Asd and adhd with aggression/dysregulation only in school - quillivant xr and abilify

[Meddyteddy]

Hello,My 6 yr old child was diagnosed with ADHD and ASD. She has shown signs of aggressive behavior(kicking, hitting, spitting) only within the school environment. We have started Quillivant XR when she began school this year, but she started to exhibit dysregulation/unsafe body and aggression as above. She's also started echolalia which we believe is a sign of her exhibiting stress/anxiety. She is a very verbal, bright, social friendly kid. She did great for approximately 4 weeks in school , however started showing signs dysregulation starting last week. The psychiatrist recommended adding in Abilify to already low dose Quillivant XR. I believe she's showing signs of anxiety tied to previous school trauma, but the psychiatrist recommended Abilify over Prozac because it has a quicker onset of action.

I'm looking for other parents who has experience with this combo or Abilify alone.

[adoptivemom]

Hi! Welcome to the forum!! You're among friends! I've learned so much from the people here.

My son is 7 (almost 8). He has anxiety/depression and ADHD as well as PTSD . He struggles with emotional regulation. He has been on Abilify (the generic one) for the last year or so. It has some major side effects so it wasn't our first choice. We tried several other meds with little to no help. It has helped stabilize his moods. We add that and a low dose of Clonidine at bed time - it helps him sleep too which is a bonus.

We added Prozac a few months ago and I think the impact of that has been bigger than the Abilify. We've tried several different ADHD meds (mostly stimulants) but they have been awful. For now we're just sticking with the nighttime Abilify and clonidine and morning prozac. He's still distracted and hyper/impulsive at school, but is more cooperative and generally happier now.

We have a prescription for strattera but have not started it yet. I wanted to give this some time before trying again. The stimulants we tried did not go well so some peace and stability were welcome after those attempts.

I hope you're able to find what works for your daughter.

[Isabellarose in reply to adoptivemom]

Hi,

Can I please ask your experience with what the side effects of the stimulants were? My 5 (almost 6 year old) has just started Ritalin short acting he only takes 10mg once a day at the moment and im struggling to see much (if any difference) especially with his impulsivity, and then the come down is awful he displays worse behavior then he ever did not on meds

I’m looking for other parents experiences with stimulants and the side effects.

[adoptivemom in reply to Isabellarose]

Yes, it was the rebound that killed us. When the med wore off he'd have horrible melt downs. Crying for an hour, kicking, scratching, screaming, hitting his head into the wall. It just wasn't worth it. We tried last year and again this year - hoping he'd have outgrown some of it. There wasn't enough benefit to justify the terrible rebound for him.

[Isabellarose in reply to adoptivemom]

Thank you so much for responding. I think we are heading towards the no go with stimulants because while the teachers see the benefits from the calmness during the day, I need some sanity at home and the come downs are making life extremely difficult, effecting my other children and my relationship.

So I’m glad to know it’s not me being selfish that others have felt the same.

[Alt49 in reply to Isabellarose]

This happened to us and we ended up giving a booster dose around 3:30pm (half of his regular dose) which fixed the problem. The stimulants work well for my now 7 year old

[Isabellarose in reply to Alt49]

Thanks for your response. I hadn’t thought about that, I will definitely discus this option with his psychiatrist.

[Aspen797]

Hi MeddyTeddy! Our son has similar diagnoses to your daughter and is also bright and verbal. When he was younger, behavior was a challenge, mostly due to differences in perspective taking and emotional regulation that led to anxiety. If you haven’t already explored it with your MD, I would highly recommend looking into guanfacine. It works on the prefrontal cortex to help with emotional regulation/anxiety, as well as working memory/executive functioning. It is a good adjunct to stimulants. We have found it extremely helpful! However, we had to start with an extremely small dose (1/4 tab) and very, very gradually increase to avoid side effects. That said, for the issues ASD brings out in our child, this has been a game changer.

Another huge benefit for us came with adding a simple over the counter b-complex vitamin that included L-5-methylfolate. Kids on the spectrum can be more likely to have various processing differences/receptor abnormalities that affect their ability to utilize nutrients and in our case, correcting for this made a significant difference. More on this here in case curious: tacanow.org/family-resource...

We haven’t had experience with antipsychotics, so I can’t speak to the Abilify. Hopefully someone else has experience they can share regarding that drug.

Is your child receiving OT and SLP at school? Have they had a FBA to look for triggers and plan for teaching replacement behaviors that meet needs of original behavior? Schools are so underfunded and it can be so frustrating. Another good resource is Jessica Minahan’s The Behavior Code as well as books by Brenda Myles on ASD in the school setting. Sending best and warmest wishes!

[Mamamichl]

Prozac made me have suicidal ideations. Your kid is definitely having anxiety, imho. Generally speaking, stimulants can raise anxiety. I noticed stimulant medications made my anxiety worse, and I’m doing better on a non-stimulant (stratera).

If you’re concerned about side effects, I recommend getting a gene sight test. It mixes the child’s genetics with each of the mental health medications and will tell you which medications will give an adverse reaction and how extreme the reaction is supposed to be. It won’t say what medication she should take or what the side effect will be though. My daughter got tics when she tried a stimulant medication as well.