We have a 14 yo with ADHD and ODD has been the biggest issue. He has a good counselor, but we are REALLY struggling with screens AND it seems like we have yet to find the right medication.
He has some anxiety so he has been on prozac for 18 months. To increase his focus and decrease his impulsiveness, we have tried Ritalin (caused facial twitches), Adderall (didn't seem to do a ton, and when we moved up dose-he wasn't hungry), and now trying Strattera (however, at the starting dose-which typically is doubled after a week, he felt totally sick the first day and almost vomited). I feel so frustrated. I don't know if we should go back to the Adderall or what to do.
He is so dysregulated these days, he does not follow any rules-screen limits, swears at us, doesn't come down to dinner, is just completely defiant unless he gets his way. Honestly most days I cry and feel like I'm really losing hope.
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ORRYmom
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I’m sorry to hear this. I’ve been in your shoes and it’s incredibly hard to get through a day. And each morning you put on a brave face and try to have a fresh start only to be in the same cycle again and again.
I also have a 14yo. Currently he is on 52mg concerta, sertraline and apiprazole (abilify). That abilify has really helped even him out. It’s a super low dose, but it has helped immensely.
I’d also recommend looking into the adhd dude. I have followed his suggestions and did his parent behavior classes. I have adjusted my parenting and no longer let my son rule the roost. He must do his chores before I turn on his video games. I control his phone and the same rule applies…must take pills, do chores, have physical activity and then he has access to the phone for only 2 hours. My son hated and still hates this but his behavior totally changed when he knew he had to buy in and be accountable for his actions and behavior before he was rewarded. And let me tell you, it got worse before it got better he really amped it up hoping I’d give in b/c that’s easier than fighting. Having the right medications is a big factor here, too. You may have to play with the dosages; but it has helped him regulate better. We tried strattera but that didn’t do anything, it made him worse. He has done better on stimulants rather than nonstimulants.
I wish you the best in the journey of parenting a spirited teen! I hope some of this helps.
Our son is 8 and was diagnosed with ADHD (and exhibited ODD tendencies) starting from a very young age. He has done well on guanfacine ER and atomoxetine/straterra, maybe worth asking your doctor about it.
We tried various stimulants which did not work at all (and had weird effects on his behavior) and considered prozac and other options but ultimately opted to go with the guanfacine/atomoxetine combo.
It took a while to figure out dosing with our doctor but we are at something that works well for him now. He is still defiant and explosive at times, and often dysregulated, but it is much more manageable than it used to be, and he has managed to go from a special ed/mixed classroom to a mainstream one.
Ticks were a side effect for my daughter with some of the meds. We tried many. Vyvanse coupled with Zoloft (to control moodiness) has been a lifesaver!
Following this bc I have a 12 yr old with very similar issues. Behavior, screens, etc. Med wise I feel like we’ve tried it all! Currently he’s on medium dose of Azstarys, Zoloft 150, and seroquel. We just saw a child psychiatrist a couple months ago and started a new med regiment. I don’t know that it’s helping and I’m so frustrated. Tbh what I’m looking for at this point is a “stop being a crabby asshole” pill. 😣😞
It is such a difficult age to navigate and it is sort of normal teenage behavior. I remember my son being this way at that age.
The most difficult thing to do as a parent is to let go of their hand and let them work out their feelings on their own. This isn’t to say that he won’t want you to help him, however it is so important to make sure you do that in a way that helps him to solve his problems without your giving him the solutions.
Empowering our kids is probably the best thing we can do to help them into adulthood which for kids with ADHD, can be socially and emotionally many years off. Even lagging 2-5 years as brain maturation can be slower.
The best model for doing this is called collaborative and proactive solutions. It’s not an easy fix, but it does lay the foundation for helping him and you to be focused on problem solving and not behavior. Kids know right from wrong at about age eight. This isn’t the issue with ADHD. The issue is performance of what we know. So telling them “knowledge” isn’t helpful.
