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Inattentive ADD child meds -- need help please
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Inattentive ADD child meds -- need help please

My 9 y/o daughter was diagnosed with innattentive ADD this fall. She has become so distractable that she can't stay focused in class, at homework time or for really anything.

The pediatrician started her off with 18mg Strattera. The results were immediate and amazing. For the first time ever she would sit and do her homework (alone) without getting constantly distracted. A math paper that would previously have taken an hour or two to get through suddenly was done in minutes. She also stopped getting into trouble with her teachers, and was SO cooperative at home. No arguments, frustration, or tantrums for weeks!!! It was truly like a magic wand was waved and she was happy and still energetic, but not so all over the place.

Then it started to "wear off" and her old behaviors and inattention resurfaced. We went form 20mg to 40mg to 60mg in about a month, but it did not seem to work anymore. I was under the impression that Strattera results were immediate, but in doing some research tonight I have seem reports of Strattera taking weeks to become fully effective. Could we have jumped the gun taking her off it?

Now the Dr has her on ritalin. She started with 5mg daily and in 3 weeks is up to 20mg daily. It does not seem to have much if any effect. Her next med check is in a week and I dont know what to ask the Dr. to do. Does ritalin take a long time to show its true effects? Should we try a higher dose? Change meds again? Its nerve wracking. This is a new Dr for us so I dont want to leave it all up to her- I want to be as well informed as I am able to be for my daughter.

I was so hesitant to do the meds at all, with so many reports out there about bad effects. But, several parents I have met in recent months have had great things to say about how the meds helped their kids get through school. Before the meds she was failing and with the Strattera, even for a brief while, I can see what she can do and how meds can help.

Any advice on where to go with this from parents or doctors who know?
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Avatar_m_tn
  Oh boy, I can really understand why you say this is nerve wracking!
   First, the disclamer - I'm not a parent or doctor, but I have been on this forum for a long time answering questions.  This question caused me to do a lot more research then normal.  
   Yes, strattera does take longer then the stimulant drugs to have an effect.  Probably the best article on that is this link -    http://www.ncpamd.com/Strattera.htm
Lots of very good information here.  Basically it says it can take three weeks to see the effects of a given dose.  So it is possible that you should have given it more time.  However!
   Looking up recommended dosages here - http://www.drugs.com/dosage/strattera.html
It looks like you certainly had maxed out.  I don't know your daughters weight, but using normal weight charts I would guess that she is between 66 and 88 pounds.  That would indicate a maximum dosage of 36 to 48mgs - and she was at the dosage for a child of 110 pounds.  From what I have read, (and I refer back to the first link I gave), strattera is not as effective as the stimulant medications.  I have a feeling from past post experience, that doctors will go with it if parents are worried about using stimulant medications (among other reasons).
  In regards to the new medicine.  All good doctors always start off with a low dosage and slowly increase.  Obviously your daughter has a form of ADD or she would be climbing the walls on 20mgs a day.  The fact she has not responded yet, would indicate the dose needs to be slowly increased and monitored.
  Ritalin does not need a long time to show its effect - at the correct dose.  No you don't change meds.  Yes, you do try a higher dose. by the way - there is a lot of ways to get up to 20mgs per day.  4x5 a day. an extended release, 2x10. one 20 (would be kind of crazy), etc.  The standard is - at a certain point, yes - you do try something else.  There are different meds and they all do slightly different things.  I can give you a good site if it gets to that point.  Hopefully, it won't.
   Keep in mind that communication with your doctor is really, really important!  Its harder when you have a new doctor and have not achieved a relationship.  And Pediatricians can sometimes be really overworked.  Speaking of which, Pediatricians are not really known for giving psychological advice.  The medication is only one part (and the easiest part) of the treatment.  You said, "I want to be as well informed as I am able to be for my daughter."  I super highly recommend you get the book,  "The ADD/ ADHD Answer book," by Susan Ashley.   There is a ton of stuff you need to know to help your daughter, and this book will help a lot.  
   Hopefully, this helps.  Please post if you have other questions.  Best Wishes!
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Avatar_m_tn
Thanks, Sandman2 for the reponse. I really apprecaite your taking the time to answer. The doctor suggested we start with Strattera as it is supposed to be non-addictive. Looks like we should maybe have stuck it out longer- I just didnt know it took so long to see results. I do have a few questions:

So , as I understand your post, if a child takes ritalin and it is not a proper med it would make them climb the walls? (because its a stimulant? I dont fully understand) Maybe we arent so far off track because Its not doing that-- I just  don't see much effect at all. We saw how great the strattera worked for a while and the ritalin does nothing close to that- her math teacher concurs that she is spacey and less focused on the ritalin thus far. Right now I feel like I am having her take the ritalin for nothing, however we have a week to go before her Drs appt and I guess she needs to continue it til then.

