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6yr old on fluoxetine and tenex

Hello, my son with PDD-NOS, ADHD and OCD has been on 10mg/day fluoxtine for 16 months as a treatment for his OCD. This medicine makes him hyperactive and so the MD prescribed Tenex twice daily (one and a half pill per day). His blood pressure is too low (80 upper) and so we are decreasing the Tenex, but he is starting to get hyper again. Any ideas what to try in order to damp down the hyperactivity? He was NOT hyperactive before the fluoxetine. The fluoxetine is working to control his OCD. Thanks
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340676 tn?1383325484
MEDICAL PROFESSIONAL
I am not surprised to hear that your son, with a diagnosis of PDD-NOS engages in the types of stereotyped or ritualistic behavior that can also be observed in individuals diagnosed with OCD.  In fact, this type of behavior is also part of the DSM IV criteria for autism spectrum disorders.  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.
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