medicine

My son is 4 and I have been told by his doctor & teachers that he may have a mild form of pdd along
with adhd.  he is very impulsive.  we tried ritalyn and it made his symptoms worse.  now were doing
1/2 mg guanfacine and he acts like a zombie.  have you ever herd of this med being used before?
I understand its an high blood pressure med.  The doctor wants to continue to see if the side effects
will go away.  what do you think?  he is in early childhood dev. w/ot and speech.

[Jason C Bourret, Ph.D., BCBA-D]

Hi RaeJean,

I can tell you some general information, but please also see the Child Behavioral Health Forum for information particular to medication.  

Guanfacine (brand name Tenex) has been used as treatment for hyperactivity, impulsivity, anxiety, irritability, temper tantrums, and tics.  It is sometimes used together with a stimulant medication for ADHD.  Improvement is not typically seen for 2 weeks following the initiation of the medication and the full effects may not be apparent for two to four months.  Daytime sleepiness and fatigue are common side effects, so your describing him as being like a “zombie” is not surprising.  Any observed side effects should be reported to your doctor should be taking these into account in determining if this is the right medication or the right dose for your son.  As always, you should be comfortable with the doctor that is prescribing the medication and the doctor should explain to you the long-term plan regarding evaluation of the benefits and limitations of the medication.  If you aren’t on board with decisions being made or feel that they aren’t being explained to you sufficiently make sure you tell your doctor and/or seek a second opinion.

Below, I’ve included the text answering a different posted question regarding treatment of hyperactivity.

The hyperactivity that you are noticing, while not part of the criteria for diagnosis, at least in my experience is not uncommon in individuals diagnosed with PDD-NOS.  Research has shown behavioral interventions alone (Coles et al., 2005; DuPaul, Guevremont, & Russell, 1992; Fabiano & Pelham, 2003) and behavioral interventions in conjunction with medication (Jensen et al., 2001; Miranda, Jarque, & Tarraga, 2006; Pelham et al., 2005) to be effective in treatment of hyperactivity.  Behavioral interventions have frequently involved identifying potent sources of reinforcement and arranging them contingent upon things like compliance with directives, sitting in seat during work times, and the absence of problem behavior.  These types of intervention often work best if the schedule of reinforcement is initially quite dense and then faded over time.  For example, one way of determining a reinforcer for your child might be to give him free access to his toys, videos, music, and some snacks and paying attention to what he spends his time interacting with.  If he happens to particularly enjoy a particular video, a work space might be arranged with a video player.  Initially, he might earn one minute of video for each 30 seconds that he spends in his chair being compliant.  The amount of time that is required of him would then be slowly increased as he becomes successful given his current criteria.  These procedures are sometimes used in conjunction with a token system, for example, he might earn one token for every 10 seconds of in-seat compliance and following the delivery of 3 tokens the video becomes available.  This also allows for fairly easy fading (e.g., first he needs 3 tokens, then 4, then 5, etc…).  This type of intervention is commonly initially put into place for only a short time each day and then the amount of time gradually increased.  I would recommend that you attempt to find a behavior analyst in your area that has worked with individuals with characteristics similar to your son’s previously (a directory of certified behavior analysts can be found at www.bcba.com).  Behavioral interventions for hyperactivity can be successful, but they should be overseen by someone who has experience in implementing them.  

Coles, E. K., Pelham, W. E., Gnagy, E. M., Burrows-MacLean, L., Fabiano, G. A., Chacko, A., Wymbs, B. T., Tresco, K. E., Walker, K. S., & Robb, J. A. (2005). A controlled evaluation of behavioral treatment with children with ADHD attending a summer treatment program. Journal of Emontional and Behavior Disorders, 13, 99-112.

DuPaul, G. J., Guevremont, D. C., & Russell, B. A. (1992). Behavioral treatment of attention-deficit hyperactivity disorder in the classroom: The use of the attention training system.  Behavior Modification, 16, 204-225.

Fabiano, G. A. & Pelham, W. E. (2003). Improving the effectiveness of behavioral classroom interventions for attention-deficit/hyperactivity disorder: A case study. Journal of Emotional and Behavioral Disorders, 11, 122-128.

Jensen, P. S., Hinshaw, S. P., Swanson, J. M., Greenhill, L. L., Conners, C. K., Arnold, L. E., Abikoff, H.B., Elliott, G., Hechtman, L., Hoza, B., March, J. S., Newcorn, J. H., Severe, J. B., Vitiello, B., Wells, K., & Wigal, T. (2001). Journal of Developmental and Behavioral Pediatrics, 22, 60-73.

Miranda, A., Jarque, S., & Tarraga, R. (2006). Interventions in school settings for students with ADHD. Exceptionality, 14, 35-52.

Pelham, W. E., Burrows-MacLean, L., Gnagy, E. M., Fabiano, G. A., Coles, E. K., Tresco, K. E., Chacko, A., Wymbs, B. T., Wienke, A. L., Walker, K. S., & Hoffman, M. T. (2005). Experimental and Clinical Psychopharmacology, 13, 111-126.