My 4 year old was diagnosed with ADHD and Anxiety about 3 weeks ago. He is aggressive with me, his teachers, and peers, and is extremely hyperactive. He was dismissed from 1 preschool prior to diagnosis, and at his new school we were asked to pick him up by noon daily going forward until we can get him on the right track. Most, if not all, struggles occur in the afternoon!
Immediately upon diagnosis our Pediatric Psychiatrist prescribed Ritalin and it was awful. Behavior was 10x worse. After a couple of days we decided to put him on Guanfacine IR 2x a day and it was amazing…. For a week haha. He had some drowsiness, but had zero aggression, was attentive and caring, just a complete 180 from where we were- I felt like I finally recognized my little buddy again!!
The following week we noticed slightly less effectiveness- no aggression still (a win!!) but more hyperactive, and slight combativeness.
This week (13 days later) the evenings/afternoons are a struggle again. No real aggression, but we are throwing toy’s inappropriately, and getting major combative responses and angry outbursts again. I am very fearful that we will end up back where we were. Which was a state of MISERY in our home. I felt like I had tried everything, and was at the end of my rope. This medication made us so hopeful, but I am terrified now that we are headed back to that place again.
I hate my son is son little and we’re already in medication. But we needed immediate intervention. He is in Occupational Therapy as well.
School is closed for 2 weeks for Christmas- so there is a possibility he is just getting stir crazy maybe. But just curious if this has happened to anyone, and if so what worked for your child?
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Our son also started guanfacine at 4 (and we found it helpful), he’s now 8 and takes guanfacine ER and atomoxetine. Similar to you as well, stimulants didn’t work for him.
Not sure I have much helpful to say other than our situations have some similarities, and that my son is also extremely sensitive to any changes in his schedule, so it seems hard to draw conclusions just from worse behavior during a break.
I’m hoping it’s just because school has been out. I was so hopeful when we started Guanfacine, because the change was immediate! I really felt like I had my child back 😓 And now I’m just so worried.
Had your little one tried Ritalin or Adderall? Our Pyschiatrist wants us to try Adderall next because she said she’s seen this pattern before with Guanfacine. I am hesitant.
it seems the non stimulant route is working some for him. Have you tried stratera yet? I didn’t do well on stimulants but I didn’t want my blood pressure lowered more, since I’m on other meds that lower it. Guanfacein can lower blood pressure, which could be why he is not aggressive, but it is definitely why he’s sleepy. That’s how my family acted too, then my stepkid feinted on it.
If you’re concerned of side effects, I highly recommend taking a gene sight test. It’s a swab in the mouth and will mesh his specific genetics with each of the mental health medications. It will tell you which ones will have adverse effects and how srrong they will be, though you won’t know which effects they will be or if the med will work.
I’ve learned that if there’s a med that works then stops, try a sister medication. Again, it definitely seems like you’re on the right track with non stimulants. And yes, a bit of it is being stir crazy. Kids with adhd need more structure than others.
If you need some more knowledge and first hand experiences in adhd, I recommend d these you tube channels and corresponding books (the audiobooks are read by the authors too): the holderness family (book is adhd is awesome), how to adhd (book by same name), and afhf_love (books are dirty laundry and small talk). These will help you learn how to support him better, though you are already doing a great job. I know it’s tough momma, but you got this! Zen hugs 🫂
First of all, from what I've heard and read, the medication research has mostly been done with children as young as 6 or 7. Not much research has been done with children 5 and under, so the effects on children at that young of an age are more unknown.• Children's brain development occurs fastest from before-birth until they are 5 years old. I've heard that as the rationale why the medications usually aren't tested before age 6.
When starting a new medication, the effects of a stimulant medication ought to be known after the first few days. So, with a new stimulant or a new dosage of a stimulant, the effects might stabilize within as little as 2 or 3 days (on up to a few weeks, depending on the individual, but the main effects ought to be noticeable within the first week).
The effects of a non-stimulant can take weeks or months to stabilize.
•Some people experience little or no effect within the first week or so. The therapeutic effects might come up gradually.
• Others might experience a big effect early on, before it comes down again, and then might oscillate (high-low-high-low), until it finally normalizes.
With any ADHD medication, you've got to have patience. Keep a daily log of your son's behavior, watching for what's changing and what's staying the same.
I see that others have mentioned Strattera and atomoxetine, which are the same medication. (Strattera is the brand name version.)
