Tag Archives: Stimulant

Adderall Update #2

At Colin’s school, they give you a daily conduct report by way of a color scale – green is best, then yellow, orange and finally red.

Monday, Colin had a red day.

Tuesday, Colin had an orange day.

Wednesday, Colin had a yellow day… but he lied to his dad and told him he had a green day, so we recorded it (I have an incentive chart at home) as red (lying is not tolerated).

Today, he was already at “orange” by lunch time when Rick went to give him his afternoon pill. He hit another student.  He hasn’t hit in a very long time.  He also misspelled every single word on his spelling test.  He’s having control issues.

Yesterday, I called Dr. L for advice on what to do.  I had to leave a message and wait for his call back.  During that time, I did some online research.  I was aware that Adderall is considered a more potent drug than Ritalin, but I wasn’t sure what the dosage comparisons were.  I found a study online that shed some light.  It seems the general consensus is that Adderall is approximately twice as potent as Ritalin. 

Colin was on a hefty dose of Ritalin.  As I read more yesterday, I came to realize just how hefty.  I read that the maximum recommended dose of Ritalin is 60mg/day.

Colin was taking 80mg in the AM and another 20mg at noon.

He’s now on 10mg of Adderall in the AM and 10mg at noon.  If you do the math based on the 1:2 assumption of potency, that means he’s currently on about 40% of the stimulant he’s been on for the past year. Our hope (and our doctor’s hope) is that the Adderall will prove to be more effective as well as more potent.  Time and trial will tell.

The upside to less stimulant is his appetite has increased.  He’s become a bottomless pit!  He eats dinner – possibly seconds – maybe dessert after…and then asks for a snack.  Of course, we don’t just allow free range feeding at our house, so he understands that meals are at certain times and I try to offer healthy options.  He can definitely stand to gain a few pounds, but I won’t impair his health by giving in to his carb cravings 24/7!

When Dr. L called me back yesterday, we had a good talk.  First, he said that Adderall can cause insomnia, but that would affect him falling asleep, not waking up.  He falls asleep fine (thanks to the clonidine) but has been waking up entirely too early.  He also confirmed that – for Colin – 10mg twice/day is a fairly low dose.  He suggested that we try 15mg twice/day if we don’t see an improvement.  He also reminded me that we’re using the IR (instant release) medication to determine dosage and once he can be put on the XR (extended release) form, we will see less ups and downs in his mood/behavior/etc.  We have a follow-up appointment with him a week from tomorrow, so we can talk about the next steps then.  He told me to give him a call in a few days with an update and we’ll see how things go.

Rick and I have both been doing a lot of reading and wonder if adding Intuniv along with the Adderall might help. My worry about Intuniv alone was that it can lower blood pressure. However, stimulants raise the blood pressure, so the result may be the drugs counteracting each other in that department.

Of course, the idea of adding another pill makes me a bit ill.  But it doesn’t seem 100% stimulant is the way to go if he was able to take 100mg of Ritalin/day and still manage to be more hyperactive than just about any child I’ve ever encountered.

 

On a happier note… Colin has a birthday coming up.  I can’t believe he will be 8! He’s changed his mind a million times as to what he wants, but I believe he’s settled on a Wii Just Dance game (he loves this game).  I’m also thinking about making him a fuzzy blanket.  He loves smooshing his face on the dogs and rubbing on them at all the wrong times/places.  A friend suggested a furry blanket that he could use as a release for that impulse. Nothing too big, but something that’s just his that he can run his fingers through and rub his face on, etc.

And of course, there will be a mad dash through Chuck E Cheese.  All in the name of getting that glorious 10 seconds inside the infamous ticket blaster!

We discovered last year that you can have a birthday party of as little as 4 children at CEC.  We have 3, so we just booked the 4 kid party and called it good – Rick and I shared the 4th kid’s pizza slices and soda and we gave the extra tokens to the kids!

This year, I’m going to invite a new friend I made recently. We met at the park and her son is also a spectrum kiddo – he has Aspergers. Hopefully they can come and he can be our 4th!

