What should I do about my childs ADD meds

Christine - posted on 05/17/2011

Laura,
My daughter has ADD- Inattentive type. She was diagnosed at age 6. I am also a Family Nurse Practitioner. There is no real way to match which drug will work for which kid. My daughter hasa tried Ritalin- both short and long acting, Concerta, Adderall, and the patch which worked well but the adhesive was rough on her skin. If the Concerta is controlling the child's ADD symptoms, lasting all day, not causing too much weight loss and not interferring with sleep then it is a match. Luckily with Concerta it doesn't need to build up in the system so if a dose is missed it's ok. His mom is either A.) in denial about the diagnosis B.) scared of the diagnosis or C.) she has sought advice about the drugs from too many non professional people. Kids with ADD will most likely have it into adulthood. If it is not treated then these kids grow up to having problems with the law, the girls tend to get pregnant as teenagers- both due to the impulse control issues that kids with ADD have. Also, kids with ADD tend to blurt out whatever is on their mind so their friends start to look at them as weird so they tend to not make friends easily or keep them which causes self-esteem issues and comorbid conditions such as depression and anxiety. They tend to not be able to hold down a job, do not do well in school as they progress in grades. They are very bright kids. My husband used to equate ADD with being stupid until I and a psychologist explained to him otherwise. Medication works only on kids that have ADD. I tell my parents of my patients that if they didn't have ADD then the medications would not work. His mom really needs to get some professional information regarding the diagnosis, treatment and consequences of not treating the ADD. I recommend 'All about Attention Deficit Disorder' by Thomas Phelan. He also has an awesome book called 1-2-3 MAGIC. The ADD book breaks it down into simple ad easy to understand and he lays out all the pros and cons of treating and not treating and he is a very respected Psychologist. Hope this helps. I live a life with a child with ADD and I treat them so I understand. Hope this helps.

Crystal - posted on 05/17/2011

I would say if he is good on it leave him be for the time being. As for his mom not giving it to him. That I would talk to the doc and the court. My ex tried that and the judge told him if he did not give the child his meds he would no longer get them.

Jane - posted on 05/12/2011

First of all, in my experience with my son and his meds, if it ain't broke, don't fix it. If the Concerta is working well, leave it alone. As your son grows his needs will change and so his dose or even his medication will change over time. It would be very helpful if you could work with your son so that he can tell you when he feels as if the meds aren't working well. Otherwise, you make changes by observing his behavior.

As to meds that are available, the most popular and typically most effective are some type of "upper." Concerta is one of the long-lasting forms of Ritalin (Methylphenidate HCL), as is Metadate CD and Ritalin LR. These are designed to last throughout the school day. The Daytrana patch is another long-lasting form of Ritalin.

Then there is a different amphetamine, Adderall (actually a mix of several amphetamines) which works better for some folks, but not my son. There is also Vyvanse, which is just an updated form of Dexedrine, yet another amphetamine but with a fancy name to bump up the price. These are all schedule II drugs, meaning that they are controlled tightly so you have to sign for it and you have to be careful with the pills as you can't get them replaced easily.

There are other ADHD meds that are not stimulants, including Intuniv (aka Guanfacine and Tenex) which is also used to control anger, Strattera, which keeps more norepinephrine in the brain cells, Wellbutrin, an antidepressant, Risperdal, a tranquilizing antipsychotic, and several others, some of which have scary side effects.

According to clinicians, roughly 1/3 of people with ADHD will respond best to an amphetamine type medication like Adderall or Vyvanse, roughly 1/3 will respond best to a Ritalin type medication like Ritalin and Focalin, and roughly 1/3 will respond equally well to both. All have side-effects of various sorts, some more severe than others, but by and large most folks use either a Ritalin-based medication or Adderall.

It won't hurt him to skip the pills on the weekends and days with no school. As long as his mom can keep up with him, that is. However, if he does badly in school without the Concerta and she decides not to give it to him, then that IS a problem. As long as he has it for school, it will be okay. However, you might ask his choice in the matter. If the Concerta makes him feel better, then she should be encouraged to give it to him even when he isn't in school. If it doesn't seem to matter to him (perhaps he doesn't need to sit and focus as much when he isn't in school) then I would leave it alone.

My brother's son is on Adderall but his mother (divorced from his dad) refuses ever to give him his meds, school day or not. That has indeed caused problems because his school performance is all over the place. During "her" weeks he flunks and during his "dad's" weeks he is a star student. However, my nephew has all by himself discovered that exercise helps, so during "her" weeks he plays lots of wall ball and ultimate frisbee and that helps. In this case, the only way to change things is with a court order, which she would do her best not to follow anyway.

Good luck with your son.

What does your son say about his meds? Does he agree that they are helpful?