ADHD/med management and behavioral issues

[DarcyMad]

Hello.  My 7 year old son has been diagnosed with ADHD and possibly PDD or Aspergers.  We are currently managing him on Concerta, methylphenidate (short acting), risperidone and Prozac.  There's a very fine balance and if they are not in synch we see behavior issues.  Now, at school he's great because he's in a program that's more like a boot camp but he's done SO well since being put in it.  But....at afterschool program we see hitting and kicking etc.  That's why we introduced the methylphenidate and some risperidone in the afternoon.  I continue to have issues but I'm wondering if its not time to put him on a non-stimulant.  He's been kicked out of every daycare he's been in and we're about to lose the one he's in now.  I'm a single mother and cannot afford to quit my job!!!  Are there any daycares out there that specialize in taking care of kids with behavioral issues??  I'm at the end of my rope!  Any help would be greatly appreciated!

[Sandman2]

   Ok, I just wanted to make sure that the last test was not when he was 5.  Being tested while medicated has both its advantageous and disadvantageous.  But overall, I think the advantageous outweigh the disadvantageous since they are looking at the school setting.  It does seem from the psyc's opinion and from your earlier statements that the meds are working during the early part of the day.  Its only as they are wearing off that the problems begin?  
   If so, that will improve as he gets older.  Of course, one can always keep tweaking the meds.  But he can also be trained to stop some of that behavior.  Notice I say  "trained" not punished.  Punishing him won't change him.  What he needs is to learn alternate strategies for how he is dealing with things.  Its not easy - it requires a lot of work on yours and the teachers part (mainly consistency and communication).  But if he can learn better behavior at home, it will carry over.   Ashley has many good suggestions in the book I recommended to you.
    By the way, I am not sure what he is doing that is getting him into so much trouble after school, etc.  But there is a wonderful set of books that you can buy and read to him.  They are aimed at the 4 to 7 year old child and make a great thing to do at bedtime and then talk about.  I would maybe start with "Hands are not for hitting" found here -
      http://www.amazon.com/Hands-Hitting-Ages-Best-Behavior/dp/1575420775
      and you will find many other good suggestions as you scroll down the link.  

[DarcyMad]

He was just tested earlier this year.  I was told that I could ask for more testing but generally its every 3 years.

[Sandman2]

When was the last time he was tested?

[DarcyMad]

Yes, thank God, he does have an IEP.  I foster parented before having a child of my own and knew very well what the school district could do to help him.  He was assigned with an IEP while in pre-K and it has continued.  The one thing I didn't agree with was that the LSSP did his psychological testing while he was medicated so, of course, none of the obvious signs of a mood disorder or autism-spectrum disorders were evident.  Right now he's considered OHI.  I'm happy with this but I feel that they are still missing something by testing him while medicated.

[Sandman2]

Wow, dealing with adha is tough - but to have a child hospitalized with depression is really hard.  gotta be a real helpless feeling.  
   At his age there is a lot of experimentation to get the dose correct and still allow him to sleep at night.  Hopefully, a bit more tweaking of meds will allow more control in the afternoons.  You might try the YMCA again.   Many times if they know the child is being actively helped, they will try again.  Can't hurt to try.   And yes, depression does get caused by adhd - Ashley talks about this.  Is he on a 504 plan or an IEP at school?  There are specific things a school can do to help kids with adhd - besides a very constant routine.

[DarcyMad]

Thanks for your reply.  I do like the stimulants.  They work and work quickly and effectively.  The downside to that is that my son needs to be on them constantly so he requires an ever-increasing dose to maintain its effectiveness.  He was given the Prozac due to depression which, I believe, stems from the ADHD.  The two together, however, seem to keep him moody.  He is moody when he's not on anything at all as well.  The risperidone was started when he was hospitalized with the depression.  It was my hope that they'd figure out what, if anything, else was going on beyond the ADHD and depression and could be treated accordingly.  The psychiatrist there said that he displayed symptoms but not enough in one area to diagnose him beyond the ADHD.  He said it could be PDD NOS, Aspergers or bi-polar disorder and we'd only know as he aged and more symptoms were present.  As far as his school and afterschool programs.  The school itself does not offer afterschool/summer programming.  There is an afterschool/summer camp run by the YMCA but, unfortunately, my son has already been kicked out of that program for behavioral issues.

[Sandman2]

   Does his school do any kind of day care?  Sounds like they have a good system going and are used to him.
Also he was put on the methi because the concerta was wearing off.   The tablets take "30 to 60 minto take effect."    Are his problems coming at this time?  In fact - how do you even know he is taking the med?  I assime the school nurse is giving it to him?  
    Sounds like the stimulants are working at school - why drop them?  Personally, I'd prefer stims over Prozac as that is dealing with the adhd problem.   Your doctor does need to know what is going on - these may be more related to doses and time of doses than anything else .  
   AND PLEASE READ MY POST BELOW - and get the book I suggested.
http://www.medhelp.org/posts/ADD---ADHD/Equasym-xl-Vs-Medikinet/show/1695884#post_7753107
   Do post back if you have any more questions.  Best wishes!