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Avatar universal

Any had similar situation?

I have a 12 year old grandson diagnosed with ADHD/ODD/Bipolar.  He was first prescribed concerta.  He did very well for about two weeks and then started to act very violent aggressive and angry.  The doctor doubled the dose and the anger and aggression etc. became worse.  That was when the doctor diagnosed Bipolar and took him off stimulant and put him on Resperidone / mood stabilizer.  He has been on resperidone for 11/2 week showing only ADHD and ODD symptoms. He is driving us crazy but not showing any signs of anger or aggression. We then introduced ADHD medication, guanfacine,  evening only.  Second day he started exhibiting more aggressive, angry behavior. I plan to call the Doctor on Monday, but wanted to know if anyone else had similar situation?
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5914096 tn?1399918987
Who is prescribing these medications to your grandson, a general MD or a psychiatrist?  These meds should ONLY be prescribed by a psychiatrist as proper testing needs to be conducted to determine proper diagnosis and treatment.  Also, is your grandson being seen by a mental health professional for talk therapy?  These medications are psychotropic medications and with an ADHD diagnosis, your grandson would be best served by seeking the counsel of a mental health therapist.  

Some MD's throw medication at the symptoms but never solve that actual problem.  When you are dealing with an emotional/psychological problem, you should be evaluated by only those professionals that are trained to deal with emotional/psychological issues.
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189897 tn?1441126518
COMMUNITY LEADER
   Mark is right on with his comments.  I also wonder about the prescribing doctor.
   Another thought is have you (or the doc) looked at Sensory Processing Disorder.  ADHD is many times mistaken for this.  And if the normal stim meds are given for this, you get the same results that your grandson had.  SPD is not treated by medication.
    You might want to check out this site on SPD - http://www.sensory-processing-disorder.com/    
     If it seems possible we have a very experienced person on medhelp that you can ask further questions here - http://www.medhelp.org/forums/Sensory-Integration-Disorder-SID/show/1396
     You can read about the other meds here - http://www.leeheymd.com/charts/adhd_1.html
      But since both are a kind of sedating medication, the angry behavior I don't think would be related to them (except for perhaps too small a dose).  This really does make me think that maybe the root cause is not being answered - which leads me back to SPD.
      And this does lead back to Marks question.  This definitely is something that "should be evaluated by only those professionals that are trained to deal with emotional/psychological issues."
       Let me know if the SPD site answers any questions for you.  Best wishes.
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Avatar universal
He is seeing both.  Thanks for your concern.  He also sees a behavior analyst at school twice a week. The therapist he sees is suggesting tough love approach.  The problem I have with that is that it seems to provoke more episodes.  I do find that consistency such as saying "no means no and I am not going to negotiate" works a lot of the time. I am going to call the psychiatrist  tomorrow.  I am not giving him the adhd med again until after I talk to the doctor. Thanks again for commenting.
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Avatar universal
I will check it out.  Thanks so much for your reply.
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189897 tn?1441126518
COMMUNITY LEADER
   He probably has not been on the adhd med long enough to matter (hopefully), but if you read the link I sent you - http://www.leeheymd.com/charts/adhd_1.html   -   You should NOT suddenly stop either of those meds.  
   Always, always read up on any med prescribed by the doctors and never stop without consulting them on the correct way to stop.  Note, most stim meds like concerta, etc can be suddenly stopped.  Resperidone and guanfacine are different kinds of meds.
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189897 tn?1441126518
COMMUNITY LEADER
       By the way I have my doubts about "tough love" working for medical conditions.   If the child is spoiled and used to getting their own way - maybe.  But to use tough love for something that the child may have no control over is certainly not an acceptable course of action.  I wonder how much experience this analyst has with kids with ADHD (or maybe SPD) .
      And yes, consistency is highly important.  And I can recommend several good sources for other ways to change his behavior.  But we gotta first find out what the problem actually is.
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Avatar universal
I did not see guanfacine on the list that you linked me to.  I did, however read that the side affects sometimes include a mood change. I am going to call the doctor today. The doctor took him off concerta because of putting him on resperidone.  The concerta did work great at first, but then he became aggressive and mean.  That is when the psychiatrist prescribed the resperidone for mood stabilization. The doctor said that because the concerta worked reinforced the diagnosis of ADHD, but until his mood could be stabilized he would not keep him on concerta, so prescribed guanfacine.  Thank you for your comment on tough love.  I am going to reenergize my efforts to find behavior tools that work.  Any help in that area????
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Avatar universal
I take it back. After reading the fine print, I see that guanfacine is intuniv.  I do not see the mean aggressive behavior as a side effect.  Thanks again, for being so responsive.
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189897 tn?1441126518
COMMUNITY LEADER
   I will definitely send you some links, etc for behavior modification.   Did you have time to check out the Sensory link.       http://www.sensory-processing-disorder.com/     .    What did you think?
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Avatar universal