Adderall Update

It’s not going very well, in my opinion.  Saturday was our first day.  We gave Colin 5mg in the AM, but I wasn’t with him all day. Rick took him out to Charis Hills for an open house. I wanted to go – we were going to take all three boys – but my sinus infection had taken me down and I could hardly get out of bed.  Rick decided to take Colin and left Robbie and Ryan at home with me for the first half of the day.

Colin did fine at Charis Hills, but he also had plenty to keep him busy. So many new sights and sounds – people to meet, things to touch!  This is a camp for ADHD and Autistic kids.  We’re hoping to scrape enough together to send Colin there for a week in July.  (This is a pricy camp, but I think it would do him so much good.  He’d be surrounded by kids like him, counselors that are trained to work with special needs kiddos, etc. I think it will be good for all of us, really.)

He took another 5mg around 11:30am.

Saturday afternoon, he was a handful.  Bouncing off the walls, driving everyone crazy. He was pretty out of control. Saturday night brought a few meltdowns, but the clonidine helped him mellow out and get to bed. He was asleep by around 9:30pm, if I remember correctly.

Sunday, he was up at 5:30am. Rick let me sleep and got up with him. After shattering a pill in an attempt to break one in half (we were given 10mg pills and told to try doing 5mg first, then up to 10 if needed), he gave Colin a full 10mg. I don’t know that the morning really went any better. I wasn’t up until 9am (I love my husband!) and wound up passing out again around 11am for an hour. (I try to listen to my body – when I can! – in an attempt to really heal when sick.) We gave him 5mg at noon.  The rest of Sunday was very frustrating. He just couldn’t control himself whatsoever.  Beyond just body movements, he was doing things heknowsaren’t allowed (ex: locking the dogs in his bedroom with him). I tried to keep my cool. We tried our best to explain to his brothers that this wasn’t Colin’s fault and we needed to show some patience.  For me, being sick wasn’t helping.  By Sunday night, I was starting to feel human again, though. 

Colin couldn’t sleep Sunday night.  I felt bad for him. I don’t know if the extra medicine in the AM was messing with him or just the Adderall in general was an issue. At one point, he was standing in his doorway and I asked what was wrong. “I just can’t fall asleep,” he said. He never speaks that plainly. I told him if he’d lie down, eyes closed, in the dark…sleep would come. I think he finally fell asleep around 10pm. Maybe.

Yesterday (Monday), he was up around 5am. He might have been up earlier, but that’s when I heard him. He kept sneaking around the house, into our bedroom while I was in the bathroom – anywhere but his own room. I got very frustrated and read him the riot act, even though I knew I shouldn’t and I knew it wouldn’t help anything.

I gave him 5mg of Adderall.  We went into the living room and he didn’t say a word.  I let the dogs out and came back in…fed the dogs.  Still nothing.  I asked him if he was okay – he looked awful.  “Yep.”  He always says yes.

I sat down on the couch and called him to me.  I put my arms around him.

Me: Did you sleep at all last night?

Him: Yes. I just had to poop a lot.

Me: You had to poop during the night?

Him: Mhm. Can I have breakfast now?

I knew insomnia could be a side effect – it’s the same with all stimulant drugs. Rick checked and found that diarrhea can also be a side effect of Adderall.  Normally, Colin has the opposite issue since we have such a hard time getting him to eat fruits and vegetables.

Yesterday at school, he had an awful day.  The teacher said he was just hyper all day long.  He was given another 5mg of Adderall at noon, but that didn’t seem to help.

Last night, he slept.  Oh thank goodness, he slept – from about 8:15pm-5am. A decent night’s sleep.

This morning, we tried a full pill – 10mg.  I hate yoyo-ing like this, but we want to see if that helps at school. I’m worried he won’t sleep tonight, though.  I don’t think Adderall is going to be our answer.  We’ll probably give it a few more days, but so far this week has been rough and we’re only on Day 4.

Psych Visit #2

I’ve been a little lax on posting because I haven’t felt well most of the week. Yesterday, I finally called into work and went to see a doctor.  Everything checked out – just a bad case of allergy issues – so I got a shot of steroids and an Rx for antibiotics should things not improve.

