Question
My daughter is 9 and has ADHD and Asperger's. She takes Methylphenidate twice a day so that she may focus at school, but when the second dose wears off she becomes uncontrollable. She is loud & completely disobedient. I have a 6 year old son also and am a single mother. I am at my wits end. I feel like I have tried everything and nothing works. She talks back to me always. There is not one time that I ask her to do something that she doesn't argue back. Please help me :o)
Answer
It sounds like she does fine until her meds wear-off. We’ll start there…
Have you tried sustained release forms of ADHD medication, or one of the long acting stimulants?
Sustained release forms of these medications have the benefit that the medication is often still working after school, as your youngster is trying to do his homework. The sustained release pills must be swallowed whole (except for Adderall XR).The long acting stimulants generally have the duration of 8-12 hours and can be used just once a day. They are especially useful for kids who are unable or unwilling to take a dose at school.
At least 80% of kids will respond to one of the ADHD stimulants, so if 1 or 2 medications don't work or have unwanted side effects, then a third might be tried. It can help if you are aware of the different medications that are available. Stimulants are considered to be first line treatments, and antidepressants are second line treatments and might be considered if 2 or 3 stimulant medications don't work for your youngster.
Here is a list of long acting stimulants to explore with your youngster’s doctor:
• Adderall XR— Adderall XR is approved for use in kids over the age of six years, although regular Adderall can be used in younger kids from 3-5 years of age. Adderall XR is a sustained release form of Adderall, a popular stimulant which contains dextroamphetamine and amphetamine. It is available as a 10mg, 15mg, 20mg, 25mg, and 30mg capsule, and unlike many of the other sustained release products, the capsule can be opened and sprinkled onto applesauce if your youngster can't swallow a pill.
• Concerta— Concerta is a sustained release form of methyphenidate (Ritalin). It is available as a 18mg, 36mg and 54mg tablet and is designed to work for 12 hours. Teens can take two 36mg tablets to get to a dose of 72mg. Like Adderall XR, it is only approved for kids over the age of six years.
• Daytrana— Daytrana is a methyphenidate or Ritalin patch. The patch is available in 10mg, 15mg, 20mg, and 30mg dosages, which are worn for about nine hours at a time on a youngster's hip. The medication in your youngster's system then continues to work for a few more hours once you take the patch off, although you may have to figure how the patch works best for your youngster. One benefit of the Ritalin patch, in addition to working well for kids who don't like to take medicine, is that it gives you a lot of flexibility. For example, on some days your youngster could just wear the Daytrana patch for a few hours and on other days he could wear it a little longer if he has extra homework (as long it doesn't interfere with bedtime).
• Focalin XR— An extended release form of Focalin, with the active ingredient dexmethylphenidate hydrocholoride, which is also found in methylphenidate (Ritalin). It is available in an 5mg, 10mg, 15mg, and 20mg capsule.
• Metadate CD— This is also a long acting form of methylphenidate (Ritalin).
• Ritalin LA— This is is a new long acting form of methylphenidate (Ritalin). It is available in 10, 20, 30, and 40mg capsules. Unlike the other long acting forms of methylphenidate, the Ritalin LA capsules can be opened and sprinkled on something if your youngster can't swallow them whole.
• Vyvanse— The latest medication to get approval to treat ADHD is Vyvanse, a long acting stimulant that is similar to Adderall. In fact, its main ingredient is lisdexamfetamine dimesylate, a derivative of one of the ingredients in Adderall. Initially available in 30mg, 50mg, and 70mg capsules, newer 20mg, 40mg, and 60mg capsules should be available soon.
Side effects of stimulants can include a decreased appetite, headaches, stomachaches, trouble getting to sleep, jitteriness, and social withdrawal, and can usually be managed by adjusting the dosage or when the medication is given. Other side effects may occur in kids on too high a dosage or those that are overly sensitive to stimulants and might cause them to be over-focused on the medication or appear dull or overly restricted. Some moms and dads are resistant to using a stimulant because they don't want their youngster to be a 'zombie,' but it is important to remember that these are unwanted side effects and can usually be treated by lowering the dosage of medication or changing to a different medication.
Here are several points to keep in mind with regard to medication for Aspergers and High-Functioning Autism:
• Anti-Depressants May Be Needed— While many kids with Aspergers present with hyperactivity, there is a tendency for teenagers to suffer from depression. There are various reasons why depression may be so common. For example, teens with Aspergers generally want to fit in socially. They can become depressed when they fail to fit into society's molds or norms or can't grasp the importance of its rules. Depression may also hit as they deal with anxiety and obsessive behaviors.
• Consider non-Medical Therapies— There are several therapies that are proven to be effective in treating and improving behaviors in children with Aspergers. Behavioral therapies help the child learn to cope with obsessive tendencies, deal with tantrums, cope with anxiety or control angry outbursts. Social skills classes help them to understand more of the back-and-forth nature of communication. Speech therapy can help them understand different uses of language. Occupational therapy improves the clumsiness or lack of co-ordination problems.
• Diet and Vitamin Treatments Improve Symptoms— Nutritional deficiencies and mal-absorption problems are common in Aspergers children. Many parents report success with a restricted diet or adding vitamin supplements. Other parents report success with the gluten and casein-free diet or a low-sugar, low-yeast diet. It is best to get a blood or stool test to check for any food intolerances or vitamin deficiencies. Consult a nutritional therapist if you want to go this route. After testing, some common vitamins that Aspergers children often use include: B vitamins, zinc, magnesium, Vitamin C and cod liver oil supplements.
• Medications for Anti-Anxiety or ADD/ADHD are Useful— Anxiety and stress are usually elevated in Aspergers children and teens. They often require medications to cope with the anxiety. Children with Aspergers also struggle with concentration, hyperactivity, focus and attention. Medicines to target ADD or ADHD have proven useful for Aspergers. There can be side effects with new behaviors showing up, however, so any medication use needs to be closely monitored.
• There Is Not Just One Medication— While many of the symptoms of Aspergers can be treated with a variety of medications, there is not one magic pill for the syndrome. Aspergers children and teens often lack proper social skills, have obsessive tendencies and can be clumsy or awkward. Some medications can be used to improve specific behaviors associated with Aspergers, such as anxiety, hyperactivity or attention deficit.
My Aspergers Child: Preventing Meltdowns and Tantrums in Aspergers Children
COMMENTS:
• Anonymous said... I feel your pain.... I have 3 with ASD and complex behavior challenges including ADHD. Maybe there is a different dose that is more time released ? I am about to go the med route for my daughter. She is so difficult and has been since she was 1.5... She is six now. Ugh it's so draining!!!
• Anonymous said... I'm familiar w this. Repeat every request and or argue for every little thing.
• Anonymous said... We have three rules for our family. Each one has a clear consequence. By making these clear then following through discipline is simplified enough that we can spend most our energy on positive interactions with our son. Two years on this approach and he's got himself so much under control that he and his therapist weaned him off all meds. In his case he would take all the emotional power we would give him, so we just had to take the emotions out of correction and give him very clear expectations and hold him calmly to them. Then, we did all we could to let him know we adore and enjoy him just the way he is. In the end my belief is that the work is Gods inside our kids hearts, so prayer is the best thing you can do for your kids, but schedule, routine, clear expectations, calm correction, and happy parents are things that can benefit every family.
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