him do the thing. Do the thing with him rather than for him. Keep helping him for as long as he needs it. If he's not doing something you feel would be helpful, there's a reason. Figuring out that reason, and either finding a workaround or a support that gets him through is key.
7) Educate yourselves as much as you can about ADHD, anxiety, learning disorders, etc. FROM REPUTABLE SOURCES. The better equipped you are with evidence based approaches, the more likely you're going to be effective in supporting him.
8) Self-compassion. Read about it. Teach it to yourself. Teach it to your son. Practice it. Kids with ADHD are flooded with negative feedback, and it is very easy to internalize it and transform it into shame, self-judgment, and some truly horrifying self-talk. Parents often get treated like they're bad parents simply because their child has a neurodevelopmental disorder. You are a good parent. Seeking help and support here (and the way you're doing it) shows that. But so often as parents we get enough negative feedback that even though objectively we know they're full of ****, we begin to believe them. The need for intentional self-compassion cannot be overstated.
9) Never turn down an offer for help. (I highly recommend the book "How to Keep House While Drowning" by KC Davis -- short digestible chapters, and available as an audiobook) Even if it's someone to look after him for a few hours so you can go for a walk with your partner (or by yourself), or even so you can have a nap, do it! The idea that anyone can do everything on their own is absurd. Take a look at any successful person and ask if they refuse help. Accept all offers of help. If someone helping you do the dishes while you vent to them is helpful, then great! If you can afford to hire someone to do things around the house that are draining the life out of you, go for it! Whatever help you need, and whatever makes the biggest impact, do it.
10) See if you can connect to other parents of kids with ADHD at your kid's school. Statistically there's probably at least one other kid in his class, let alone the whole school. Share strategies, frustrations, successes, resources, food... We all have unique strengths and challenges, so the more we band together the more skills and abilities we have to draw on.
Sorry this was so long. I'm nursing a migraine, so this is both a distraction and my ability to reign things in is a bit impaired. Nonetheless I hope it has been helpful!
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