Do you think my son needs to be on Seraquel 75mg, and Concerta?

[Desperatemother]

I have an 8 year step-son who I have raised since he was four. His mother lives in Oklahoma, and contact him all the time. His father is not able to spend alot of time with him because of his work. He has (in my observation the last 4 years) is defiant disorder. He disrespects me, and he acts out in school. I have had him tested for disabilities, counseling at three diffrent places and all say he has ADHD. I can accept that. He acts out in school when he does not get his way. If he does not want to do something he does not do it. His father has NEVER seen this behavior. He is like an angel around him. He is fine with others until he can not get his way. Recently, his father and grandmother had him admitted to a mental facility because he got in trouble in school. I was not their to speak with the counslers to advise them anything about his behavior. The grandmother was there and she has only been with him 5 times in 1 year and he is fine with her. Anyways, the next morning the physician evaluated him and out him on Concerta in am, then Seraqual 25mg at 4pm and Seraqual 50mg at 9pm.  I am having a hard time with this because I do not feel that they gave him a full evaluation. I understand the diagnosis, but does he need to be on Seraqual? No one at this facility could answer any of my questions, they did stated that the Seraqual was to control his anger problems. I do not understand, if he can control his anger at home, friends house, and with his father, Does he really needs meds? I think his problem needs to be firm discipline, because when he acts out in school, we never follow through with his punishment. Please help me. I want what is best for my son. He is not scheduled to f/u with the therapist until 12-14-06. In the meantime, his father and grandmother feed him these pills. I want to leave the relationship but I want to make sure he is taken care of first.

[Roger Gould, M.D.]

You have a very good point about how he compartmentalizes his anger. I can't advise against the Sequal,because it does work,but if you can help him do better without it, that would be best. Your ideas about discipline and follow through are correct, but the only person who can do that, if I understand the situation,is the father.  He has to understand your observations.  Seeing him and therapist together would be the best way to do that.

[ABCMomof3]

My youngest son (who is 14 years old) is just starting to take concerta. He took adderal several years ago, but he lost way too much weight and after a few months he was removed from the medication and we dealt with his ADHD without meds. Puberty has really made his ADHD worse and we all feel (my son included) that trying another medication might help him do better in school.



I feel really bad for what you are going through, because I know it's not easy seeing a child struggle in life or to see a child have to take meds that are so *controlling* if you know what I mean. My son has outburst as well, and it saddens me to see how remorseful he feels afterwards(he feels so ashamed of the way he acted and he appologises profusely)



Our pediatrican recommended the concerta (explained in detail what to expect) and he also would like to try my son on a perscription called *ativan* for anxiety; which will also relax him when he is angry or feeling overwhelmed and to help with sleeping if the concerta gives him insomnia.



I like the thought of my son trying the ativan, because the dr. said it is only to be taken *as needed* so it's not like he will have to take it everyday and the dr. said I will be in charged of when he takes it; because as his Mom, I can see when he is going to get worked up over something.



maybe talk to your dr about trying something *as needed*



My thoughts are with you.

[Desperatemother]

Thank you so much for the information. I would feel better giving him "as needed". I just feel really unconfortable giving him this Seraqual. All the information I have found on this is negative. Thanks again, and my thoughts to you and your family.

[headshrinker]

The Ativan is an adictive and tolerance building substance.  'As needed' sounds great but it's a big trade off for the risk of addiction.



I have treated adolescents with Seroquel - it acts as a mood stabilizer.  Depakote is also good for impulse control disorders and mood swings.  The fact that he can control it sometimes makes it sound more like conduct disorder, and oppositional/defiant DO.    Both Seroquel and Depakote can be sedating and this is a sad side effect in an energetic child.



Any medication should be given with GREAT care in an eight year old.  Only a couple psych meds are approved for youths.  A VERY EXPERIENCED child psychiatrist should be consulted.  Someone with abundant clinical experience evaluating treating children.



Good luck with this.  I wish you the best.



-headshrinker MD