Currently taking low dose immediate release guanfacine and resperidone, both twice a day.
There is definitely a sensory component but since the beginning his psych felt the core underlying cause of aggression was anxiety. Because of the hyper/sensory/impulsivity need we’ve also tried some stimulants and guanfacine.
We’re still in a place where he’s tearing apart a classroom or aggressive towards adults. He’s in a therapeutic school with lots of supports.
Both my husband and I see the anxiety and panic that he feels (even if it wouldn’t be that intense to someone else) behind a lot of the major incidents. When we tried both fluoxetine and Sertraline it seemed to make things worse with reckless behavior or suicidal comments.
Has anyone had experience with other SSRIs or SNRIs working when fluoxetine and Sertraline did not? It’s so much trial and error and we just want to help him!
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Risperdone is a strong drug but the only thing that kept my grandson from destroying things or hitting people. We graduallly added Straterra, Guanfacine and recently sertraline for depression.
He still had some anxiety but is able to function in life
My son struggled with aggression for years, starting when he was 4 (he is now 8). Definitely a sensory component but he is also very anxious at times. He has been on a combination of guanfacine ER and atomoxetine for about two years now with success and we have seen significant improvement and he has been able to move from co-teaching to a regular classroom. We considered other medications but decided to hold off and, for now, are glad we did.
For anxiety, fluoxetine was HORRIBLE for me. I was on Trinnellix (2 part sSri, 1 part snri) and it worked well, though getting off of it after 10 years was hard. I did well with Citalopram and now on the sister medication, Ecitalopram right now. I feel your issue deeply.
Have you found out the causes of the anxiety? Does it seem to happen at the same time of day or with a particular activity/ subject? Usually when working in ABA, I was always tracking and looking at ABC data (antecedent, behavior, consequence). You may want to have the school start tracking it, or perhaps start ABA therapy.
I can relate. My daughter is 7 with ASD, ADHD, Anxiety and a sleep disorder: Periodic Leg Movement Disorder. She is on 20 mg fluoxetine, 25 mg strattera in the am, followed by 3 mg Guanfacine right after school around 4 pm and 300 gabApentin an hour before bed plus melatonin. The morning combination has made a huge difference, especially at school. The classroom hasn’t had to be cleared out due to behaviors since she started straterra. Nighttime transitions are difficult in general but the duration of meltdowns at night has also decreased for her. Trial and error but getting better for us over time.
This is great! What were some triggers for her in the classroom before straterra? How long did it take to see positive results? I know this one can take time. Any negative side affects?
Meds are sooo tricky and individual to each person's chemical makeup/body. I'm sorry your son is going through this. Our 15yo. son is ASD and ADHD. We tried risperidone and it was awful for our son. I either had a raging lunatic or a walking zombie, it seemed. We switched to aripiprazole (just 2mg) and it was great. The unfortunate side effect is that he gained 20 lbs. in one month, so he's on metformin to control weight gain. He's been on aripiprazole and metformin now for around a year and doing well. Just needs labs drawn every 6 mo. He is also on sertraline for anxiety and we just increased it a week ago to 75mg. He takes it at bedtime, as that's when his anxiety is the worst. We only recently got the ADHD diagnosis this past month (actually ASD diagnosis was only a year ago), so he started methylphenidate for the ADHD and we've seen a huge improvement in his behavior, also. Not sure anything I've said is helpful, but big ((hugs)).
Thank you so much for this! We tried Abilify with some super weird fixations on buying things. We need to lower the resperidone for sure, the weight gain is terrible! I’d like to try a stimulant again. We have tried a few with bad rebound effects. I heard about Azstarys recently that’s newer. It’s supposed to last longer. Did you have to try a few before finding one that worked for your son? Thank you again!!
My son is super sensitive to med adjustments, so I was terrified of putting him on yet another med, but incredibly, the methylphenidate was really effective from the beginning. We have an adult daughter who struggles with mental health issues and has been through the wringer with meds since she was a teenager...also super sensitive. I feel like she's tried every med under the sun. She even did the genetic testing that's supposed to tell you what meds work best with your body chemistry, but, for whatever reason, and the meds that were supposed to work well for her did not. She's in a good place, now, though, thankfully, and has been for a while. Meds are just a love/hate relationship, aren't they?!
It's quite the journey finding medications that will work with minimal side effects. My 7 yo son had been on a wide range of meds and we are about to revisit ADHD meds (starting with the stimulants again). He added Prozac 2 months ago and the impact has been huge! He'd been on ariprizole and clonidine at night for over a year, with some improvement, but we are now weaning him off of his ariprizole. So far, so good. He is much happier and more consistent in mood with the Prozac. He's completely himself and still all over the place at school, but he's relaxed and totally himself. I did not realize the impact the anxiety had on all of his life.
