Motor tics while Weaning Concerta ? and what to do for ODD med wise ?

[nipper317]

My son has ADHD, complex tic disorder, and ODD as well as gluten and casein intolerance, hypothyroidism, and we had a peds neurologist doing all his med adjusting.  He is 10 and on Concerta 54 mg (for last almost 3 years) and Zoloft 100 mg and Intuniv 2 mg and recently Risperdal 0.25 mg every am and 0.5 mg q pm.   The neurologist wanted to add another med Abilify on board as he was still having some outburst behavior.  I find this troubling that he wants my child on 5 psychoactive meds.   we sought a second opinion from a psychiatrist that our son's therapist recommended.  This MD was shocked and feels my son is on too many meds and the combo may be contributing to his aggression and anxiety.  He started a weaning of the Concerta and wants it off in 3 weeks, and increased the Intuniv to 3 mg and kept Zoloft and Risperdal the same.  My son has now started to have horrible motor tics again....is this common when weaning off a stimulant ?  Also My son has gained at least 14 lbs in 2.5 months of Risperdal and is now in the obese BMI range  

[Sandman2]

   Good points by specialmom.  And yes, abilify, risperdal and intuniv probably are all used to treat the same thing.  Although intuniv is also listed for hyperactivity as well as tics.
   Hopefully, his school is well aware of his situation (he has a 504 or an IEP?) and are working to allow his handicaps.  He is at an age where the school work is getting much harder and that certainly adds to the stress levels.  I also would assume that he is getting behavioral modification therapy and that you (and the whole family) are also involved.  Working with a child with ADHD is difficult and the normal methods of behavioral modification often don't work (which really adds to the home stress situation).  Meds, as I am sure you are aware are only part of the answer.

[specialmom]

Tics are interesting.  My son has a complex vocal tic (he says 'ya') and has had others that were more motion oriented with his hands.  He has sensory integration disorder and I've always tried to figure out where the tics fit in.  Anxiety is something that we've seen increase the tics.  Even he now gets this.  He just turned 10 and he will be saying 'ya.'  pause 'ya' pause and I will ask if he is okay and he'll say "I'm excited" or "I'm nervous".  We don't make a big deal about it.  It really does come and go with him and he too has had some tics that came and completely went away.  This vocal tic is hanging around but again, it is very intermittent and seems to come when he is anxious or overly excited and he is trying to calm himself down.  By working on strategies for anxiety, it has decreased.  

[gina9431]

My son got more aggressive on Zoloft.  He was then switched to Prozac which helped with his depression/anxiety.  My son has always had tics since we first started stimulants (Concerta) 6 years ago. The tics come and go even when he is off the stimulants (we took a long break after the tics started, but they did not go away like the doctor said).  I wonder if it is just the normal coming and going of tics.  Once thing I have learned about the tics is to be patient as they will pass.  I know that is hard.....I can hardly stand when he starts a new tic, but they have always stopped (or moved on to another tic).  I think he is on way too many meds.  Risperdal made my normally too skinny son overweight too.  I can't say for sure, but I think the Intuniv might have been the one that gave my son more tics???  He is 12 and currently takes 50mg of Vyvanse and 15mg Prozac.  We just increased both of them as he has been having problems and school and has been oppositional at home.  It seems like a few of those meds are treating the same symptoms (abilify, risperdal and intuniv).  My son has tried all of them, but not at the same time.  Hope you get the help you are looking for.  I know how hard and scary it is to medicate your child!

[Sandman2]

   Sounds logical.  Do tell him about the motor tics.

[nipper317]

yes the hypothyroidism is quite under control and he gets labs done every 3 months.  His PCP monitors that.   He takes Armour thyroid and Cytomel for it.

[nipper317]

The aggression and irritability were present before the Risperdal was ever added.  I understand they can be also caused by it.  The plan with the new psychiatrist is to wean off the Concerta.  He wants it weaned as my son has been on it such a long time.  Then monitor him.  If he becomes more impulsive or anxious or hyperactive he said we could increase the Intuniv.  Once he looks stable like that, he said the next focus would be to taper and wean off the Risperdal.  This is a new psychiatrist we are seeing.  Previously it was the pediatric neurologist dosing everything.  The peds neurologist actually wants to add a 5th med !!! He wanted to add Abilify.   I am just so hoping my son feels better.  He doesn't look like the same child at all.  

[Sandman2]

  I think the problem is more the Risperdal then the Concerta.  Side effects listed for Risperdal include -  Aggressive behavior, agitation, anxiety, stiffness or weakness of the arms or legs, tic-like or twitching movements, trembling and shaking of the fingers and hands, trouble sleeping, and twisting body movements.
  The site said to, "Check with your doctor immediately if any of the following side effects occur while taking risperidone:" talking about those mentioned above.   From -  http://www.drugs.com/sfx/risperdal-side-effects.html          
   Also Weight Gain is listed as a common side effect.
   Your new doctor needs to know about this immediately!!!   Don't try doing anything yourself.  Risperdal needs to be very slowly stopped.
    Good luck - keep us posted!!

[Sandman2]

   Hi, I was reading up on the psychactive meds your son is on.  It looks like the Risperdal could be the reason for the motor tics.  Which would make more sense then the Concerta being the problem.  And Risperdal could be the reason for the weight gain too.  Here is a link to the info I was looking at on Risperdal -  http://www.crazymeds.us/pmwiki/pmwiki.php/Meds/Risperdal
  By the way, don't suddenly stop the Risperdal.  You must sloooowly come off of it.    Good luck!

[Sandman2]

   Wow, I feel for your son!  And you, having to deal with all of this.
My first thought is - is his  hypothyroidism being monitored and under control.  At least some of those symptoms seem related.
    My second thought deals with the weaning off of Concerta.  Usually, if someone has ADHD the stim meds can be started and stopped instantly.  But given all he is taking - I guess its a good idea?   The motor tics restarting has he is coming off is really weird and the doc obviously needs to know about this.   It may be that the ADHD meds are helping with his anxiety, and as he is coming off, the anxiety is increasing?  
    And ya, he is on a ton of meds.  Something does need to be done and unfortunately, it will probably take trial and error to find what works the best.
    Keep in really close contact with your new doc.  Report all that is going on.  This is very complicated and beyond anything I have dealt with.
     And do keep in touch.  I would like to know how things are going.  I can recommend some good sites for working with the ADHD if you are interested.  Best wishes.