The ritalin dose started with 5mg in the am, then added a 5mg at lunch, then went to 10mg am and 10mg at lunch. I have no idea if this is a lot. She weighs about 96lbs (sh'e pretty tall). What is a normal dose of ritalin for her age and weight (96lbs, 9 y/o) ?

After posting the first question I read more about drugs like adderal, focalin, etc and no one that I saw seemed to have had great long term experience with any of them. I dont want to subject her littel body to a bunch of different drugs- this is really scary. I have seen reports of parents shose children have become violent, angry, zombie-like, constant sleeping, etc and just dont know what to do. Howeverm Its clear she has a real problem and needs help and that a med could be a good answer, but I need to keep her safe first and foremost. Any advice on the other meds the doctor might suggest if she decides ritlain is not right for her?

Thank you!
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Avatar_m_tn
  I know its hard to believe, but a stimulant medication will not make a person with ADD/ADHD hyper.  A person without AD/HD will get wired.  That is because of the - well, it gets complicated, but well documented - and easy to find out how the whole process works.  But, yes, if she did not have ADD, the meds she is getting would be enough to make even your day very interesting (if you took them).
  Dosage wise, 5mgs is the smallest dose.  Your doctor is doing the correct thing by slowing increasing.  Your daughter is in the 90 to 98% level for weight for her age.  Weight is an important factor in dosage (besides severity of the AD/HD).  So I would not be surprised to see the dose increased.
   It is interesting that there is not a great deal of information on the long term usage of these meds.  Ritalin has been used since the 1960's.  Apparently, there was no need (or money) to do long term studies because many people stopped using the meds once they were out of school.  My guess would be that with the hundreds of thousands, if not millions of people who used stimulant medication, if there were problems - there would have been many law suits by now.  I do believe that all the reports you allude to - "violent, angry, zombie-like, constant sleeping" - are due to overmedication or kids who never should have been medicated, or a complete lack of communication between doctor and parent.
    Again I stress that communication between parent and doctor is really important.  If you are not getting that communication, then I would look for a pediatric psychiatrist.
And do get the book by Ashley that I suggested.  This is so much more then just about the meds (although that is also covered).  Let me know if you need any more info.
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Avatar_m_tn
Thanks Sandman, for the help. I will pick up Ashley's book. I recently bought "driven to distraction" and "delivered from distraction" and have begun reading them--good insight from an adult doctor who went through ADD a sa child.

So, at least the ADD diagnosis is most likely correct given her reaction, or lack thereof to the ritalin. I'll just keep hor on the 20mg and work it out with the doctor next week.

Thanks again!
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757137_tn?1347200053
As a mother I would never give my child ADD medication. I refused it for one of my children. She learned how to confront her inattention. She is an adult now and just fine.
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Avatar_m_tn
  I thought your child was wrongly diagnosed with ADD?
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757137_tn?1347200053
Yes, that is true and I think many of those who post on this forum have had children wrongly diagnosed, perhaps for the same reasons. I can think of three conditions that can give rise to  false diagnoses: sleep apnea, excess sugar consumption, and dislike of school. There are undoubtedly others.

But even though my daughter did not have ADD, she was inattentive in class and could not settle down. She had to learn to focus and that was a struggle.
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757137_tn?1347200053
By the way, at the time they wanted to medicate her I did not know enough about ADD to know if the diagnosis was right or wrong. I said no to medication because I did not want to mess with her head, and who knew what the drugs would do. My father was a chemist who worked for the ethical drug houses so I have a healthy dose of medical paranoia.
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Avatar_m_tn
  Thankyou, I thought a while ago I had read in your posts something to that effect.  And I agree with you that there are many times false diagnoses - especially by the parents.  
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757137_tn?1347200053
Maybe many of the parents are looking for a quick fix for a behavior problem that they don't wish to handle. In all fairness, schools often pressure them to take the pill route.
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