The website is a non commercial non profit organization that helps parent, teachers to understand some helpful underpinnings of ADHD behavior and how concerning behavior is just a symptom of the problem. Solving the problem is a better focus than solving the behavior.
I’m so sorry what you’re going through. I have been there and still am. Some days are harder than others. My 13 year old son (who is also borderline ODD) is on the max dose of Jornay PM (because he is a big kid) and a booster at noon of Methylphenidate. The booster was added about 2 months ago and has worked very well for him. But I am checking into ADHD Dude too (and I listen to his podcasts). We parents have to change ourselves instead of us trying to change our kids. It’s hard - I know. He is an only child and is so spoiled - all my fault. God knew I could only do this once. But I think the best thing you can do is to keep trying different meds and doses until you find the right one (it takes a long time and lots of patience but he is worth it) and learn as much as you can about your son’s conditions. Best wishes. Hang in there!
Hello! Thank you for sharing. We too struggle with screens. This summer, my 4th grader figured out our parental lock password, and stayed up all night for weeks before we figured it out. We use apple devices which helps us with screen time, but there are other apps (bark, Qustodio, etc) that can also help. What i like about them is that you set it and the device shuts off automatically, so you’re not having to wrestle the device away.
As for medications, my family has has a lot of adverse side effects between us. We learned about the Gene Sight test for my partner, and it helped him tremendously, so my daughter and I got them. It tells you which medications will have adverse effects, but not what the adverse affect symptom will be. It also won’t tell you if the medication will treat the ADHD symptoms, but it does narrow down where to start. It shows all mental health medications, including those for anxiety and depression. If insurance doesn’t help with the cost, it can be $5-6k.
There are two main routes for ADHD medications: stimulants and non-stimulants. Stimulants basically have 2 main families, and can be immediate release or extended release. Some of the non-stimulant ones can help with impulsiveness and aggression, but doesn’t help as much for inattention. They can be mainly medicines to lower blood pressure, and have caused lightheadedness and feinting in my family. I have heard the newer medications seem to do better in general, but can be expensive even with insurance. Prozac also had adverse side effects for me, which also showed up on my gene sight test.
Quick note on Strattera. You may know if it bothers the stomach it is best to take it with a meal. What many people don't know is that milk can be the main cause of nausea when taken together for some people. So don't take with milk and cereal for example. I had issues with nausea. I am fine if a take it with food. But if I take it with milk, nausea will persist on and off all day. Strattera gave me bad constipation after a while so be aware of that. May need a stool softener if it becomes a problem.
A note about Vyvanse. It may be an option still if other amphetamine based meds like Adderall failed. I always recommend Vyvanse first if trying the amphetamine meds.
Vyvanse converts to a little under half it's dosage of dextroamphetamine. e.g. 70mg Vyvanse converts to about 32mg dextroamphetamine. Then it has a long slow release over I think 8 to 10 hours which means the peak blood concentration is far far lower than Adderall, Adderall XR, Zenzedi, Dexedrine. Which also means it builds tolerance slower and has less side effects. Even Adderall XR is just 50% immediate release and 50% 4 hour delay which nearly doubles the blood concentration for the afternoon. Slim chance your therapist knows these deeper details of these meds but kudos if they do.
Qelbree is similar to Strattera in how it works but I don't know if it has similar gastrointestinal issues. Some like it better.
Clonidine is similar to guanfacine. You can look them up online for the differences.
Wellbutrin can enhance ADHD meds when they are in low or medium doses.
If every thing else fails, modafinil or armodafinil may be something to try. They are specifically wakefulness promoting drugs that act about the same as each other except moda about 5 hours and armoda about 12. They also work on dopamine and norepinephrine but target other parts of the brain more than Adderall or Ritalin. Have been used off label for ADHD on some occasions.
Did a quick look online. This article mentions a ton of things in regards to ODD that may be relevant including pharmacology.
How extensive was the screaming for ADHD? Did he get a blood test for any nutrient deficiencies, did a neurologist check for a neurological issues, did they do testing that also rules out other potential disorders that look like ADHD? Check for learning disorders? There is over a dozen, probably closer to 2 dozen disorders that present with ADHD like symptoms.
