Genetic Testing for Meds?

[BabbleMom]

Hi Everyone!

I have a 10 year old son who is diagnosed with ADHD, Anxiety, SPD/IPD and rule out of Asperger's/PDD in 2013. Currently, we have him on Methylphenidate ER 30mg per day, but lately we have been noticing issues. Mind you, the school hasn't been very helpful this year with information on how he is doing so I can only go by the vague messages received... the first 6 months, they say he was great! Though I have documents to prove otherwise - lately though, the teacher keeps saying he lacks focus, needs to pay attention and all that jazz. (I say it so flippantly because this teacher has been a pain to work with...)
I spoke with the doctor and she wants us to come in next week to discuss his meds, but we have had issues with additives in the past and it's not a route I want to go... to sit and wait. His diet is modified already, we also work with a behavioral therapist and a chiropractic neurologist and he takes Taekwondo.

With all this, I'm wondering if anyone has tried the genetic testing (IE: HarmonyX or Genesight) to see what meds would work best with his specific genetic makeup??
I read all these stories of parents having all these issues and suddenly their kids are on Vyvanse or something else and it's a miracle.  I wouldn't mind that... him being able to function better at school (academically and socially) ... he gets bullied (though he can start it up too) - I just wonder, what next???

Here is his medication history:

August 2011 – Vyvanse ??mg (very small amount)
September 2011 – Vyvance 30mg (adjusted to 30mg)
May 2012 – Trial samples of Intuniv w/ Vyvanse for two weeks. After two weeks he was out of         school and parents decided not to continue the Intuniv.

September 2013 – Intuniv 2mg w/ Vyvanse
September 2013 – Concerta 36mg (removed from Vyvanse and Intuniv because he became over-emotional and violent/aggressive)

December 2013 -  Concerta 54mg (Dr. Snyder prescribed)
March 2014 – Methylphenidate 10mg (3 times a day) (March 7th thru March 14th)
            Methylphenidate 15mg (3 times a day) (started March 15th)
April 2014 – Methylphenidate 20mg (3 times a day) (started April 14th)
May 2015 – Adderall 10mg (3 times a day) (started May 14th)
June 2015 – Adderall 15mg (3 times a day) (started June 3rd)
August 2015 – Guanfacine 1/2mg (3 times a day) (started August 21st)

September 2015 – Methylphenidate ER 30mg (once a day) (started September 6th)

[Autismstepmum]

Yes. Get genetic testing. You should too. It runs in families. Medications are all processed in the liver. If he had a slow or fast metabolizing liver. Some of these meds might not work at all or the doses are all off.

Not only that, it doesn’t just include psych meds. It includes everything.

Example. If you have CYP2D6. That’s a slow metabolizing liver. If you go under anesthesia, the doctor needs to know. If you go to the ER and need pain meds? They need to know. Some medications can even kill you. Same for fast.


But again, not everything that’s prescribed is correct because you don’t know how the liver responds.

Tell the doctor, or find a lab that can find out if he’s a poor, normal or fast metabolizer.

You can also test yourself. It’s genetic!

And there won’t be anymore problems.

[Mystershyster]

So I am a little confused. Was your son diagnosed with  Asperger's?  If so, I question the  doctor's use of ADHD meds because this maybe aggravating the Asperger's which is causing him to lash out.  People with Asperger's need stability and routine and counseling to help work through their social disconnect.  I say this because I have a son with Asperger's and a son with ADHD so I am familiar with the signs of both.  We absolutely do not give my son with Asperger's any meds. With a few years of counseling, he has gone to non-participating and rebellious to a calm, content straight A student with some friends and alot less conflict.  My son with ADHD tried several of those meds and Concerta was by far the best till they changed him to the generic form which has a filler that alters the results of how the meds work.  I wish the best for you and as a parent, I suggest you try the counseling aspect and wean him down off the meds to truly see if that is the issue.  

[Sandman2]

Thank you for responding.  The person did say that Aspergers was ruled out in 2013.   Interesting point you made about the generic form of  Concerta.  I have seen several other parents questioning the generic forms.

[specialmom]

Sandman, this is what I've bee told.  Generic companies have to make a product that fits into a specific area of the brand name medication.  Normally, the difference between generic and brand name and generic compared to another generic is nominal and goes completely unnoticed. Someone super sensitive may feel a different though.  My son is now on medication for depression (been such a difficult year that I'd love to chat with you about) and I had this concern.  The prescribing caregiver said that they've not known anyone to actually have an issue but that has also read that it 'could' happen and for that reason, will do the steps of gaining prior authorization to prescribe a brand name with no substitutions listed.  But I think not to many in reality feel a difference.  Certainly doesn't help if you or your child does.  

If we end up having trouble with this first prescribed med, I'm considering the genetic testing as it's probably well worth the money to narrow down best options.  

[Sandman2]

   This link might answer your question.  Read the comments that follow the article as they give real life experiences of people who have tried the test.
The link is - http://www.additudemag.com/adhdblogs/19/11227.html
    In terms of the meds you have tried.  First let me say that I really appreciate your detailed listing of them.  Usually, parents can't remember what has been tried.
    Basically Vyvanse is a smoother, longer acting form of Adderall.  Concerta is a longer acting form of Methylphenidate.  Usually, but not always, the Adderall type of medications are considered to be stronger.
    Intuniv is a longer lasting and newer form of Guanfacine.  Not a stim med like the above mentioned, but can be successful.  More on Intuniv here - http://www.corepsych.com/2013/12/intuniv-for-adhd-details-updated/
  
     He was on Vyvanse from Sept 2011 to May 2012 apparently without any problems.  The Intuniv was then added.  It would seem that it might have been the Intuniv that caused the problem in Sept 2013 since he had been on the Vyvanse before.   Note:  from the following link Concerta 36 seems to be equal to 30mg of Vyvanse, Concerta 54 would be about equal to 40 of V - http://addadhdblog.com/vyvanse-dosage-how-to-get-the-right-dose/?doing_wp_cron=1459293415.8103790283203125000000#c987e
       And finally, one more link listing all the meds and durations
        http://www.leeheymd.com/charts/adhd_1.html
     To answer your question.  It doesn't sound like the Genetic testing is worth the money.   Yes, increasing the meds might be a good idea.  I would be tempted to try a 40 Vyvanse.   Definitely show your dosage information to your doctor.   It should help make a choice easier.   And ya, every child is different - thus its, always trial and error.  Good luck.  Hope this helps.