The upside of being off yesterday was that yesterday was our follow up appointment with Dr. L, so I was able to go with Rick and Colin. Our appointment was at 12:45pm. Rick and I picked Colin up from school at noon and he wound up eating most of his lunch in the car on the way there.

Unfortunately, the good doctor was running about an hour behind, so we had some waiting to do.

Colin got anxious. He kept tightening his lips and looking around. He’d press his fingers on his throat and say he was thirsty. He wanted the TV turned off. He took about seven trips to the bathroom. Rick offered to take him outside for a bit, but Colin declined. He was very quiet…and incredibly nervous. He finished his juice box and wanted more to drink. The water fountain was back by the doctor’s office, so we told him he had to wait.  He stayed quiet, still looking around, wide-eyed, pressing his throat.  I’m wondering if he was having flashbacks to his butterscotch swallowing from the last visit.

The TV show that was on ended and a soap came on.  I could tell the voices on the show were starting to stress him out further.  At one point, someone on screen yelled at someone else and Colin’s eyes went wide and he rocked a bit.  I went to the receptionist and did something I rarely do – I asked her to change the channel.  If anyone should understand, a psychiatrist’s office should, right?  She glanced up and told me someone must have changed it because they never allow soaps. She quickly changed it to PBS.  I asked Colin if that was better.  “I just want it off, please,” he said, so politely.  I explained I couldn’t do that.  He asked a few more times over the rest of our wait, but never got upset.

After our hour of waiting – and a few more trips to the bathroom with Rick – we were called back.

Dr. L asked how the clonidine was working for us.  We explained that the .05mg dose wasn’t working, so we went up to the full .1mg dose after a couple of days and that seemed to help.  For a while, he was waking up earlier and earlier – as early as 4:30am!  But now that seems to have tapered off.  He’s waking up between 6-6:30am, which is wonderful.  I need that 15-20 minutes on my own in the AM.  Before, if I woke up earlier, so did he.  The slightest sound woke him.  He seems to sleep more deeply now. I can shower, let the dogs out, etc, and he doesn’t wake up.

As a result, we’ve been watching a lot more Animusic. Small price to pay!

Next up during our visit was discussion of his ADHD meds.  Rick and I both would like him on something longer lasting.  One of the biggest issues Colin faces are the highs and lows.  He’s on a roller coaster all day – he gets his morning pill…crashes…slowly amps back up until noon when he gets his afternoon dose….back down again…slowly amping back up.  Repeat. 

Therefore we discussed what we and the doc felt were the best options – Concerta or Adderall XR.  Concerta is essentially the same medicine he’s on now (a methylphenidate stimulant – i.e. Ritalin).  Adderall is an amphetamine stimulant.  Dr. L said that with the high dose of Ritalin Colin is already on, it may be a good idea to try a stronger drug like Adderall. He suggested we start with the short acting medication so that we can determine where he needs to be, dosage-wise, and then change over to the XR once we know how he reacts, how much he needs, etc.  We’re making the change this weekend – Saturday will be his first day on Adderall.  Fingers crossed. We’ll start with 5mg in the AM and then 5mg at noon.  If that doesn’t seem to be helping, we’re to give him a full 10mg in the AM and another 10mg at noon. The only real concern I have is that Dr. L said the crash from Adderall can be worse than that from Ritalin. I hope it’s not too traumatic.  I hope he reacts well and that this is a good change.  I’m nervous as hell.

As a side note, I think it’s interesting that Dr. L seems to possibly be on spectrum himself.  His mannerisms and the way he presents things… little things make me think there’s a high probability that he might be.  What really convinced me was yesterday during our session when Colin said, “What’s that noise?” 

I didn’t hear anything.

“It’s the speakers in the hallway playing music,” Dr. L answered.

I listened closer – oh!  I could hear it if I really concentrated!  But to Colin and Dr. L, I have a funny feeling it was the most annoying sound on earth.  He knew exactly what sound Colin meant.  Little moments like that make me feel like this is a good doctor for us. He’s not just someone who’s read a thousand books… he may very well be living through it as well.

Fingers crossed for this weekend.