The aripriozle was supposed to stabilize his moods, but I don't feel like it did that much. The down sides to it are significant so I'm relieved we are weaning him off of it.
I'm waiting for the Dr to call me back and get started with the ADHD meds. The rebound was so awful on them when we tried it last year that it just wasn't worth it. I'm hoping that now that the anxiety is under control we can minimize the rebound effect and hopefully help him focus better.
Just know you are not alone and are doing everything you can for your child. It's a hard journey, but every success has a ripple effect in their lives for years to come. KUTGW!!
oh wow!! This exactly where we are except we haven’t found an anxiety med that helps without horrible side effects. We feel the same about resperidone, he’s gained so much weight!! We just asked our doctor about revisiting stimulants too and we had the same experience previously at age 5. Focalin XR only lasted 2-4 hours depending on the dose before crazy rebound. It did help and he seemed ok before rebound though. We tried a patch because he also wasn’t good about taking a pill at the time but they were horrible. Bad skin reactions and sometimes would fall off and in the end if they did stay on it was too much meds. He got super introverted and agitated. I heard from someone else recently that Azstarys has been helpful for their 8 year old daughter without rebound. It’s a newer stimulant (approved in 2021) that is meant to last long and break down smoother. I asked our doctor about it though and he didn’t feel like it was much different than other stimulants. The other woman I talked to though said they had tons of rebound issues with other stimulants but not that one. I know it’s so trial and error, the error is just so hard on them though!! Thank you so much for your words of encouragement!! We got this!!
Thank you - I hadn't heard about that one. The new ones are terribly expensive usually ($500-600 a month with our crummy insurance) so as much as I'd like to try it, I doubt we will. I think we'll start with the Ritalin LA (if the dr agrees). I'm working with a new pediatrician as ours is out on maternity leave, so I don't know how much he will work with me. I don't know much, but have researched and researched and will listen to his suggestions - but I'm not overly hopeful.
They has prescribed guanfacine in the afternoon to try and mitigate the rebound for us last year, but it didn't really help. His reaction to the med wearing off was so severe my husband wanted to call someone to institutionalize him! That was definitely not worth a little better attention at school. The Dr said that rebound effect lessens as they get older - and I am hoping that is the case. I will keep you updated.
I wonder if you'd consider supplements in addition to meds... We took a non-medication approach prior to my son turning 11 and had a lot of success. He was dysregulated, irritable and explosive by the time he was diagnosed with combined type ADHD at age 9. Supplements alone shifted his baseline to happy, flexible and much more cooperative.
The supplement that made the biggest, most immediate difference in eliminating his explosions was nutritional lithium orotate (2mg). The second biggest benefit for him was a high potency B vitamin and iron supplement (EnLyte). We started it because my son’s genetic testing indicated a mutation in the MTHFR gene , which makes it harder for him to use folate to make neurotransmitters. It’s a prescription and is a bit pricey but it completely shifted his baseline from irritable to happy. He also takes Omega-3s. I’d be happy to share more details/info if you’re interested.
He's now 11 yo and starting puberty. His anxiety was getting the better of him so we started him on 3mg of Guanfacine ER and it's worked great.
It was actually the Genomind PGx test and yes, we asked our pediatrician to order it! It was the first time their office had placed an order so it took a little time but we did go through them.
We did genesight and I felt like it really didn’t help much. What kind of feedback did you get from genomind? Genesight everything was just categorized as green, yellow or red but things in the green have definitely NOT worked for him.
I’m sorry to hear the Genesight testing wasn’t useful. If you search the web for “Genomind PGx sample report”, you can see what the results look like.
Something important to consider about medications is that if the body doesn’t have the nutrients it needs to make neurotransmitters, medications won’t work and may have the opposite effect (like meds that should make your child more regulated end up making them angry).
If you’d like to know more, I recommend reading the book Finally Focused by Dr. James Greenblatt. He explains how nutritional and gut imbalances drive or exacerbate many ADHD symptoms. There’s a common saying in the biology world: “Genetics load the gun but the environment (your lifestyle) pulls the trigger”. I hate the gun analog but it gets the point across. Dr. Greenblatt also has a website with articles - just search for his book on the web.
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Meds for ADHD Predominantly Inattentive type (and Anxiety)
Can’t get bedtime routine under 2 hours
im torn on what medicine to try
Experience with Risperidone?
Anxiety-What I learned and what is it?
