My son is almost 5 and has ADHD. He's currently in preschool and will be in kindergarten next year. He's having a lot of issues with preschool with impulse control and aggression. We have him on Guanfacine and up his dose at the beginning of the year to see if that would help, but his behavior has only gotten worse at school.
He's so young so I wanted to know if other folks have tried different medications for 5 year olds with any success?
We started off with stimulants at age five and they were a disaster. Straterra worked much better. My grandson had lots of anger issues. We had to add risperidone for that. He is now on Guanfacine too.It is so hard to know what is going to work for your child. Psychiatrists always want to make the dose higher.But that isn't always the answer.
Good luck finding the right path for your child.
Guanfacine didn’t work for us either. We also tried Stratera which didn’t work, made him feel sick. Finally tried Concerta (stimulant) and it had made a huge difference! I was so afraid to try the stimulant because he’s so young (5 also) but it’s so much better than the non stimulants for us.
We started off our son on Guanfacine 1mg right after he turned 6 years old. He was struggling with behavior issues in kindergarten - impulse control/hyperactivity/some defiance. It was like a miracle the first week but then was never quite as effective after that first week but definitely helped him get through kindergarten with more ease. We increased the dose to 2mg before first grade started and I didn’t see any changes. The beginning of first grade was a nightmare, a combination of not a good fit with his teacher and I think the guanfacine became much less effective. The school was insinuating he had ODD which he doesn’t have per his healthcare team. Per his psychiatrist, his symptoms were caused by his ADHD not being properly managed - and the doctor ended up being right.
We switched to a stimulant, started at 20mg of Jornay PM. The first week of Jornay was probably the worst week of school he ever had. What I later found out is that almost no one (2% of kids) stay on 20mg, it’s basically a starting dose. We increased to 40mg after one week and there was a huge improvement. We increased to 60mg after another week and there was another big improvement. That’s where we are at now. Things are 80% better with his behavior I would estimate and school is much, much better. Not perfect but you can’t expect that. With Jornay PM, the majority of 6-12 years olds end up on 60mg or 80mg dose but it goes as high as 100mg. We had some loss of lunch appetite but that largely went away after about a month. My son wakes up earlier now (getting about 1 to 1.5 hrs less sleep than before but still getting more than min required for his age) which is not great but the school improvements right now outweigh that side effect.
The dosing sounds high compared to other Methylphenidate meds but you can’t compare dosage brand to brand. Jornay PM slowly releases and metabolizes in the colon which is unique to this med to produce a steady release throughout the day. Our insurance wouldn’t cover the med because there was a prerequisite to use another generic Methylphenidate first that didn’t work before they would pay for this expensive name brand (no generic for Jornay). But we use a manufacturers coupon (on their website) that makes the first month free and $75 per month after that ($25 per month if your insurance covers it).
There is another Methylphenidate stimulant we would consider if we end up switching called Azstarys. Heard really good things about this one as well. Just one dose that slowly releases throughout the day as well. They have a manufacturer coupon set up like Jornay PM as well since there is not a generic version. I think the most out of pocket it could be is $60 per month if your insurance won’t cover it ($15 if it does), so not bad at all.
I would also recommend finding parent behavioral training for ADHD (check any local big hospital system near you for an ADHD department). That helped us so much understand ADHD and give us tools to use in the moment. We have much more patience now that we understand his actual brain differences and what works for him. Also, advocate for a 504 plan once in school so the teacher provides in classroom accommodations (preferred seating, use of fidgets, prompts to get back on task, etc). If you are more knowledgeable about ADHD, that helps you advocate for your kid with the schools because I have found educators don’t know as much as they should about ADHD. Lastly, I recommend finding a good child psychiatrist for the meds, they are much more knowledgeable and better at fine tuning medication for the long term than a pediatrician. It took me over a year of heartache to figure all this out. Good luck!
Guanfacine ER (not immediate release, which worked somewhat but also caused issues) and atomoxetine have worked fairly well for our son, he's been on them for a couple of years and is now 8.
Still has plenty of issues, challenges, and quirks but he went from having a lot of challenges in school (and needed to be in a co-teaching class) to doing well in a mainstream class now. Getting an IEP was also essential for us as it entitled him to coteaching when he needed it, as well as OT and social skills group and other accommodations.
Guanfacein made my kid feint, though they were about 10yo. It’s a blood pressure med to lower blood pressure. It also made my partner get light headed. That is how it’s supposed to help outbursts; it makes it harder to get angry and riled up. The thing is, the kids can get confused about how they feel. This can freak them out more.
I prefer going the non stimulant route with kids that young though because there are fewer side effects. Stratera works well with me and my younger child should try them out since I know she gets anxious like me.
Both Guanfacine and Strattera did not work for our son (the side effects were too much). However we found that nutritional Lithium and Mood Probiotics helped him tremendously. Lithium orotate, 1 mg dose by Pure Encapsulations and Mood Probiotics by Innovix Labs are what we are using now. Aggression, anger and emotional dysregulation used to be his worst symptoms. Now those are under control, but focus and impulse control are still issues. It may be worth bringing up the supplements with your provider. Ours knew nothing about them, but I found out about them from someone in this forum.
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