He does not have the symptoms of SPD.  His diagnosis is:  ODD.  He has almost all the symptoms of ODD.  ADHD, which we have treated with diet  and counseling and now medication (because he is having a hard time in middle school) and the most recent addition is the bipolar.  Both the therapist and the psychiatrist believe this due to my grandson acting reckless, thinking about hurting himself or me, etc.  This became much more noticeable after putting him on the ADHD medication.  Since being on the resperidone, he is much happier, and playful.  The problem is the ADHD symptoms and especially the defiant behavior.  The resperidone cuts down some of the ODD behavior, but he still gets out of control and the school calls. thanks
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189897 tn?1441126518
COMMUNITY LEADER
   Does he have a 504 plan or an IEP for school?
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189897 tn?1441126518
COMMUNITY LEADER
Oh, I assume he now is in middle school?   Was he having the same problems in elementary school?
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Avatar universal
Yes.  The big difference is that he is not as supervised in middle school, and he is bullied  and made fun of which accelerates the ODD. The other problem is that he has 8 teachers to interrupt and defy and irritate instead of 2 . The school now has a behavior analyst working with him two times a week and I have also asked for a plan.  There is what's called a 504 plan in Florida schools.  The next would be IEP, but I think I am going to have to jump through several more hoops before the school will provide that.  I just talked to his Psychiatrist.  He said keep him on the guanfacine.  He will see him again in two weeks and perhaps decide if the resperidone should be increased.  Meanwhile, he suggested that the therapist may not be a good fit, so I need to look into that as well.  He also applauded me for being active in finding support for myself and I told him about the link you sent regarding the drugs.  Made his job easier.  I thank you too.
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189897 tn?1441126518
COMMUNITY LEADER
      boy, as an elementary and middle school teacher/administrator I feel for the kid.  6th graders can really get lost in the system.  Plus they go from a fairly comfortable situation where they are the top dog to being at the bottom of the pile.  That has gotta make all his problems so much worse.
     Couple of thoughts.  Get the book,  "The ADD/ ADHD Answer book," by Susan Ashley.  its around $12 on Amazon.  It has a really great section on 504 plans and IEP.  But it is just a wealth of info on working with kids with ADHD at home and at school.
     Yes, the school can make you jump through hoops.  A IEP is hard to get for ADHD, but the ODD should make him qualify.  However, a 504 can be just as helpful.
      Definitely agree with the Psyc to get a new therapist (beginning to like your doc).
      Ashley in her book says that about 33% of the kids with ADHD also are ODD.  Which to me makes sense.  The kids know something is not quite right with them.  They are basically picked on by everyone because they are always screwing up.   They get defensive, usually have anxiety, and many are depressed.  Its a vicious cycle.
      And many of the same recommended behavioral modifications for ODD are the same for ADHD.  Most based around the idea that you can not punish them for something they can't control.  Reward them for the good, thus hopefully slowly steering them in the right direction.  Ignore the little things.  Be extremely consistent.  And when they mess up, don't make a federal case out of it.  Remain calm, explain what happened, and have small consequences.
      You and his parents might want to read this link on anger overload.  It really hits on his problem.  The comments on medication are especially interesting.  Maybe even his psyc might be interested.  The link is -
      http://www.chadd.org/Portals/0/AM/Images/Understading/AUG01AngerOverloadinChildren-DiagnosticandTreatmentIssues.pdf
    Since I am not sure what specifically he does that drives people crazy (I can guess, but all kids learn to push different buttons or compensate in different ways).  I can give you a few links to sites with general info on working with ADHD kids that may prove helpful.
    This is a very good site with a lot of general overall ideas.
                 http://www.onhealth.com/tips_for_parenting_a_child_with_adhd/page2.htm
     And this site has a lot of very specific ideas -
               http://www.additudemag.com/channel/parenting-adhd-children/index.html
    I hope that some of this is helpful.
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Avatar universal
THANK-YOU!!!!!!!
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189897 tn?1441126518
COMMUNITY LEADER
   Wow, this is really interesting.  Check out this link.  It on being mad in the afternoon.

           http://bit.ly/simtulantdropinfo
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Avatar universal
I found it interesting also.  My grandson is no longer on a stimulant, but the information in the video was still very good for me to know.  I also found the link on anger overload very informative.  I believe my grandson is diagnosed correctly with ODD, but the simple tools suggested in the article are definitely worth trying.  I thank you again.
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189897 tn?1441126518
COMMUNITY LEADER
   Ya, the main reason I sent that was due to the anger when he was on Concerta.  I don't know when he got angry, but if it was only in the afternoon/night - it could have been because he was coming down off the Concerta as the video talks about.   And I suppose the same might be happening with the guanfacine as it runs its course.  Here again the anger would have to be in the late afternoon.  Anyway, it might be interesting to bounce the idea off the psyc.
   I just discovered the videos and need to go back and watch all of them.  Fortunately, they are short!  I have great regard for the expertise of the doctor in the video by the way.
   Well, keep me posted on how things go.   Good Luck!
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