Experiences with Dexmethylphenidate ER?

[AcadiaChip]

Hi, my son is 5 and diagnosed combined subtype ADHD. We started 5mg of dexmethylphenidate ER this weekend. His doctor advised the low dose probably won’t affect him much. Saturday he was fine, I did notice he was a bit calmer and able to focus better. On Sunday, he was really, really hyperactive, and bouncing off the walls. I haven’t seen him bounce off the walls like that in a while.

Has anyone else had this experience with this drug? Should I keep going until we increase the dose to 10mg? Will the increase in his energy level out, or is this a sign it’s the wrong med for him?

[Mamamichl]

what kind of symptoms does he have attributed to his ADHD? If he is more hyper and anxious (my type), a non stimulant may be a good idea. Stimulants are better for the inattentive type (like my partner).

[AcadiaChip in reply to Mamamichl]

He’s combined subtype. He’s extremely inattentive, moderately hyper. He never stops moving and he cannot pay attention at all without redirections. I did ask about trying a non stimulant first, his pediatrician said they work for a small percentage of people (compared to stimulants), but we could try. I opted for trying stimulants first.

[Mamamichl in reply to AcadiaChip]

Quick search says 20-30% could do ok on non stimulants. Start with the gene sight test. Increasing the stimulant med could make him even more hyper if it’s a side effect, but it could be a bounce back when the medication is wearing off. When does he get more hyper in relation to taking the med and is it immediate release (IR), or extended release (ER)? For example:he gets hyper 5 hours after taking the IR.

[Klmamma]

I'd give it a couple days before quitting. Was he hyper all day or was he hyper when the meds wear off?

At that age, it was pretty rough when the meds wore off bc it was such a stark contrast. My sons been on focalin for 3 years and it's the best med we've tried with the least amount of side effects. He does take guanfacine along with it and always has. I'd try both together before I gave up on stimulants.

My son is 10, almost 11 and his only side effects are some suppressed appetite during the day but he's still at the proper height and weight for his age.

Also, meds alone don't work. You need OT and eventually CBT as well. I think talk therapy and play therapy are a waste of money. These kids need concrete goals to work on and that's what OT and CBT provide. It helps with self awareness. My son has more self awareness than his 43 year old father who received no treatment as a child. I have zero concerns about my son being a fully functioning, happily married, job holding adult and father. When he was 5......that seemed impossible lol

[AcadiaChip in reply to Klmamma]

Thank you so much. He was hyper that entire day, he had a crash in the middle of the day and then the energy returned. He was fine yesterday and today is the first day at school on the med, so I’m curious to see what the feedback from the teacher is. I think he was just adjusting so I’m glad I didn’t just quit it because it made me anxious watching him go nuts haha.

I just upgraded my insurance because I wanted to get him into therapy next year. In terms of OT and CBT, did you look for therapist that specialize with ADHD? What should I seek out when looking for a therapist? I’ve only ever done therapy for myself as a teenager/adult, so this is all new to me in a sense.

Right now, I cannot imagine this kid growing up and being independent. He can’t even get dressed without stopping to do 10 other things while he’s naked because he’s forgotten what he’s doing and gets distracted. Lol.

[Klmamma in reply to AcadiaChip]

It gets better and as you find a med that works, it all helps for when his haven't kicked in yet. We still struggle with impulse control in the mornings over inappropriate potty jokes and vocal stimming, but he does his chores without missing a beat most days.

I'd look for an OT with ADHD experience to work on self regulation and emotional regulation. They help immensely with the sensory seeking behaviors. They may also suss out some learning needs. OT usually lasts about 18 months and then CBT starts around 6 or 7 and takes 18 months to two years. They'll specifically work on situational awareness, organization, expected behavior, social skills, etc. My son could spot another ADHD or a kid with any kind of developmental difference from a mile away by age 8. It helped bc I'm sure you've seen what happens when two ADHD kids get together at times. If he recognized the other kid had it too, he knew to monitor his behavior more closely and keep his distance from the kid so he wouldn't get in trouble.

[AcadiaChip in reply to Klmamma]

My son loves to vocal stim, too. It doesn’t bother me (anymore, I block it out) but it’s very disruptive in public and at school.

Thank you so much for the information! I’m going to start researching OT in my area to try and find a good fit for him. It sounds like it’s the logical next step, he tends to get very frustrated over things like taking his pants off and zipping his coat and thinks he can’t do it. His frustration tolerance is so very low. He is constantly asking me for help, and I try to show him over and over how to do things but it feels like we make no progress. I feel like I’ve been in survival mode while I tried to get him a diagnosis. I finally feel like I can help my child.

Oh yes, I always know someone else’s child has ADHD because it becomes a power struggle between my son and the other kid. You can just watch them both ramping up, and neither can control themselves. My son has also has a habit of copying negative behaviors from other kids. Monkey see, monkey do.