I have been in Strattera, and it worked great for me, but I only have Inattentive symptoms and mild impulsivity, not any hyperactivity. Since I've taken this medication, I learned as much as I could about it. As I recall, it is not recommended for small children (I believe most because the effects are young ages aren't well known). Atomoxetine also comes with a somewhat higher risk of unpleasant side effects, compared to other ADHD medications.
• (The only side effect that I experienced was nausea, if I took it on an empty stomach. When I ate first or took it with breakfast, I had no side effects, when I was on the right dosage. When my dosage was too high, I got the nausea every day, just milder when I had eaten first, and I would strangely sneeze a few times then suddenly stopped...it was a strange side effect, but regular when my dosage was too high. The benefit to me of Strattera was tremendous!)
There is a newer medication that is similar to Strattera which is named Qelbree. It is only available in the brand name medication. In studies, by comparison to Strattera, Qelbree was said to have: less chance of side effects, less severe side effects (if any were experienced), faster to start working, and working well for a higher percentage of people with ADHD who were on it.
Also, all the the initial studies of Qelbree were done with children and teens. (I don't know how young of children were in these studies.)
Regardless of the medication, the trial and error process to find what works best can take months or years.
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Has your son also been evaluated for autism?
ADHD combined with autism can add up to more behavioral issues, and I believe even mild autism can exacerbate ADHD. Unfortunately, autism traits do not generally respond well to medication, but ADHD traits can...with the right meds for the individual.
(My grandson is 10, and he has been referred for assessment of both ADHD and autism. It's believed that he has both, based on his behavior at school and home. Put him on a sports field, and he excels. Anywhere else, he can switch between good and difficult behavior all day.)
Oh, and if food allergies or sensitivities run in your family, your son's behavior might also be a reaction to certain foods, ingredients, or additives.
I was once leader to a Cub Scout who had ADHD that was mostly well controlled on a stimulant medication (I never knew which one). But, he also had an extreme reaction to a common food dye (I think it was Red 40), that would make him completely hyperactive. He had to read labels on any packaged food, or (better safe than sorry) only eat homemade or fresh foods.
This might be a topic to bring up with your son's pediatrician or pediatric psychiatrist.
We have cut dyes! That has seemingly had no effect on him, but we still avoid them for obvious reasons.
Our psychiatrist really wants us to give Adderall a go, but I am hesitant. Other than this impulsivity we’re seeing we have had zero reasons to suspect autism- though I don’t completely rule it out. This all started about 6 months ago after we switched preschools, and then has just gotten worse.
Possibly, but plenty of people with ADHD have sensory processing issues, too. It's just that with autism the sensory processing issues are more common and more severe.
I have some difficulty with auditory processing, but not to the point where I have needed to be assessed for auditory processing disorder. I also have some mild tactile and temperature issues sensory. Sometimes I've wondered if I have mild autism, but the online autism tests that I've tried have very clearly pointed to me not being autistic.
From my own parenting experience, I know that a child's personality is usually still developing until about age 5 or 6. As you're trying to figure out your child, he's trying to figure himself out, and he is figuring out how the world works.
There's no way to know how stimulants would affect your son unless you try them with him. However, you should know within the first few days if they are helping, or not. If you're considering it, then maybe ask the psychiatrist if they can prescribe just enough for a few days, as a medication trial.
Have you watched any of the videos that Dr Russell Barkley has made about ADHD? He is very informative, and some of the older videos of him were presentations that he made to parents of children with ADHD. He does a great job of explaining how ADHD affects the brain and how stimulants act to help the prefrontal cortex of an ADHD person work better.
we had this effect with guanfacine. My son is also on Ritalin (started meds around age 5). He took Ritalin first, and we added guanfacine to help with impulsivity, which is his main issue, and also some agitation that he had with the stimulant. He had an initial miraculous response to the guanfacine, and then after a couple of weeks it ‘wore off’. I know how upsetting that can be. We ended up slowly increasing the dose and went through a few more of those episodes of it working for a couple of weeks and then stopping, but ultimately we ended up having a more sustained effect. Those first couple of weeks of a change were always the most profound, I think because it was a bit more sedating until he got used to it. He started Qelbree in addition to the other two about one year later, and this combination is the most effective so far. The trial and error can be really stressful, especially at the beginning, but just keep holding onto the knowledge that he is responding to the medication, so it’s just about finding the right balance. Good luck!!
Thank you for the response!! Our Psychiatrist doesn’t seem to want to combine drugs for some reason. And every time I ask about another non-stimulant she says they don’t work 😵💫🫠
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