Do they have issues with daytime sleepiness or brain fog even when they have regular sleep schedule? If so, then may be worth seeing if Cognitive Disengagement Syndrome (formerly Sluggish Cognitive Tempo) could be a factor. 30 tp 60% of those with ADHD-I, and less so for combined or hyperactive types, are comorbid with it but it was left out of the DSM-5 due to ongoing research so almost no therapists know to look out for it. In the longshot that is a factor, research suggests a wakefulness promoting drug like moda/armoda in combination with an ADHD drug (including another stimulant) is best for those comorbidities.
I am not familiar with ODD. But if you stop making ground with one therapist, may be a good idea to look for someone who may specialize in treating ODD if there are any. Neuropsychiatrist have both neurology and psychiatry training so may be an option if the medication approach gets to complicated. They understand the brain more so can often better address things when they get more complicated. Can be hard to find one that treats these kinds of disorders as they often specialize in specific things like Alzheimer's or epilepsy, etc. I had to go the neuropsychiatrist route with someone who believes in evidence based therapy as my issues were easily beyond the curriculum of Psychiatrists and Neurologists.
Another option is integrative psychiatry. Where they have a multidiscipline approach. They take a "Holistic" approach and customize individual treatment that may include several types of non drug therapy paradigms. nutritionist knowledgeable in the gut/brain axis, life coach, family therapy, social relations therapy, traditional medicine and untraditional medicine, etc.
Just watch out for places that try to sell you stuff or are shady. If the first thing you see on a website is supplements they are selling, usually a red flag. Or like telling you to take a Neurotransmitter test. Neurotransmitters in the brain act as hormones outside the brain. Also, they do not cross the blood brain barrier and can't be tested accurately from a blood or urine test. Your gut makes more dopamine and serotonin than your brain so would really be testing levels produced by your gut. I do have a friend who is a psychiatrist and has referred people to integrative psychiatry places with good results. She also specializes in children with trauma so if it can help them...
ODD was part of my 14-year-old son's picture too. I don't know if he outgrew it, or his shifting hormones made a difference, but all of a sudden there was a positive shift. We also tried the suggestions in the book Finally Focused. That may have helped balance his system too... Hard to tell and what it was for sure. However, the author does have suggestions for reducing medication side effects. Good luck, it's tough. Keep experimenting and know that you are doing a great job!
Wow!! This is so similar to our situation (and encouraging that we're not alone). My son just turned 8 and we have tried a lot of meds and combinations. ADHD, PTSD, Anxiety/depression and borderline ODD.
Currently he takes Abilify and clonidine at night (been on this for over a year) and are trying to get his ADHD and anxiety better controlled. When we added Prozac a few months ago it helped immensely . He was happier and more cooperative than before. Then school wanted him to focus better and work more so we re-visited the ADHD medication journey (tried a year ago and gave up after many failures). We tried the various stimulants and the rebound was just too severe to stick with it. Even with booster doses etc it was not worth it.
We are now trying Strattera. I am not loving it. I am trying to be patient as the DR said it'll take 4-6 weeks to see any improvement. (3-4week mark currently) What we are seeing is escalation of behavior, more defiance and arguing, and worsening behavior - more aggressive, foul language and inappropriateness. I think it's the Strattera but can't find anyone else who has experienced this from it. I don't want to quit it too soon, just in case there is some chance it will actually help his impulsiveness and focus, but so far there has been no improvement and only worse behavior.
We haven't really tried guanfacine but I have heard good things about this with Wellbutrin. I wish I could try that but also hate experimenting on my son. I feel like he's some guinea pig and we keep messing around with it. I am so frustrated and overwhelmed with all of this and just want to help him be his best self and have a good life. He is very behind at school and even though they want to help him, he resists being pulled from class to go with the Sped teachers. We are working on counseling again and maybe adding in some behavior therapy.
All that to say, I really appreciate you all sharing your experiences. There aren't many who understand this life and I really encourages me that I'm not alone!!
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