The Right Stuff

The long, four-year tunnel finally has a faint light coming from the end!  And for the first time since Dude was born, life doesn’t seem so daunting!  Why the reprieve?  Because we finally have his medication cocktail lined out!  And, just as we expected, it’s going to be life changing!

 

How do we know?  How can we tell the meds are working at the right level?  Well, it’s simple.  I don’t dread picking Dude up from school or spending the weekend with him now.  That may sound mean, but it’s true.  Remember that Dude’s hyperactivity, impulsivity, and temper almost got him kicked out of daycare when he was just barely 3 years old.

 

About a month ago, we started medicating him, with 2.5 mg of Adderall.  At that dose, a slight difference was noticeable, but Dude was still so impulsive he ran out in front of a car in a parking lot one afternoon.  Luckily, the driver spotted him and stopped!  We bumped it up to 5 mg, and school reported that he was tired in the morning, but still aggressive.  Reluctantly we bumped it up to 7.5 mg and the poor kid was like a zombie!  He wasn’t even able to enjoy the fun special day they had at school.  He was a mess!!  We only gave him that dose once, because he was obviously WAY over-medicated!  After seeing Dr. Kristina again, we added some guanfacine to the mix, just 1 mg to start.  That was a week ago yesterday.  The change has been dramatic!!!

 

img_1114Every single day last week, Dude got a positive report when I picked him up from preschool.  Mrs. Jill and Ms. Yvonne reported that his behavior was no worse than any other 4 year old’s.  He had a couple of outbursts, but they weren’t severe and he quickly calmed down, with NO VIOLENCE!  Yes, you read that right!  My kid went a whole week without punching anyone at school!  He had a couple tantrums at home, and had to go to his room, but he recovered there much more quickly too!

 

From a less dramatic, but no less important, perspective, Dude can carry on a conversation without getting lost mid-sentence.  He is asking to hold hands in the parking lots now.  He’s even reminding his brothers of proper behavior!!  In fact, we heard a line in a movie that included the phrase “… get stuck in there with all those weirdos and criminals!”  Dude piped up and said to the TV “Do you know that even if they ARE weirdos and criminals, that’s still not nice to say?!”  He’s giving up his iPad without fussing when it’s time for bed.  He’s playing with friends and brothers better.  He’s interested in being more independent in things like getting dressed.

 

At swim lessons today, a younger boy grabbed a toy Dude was playing with and wouldn’t give it back.  I was ready for Dude to start pummeling the little guy, but nope!  He just shrugged his shoulders and walked away!  Dad and I both noticed that and realized just how significant that was!  He got lots of praise for sharing, and letting the other little boy have a turn.  When it was time to leave the pool, instead of throwing a massive tantrum that required me to go in after him, he just screamed at the top of his lungs a couple times, then complied!  Hey, a couple blood curdling screams is progress, compared to what we normally deal with!!!!  Then, when his brother Snix took off running down the hall of the fitness center, Dude told him he wasn’t supposed to run, then was sure to show me how he was walking nicely.

 

I understand a lot of people will think that this is the way kids are supposed to behave, so it’s no big deal, but if you know anything about ADHD, you’ll understand just how significant “normal” behavior is.

 

 

 

 

 

 

Medication Vacation

One topic that I’ve given a lot of thought to is whether or not my kids should have a drug holiday over summer vacation. According to Wikipedia, a drug holiday is not a modern version of Woodstock, but rather when “a patient stops taking a medication(s) for a period of time; anywhere from a few days to many months or even years if they feel it is in their best interests”.

If you’re considering whether or not to give your child her ADHD meds during summer, vacation, you’ll have to weigh pros and cons and decide if it’s right for your child. For example, medications can help your child succeed not only in school but also in social settings with peers, such as team sports, music or dance classes, church, and at home.   For our family, Snix and Dude take medication to help ensure their safety (more on that in a minute). Understood.org has a good article on medication vacations.  Don’t forget to talk to her prescriber to see if a medication holiday is appropriate and if so, how to begin it.

In some cases, it’s made sense for one of my boys to stop taking meds over the summer, and in other cases, it hasn’t. In my research, here are some things we consider any time we’re thinking of giving the kids a break from their meds.

  • Obviously, when a child goes off her ADHD meds, her ADHD symptoms reappear. That’s a no-brainer, but it has to be said.

This summer, we could have taken Snix and Dude off their meds; however, their symptoms are so severe that their safety (and my sanity) depends on it. Yesterday for example, they both ran out in front of a car in a parking lot. Luckily the driver was paying attention and was able to stop, but it could have been much different an ending. Safety issues like this are why the two of them take their meds to start with, and those issues don’t end when summer break begins. So a medication holiday is not an option for them.

  • Self-Esteem considerations are important, too.

The understood.org article doesn’t mention the effects on one’s self-esteem that the drug holiday can have on a child. When the child stops taking his ADHD meds, he may likely get into trouble more often, and we all know that getting in trouble a lot can have a negative effect on one’s self-esteem. Regardless of their planned activities over the summer, it’s important to consider that effect, too.

  • What side effects are bothering my child?

Verywellmind.com reminds us to consider the side effects.

Appetite problems and poor weight gain can be big problems for some children taking stimulants. If his medication is working very well for him otherwise, not taking it on weekends can be a good idea so that he does eat better at those times.

On the other hand, some children do have more side effects on Mondays after being off their stimulant for the weekend, as they get ‘used’ to it again, so be on the watch for that.

Between 4th and 5th grade, Buddy was on both a stimulant and a non-stimulant. He was too skinny and not growing taller as he should have been, and the stimulant was suppressing his appetite. After discussing it with his pediatrician, we decided to give him a medication vacation over summer break. He stayed on the non-stimulant but we slowly lowered his stimulant dose until he was no longer taking any. That summer, he grew taller and was able to put on some weight, something he’s struggled with since he was a toddler. For Buddy, it made sense, and paid off.

  • A drug holiday can let you judge how effective the medication is, after having used it for some time.  

Wikipedia also explains that another reason for drug holidays is “to permit a drug to regain effectiveness after a period of continuous use, and to reduce the tolerance effect that may require increased dosages.” The summer we took Buddy off his stimulant, we realized the non-stimulant managed his symptoms just fine. He started the next school year on only non-stimulant and was able to complete his work and participate in class, without his grades suffering. To this day, he takes the stimulants only on rare occasions or if we forget to give him the non-stimulant.

So, as you may have guessed, there is no right or wrong answer when deciding whether or not your child should teak a break from his medication. But think about WHY he’s taking it. Is it only to be able to focus in school? Does ADHD effect his relationships with family and friends? Will a lack of impulse control put him/his safety at risk? Is he experiencing any detrimental side effects of the medication(s)? After you consider these questions, if you decide to pursue a drug holiday, be sure to talk with your child’s prescriber. There may be specific, important, requirements to wean off the drug slowly. Whatever you decide, best of luck for you and your child!