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ADHD with anxiety

Posted by mom who doesn't know the best course of action on July 21, 1999 at 09:14:38
What is the medication most often prescribed for ADHD and anxiety in a ten year old 75lb. girl?
I've tried ritalin which has just made her depressed.  We then switched to Dexadrine which seemed to work well twice a day but when we switched to a time released capsule, there seemed to be an inconsistent release of the medicine into her system.  We upped the dosage to 35mg. per day and she went through a paranoid pschotic state with possible hallucinations at night.  Should we have lowered the dosage instead of upping it?  Thank you.

Posted by CCF Neuro[P] MD, RPS on July 21, 1999 at 12:08:31
Dear "Mom who doesn't know the best course of action"
What was the dose of Dexedrine that you used, as a twice a day dosage?  Yes, it might have been better to have lower the dose.  I think that I would make sure that the twice a day dose worked, gave no side effects, and then retry the extended release.  Sometimes there is not the same dose:effect relatiionship between the extended release form and the regular form.  When you are sure that things are back to normal, then try the extended release form again, I would suggest that you do this over a weekend day.  This way you will be around to see how well and how long the medication works.  In addition, you will be around if side effects happen as before.
CCF Neuro MD

Posted by mom who doesn't know the best course of action on July 21, 1999 at 12:45:54
My daughter was started on 15mg. twice a day of Dexedrine.  We then switched her to 30mg. spansule once a day.  She is impulsive and does not know how to handle social situations well. In fourth grade, she started showing significant signs of anxiety. When we try to talk to her about the best way to maintain friendships, she says we're being mean to her or misconstrues the main points something awful.  We had her tested for ADHD by Conners.  Are there any other tests we should consider?  Is a stimulant such as Dexedrine the best course of action for ADHD and anxiety or is there something better?

Posted by CCF Neuro[P] MD, RPS on July 21, 1999 at 17:17:05
Dear Mom who doesn't know the best course of action:
Did a behavioral pediatrician or pediatric neurologist evaluate your daughter at the time of diagnosis of ADHD?  Other than her ADHD she is a healthy normal child without any other neurological problems?  We, at the Cleveland Clinic use more than the Conner test to assess ADHD.  This is not to imply that your daughter was misdiagnosed.  The conner test only evaluates the teachers observation of the child and may be biased by his/her perception of you daughter.  I would return to the 30 mg a day of dexedrine and have a long talk with your pediatric neurologist about the behavioral issues of relationships, etc and see if there are other things to be concerned about.  Added types of counseling may help.
CCF Neuro MD

Posted by Mom who doesn't know the best course of action on July 21, 1999 at 21:08:10
Your comments have been very helpful.  My daughter is in counseling with a Social Worker.  She has seen a neurologist because of questions I have had concerning humming she has had since she was two or three and her habit of putting her finger in her mouth.(sort of like a nervous habit)  I myself have some twitching of the muscles at times. Tics are common in my family.  The Neurologist did a routine exam and felt there was nothing to be concerned at this point.  With the dexedrine, my daughter's humming stopped and she did not put her finger in her mouth anymore.  She also stopped hitting her four year old sister and inappropriate laughing stopped.  She did develop some eye blinking on ritalin and started chewing her tongue repetitively at higher doses of dexedrine. At times, prior to the medication, she would jump on other kids shoulders when she got excited or couldn't handle certain situations.  The neurologist recommended trying the dexedrine again at the lowest possible dose unless the tics recurred.
You mention other types of testing but I would appreciate it if you could tell me the name of the tests you would suggest for my daughter.  
Kids have been giving her a hard time since she was in Kindergarten.  Could the anxiety have resulted from that?
Also, I live in the Pittsburgh PA area and if you could refer me to some professionals in the area that would give my daughter a thorough evaluation, I would appreciate it. What type of counseling would you advise?  Her Social Worker suggested that we pick out very specific behaviors and work on improving them with her.  I am not so sure of this type of therapy because I am not so sure that my daughter can control these behaviors although she tries hard. Two behaviors we chose were laughing at inappropriate times and being persistent.  Do any of the Cleveland Clinic Satellite sites provide testing?  Which site would be the closest to my home?  Thank you.

Posted by CCF Neuro[P] MD RPS on July 22, 1999 at 08:21:27
Dear "Mom who doesn't know the best course of action"
I would think that Children's Hospital in Pittsburg would have the resources to contact about specific testing.  I would contact them about your concerns about behavioral issues.  Are there any learning problems?  How long has she had these vocal habits and movement habits?  When she gets excited, did she ever flap her hands or turn circles?  Does she get fascinated by turning wheels or things that have a constant motion like fans?  Does she have behaviors that would be considered obsessive or ritualistic?  ADHD is usually the diagnosis where we see the following components, inattention, impulsivity, increased motor activity, and lack of concentration.  It is not usually associated with abnormal behaviors unless it is part of another entity.  Of course there are exceptions to this.  Without examining it is difficult to diagnose over the internet.  I would set up an appointment with a good pediatric neurologist (try Children's in Pittsburg) and investigate what your daughter is expressing.  
CCF Neuro MD

Posted by Robyn on July 28, 1999 at 14:39:22
My 6 year old son displayed anxiety, short attention span and inappropriate behavior and developmental delay beginning at age 3.  Because of my HMO, my pediatrician insisted tests were not necessary, and that his problems were pychological, he refused to refer to a neurologist.  Last year, my insurance changed and I took him to pediatric neurologist, who immediately noticed his head was large for his age.  MRI revealed hydrocephelus.  He had a shunt placement last October and has improved much.  However, he still needs to be treated for AD and anxiety, and some compulsive behaviors. We then saw a pediatric pyschiatrist. We have had great success with Adderall 5 mg for attention.  The anxiety and compulsive behaviors have been treated with Prozac, which worked well for 4 months, then he became really agitated and displayed the inappropriate behavior again.  Tried Anafranil, not much change, and now were trying Paxil.  Hopefully something will work well with him.
Don't delay seeing a good pediatric neurologist or pyschiatrist.  The pyschiatrist, in my experience, is better suited to find and try various medication until the right one works.  

Posted by CCF Neuro[P] MD, RPS on July 29, 1999 at 11:29:48
Thanks for the comment.
CCF Neuro MD

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