Behavior on ADHD meds is NOT consistent (also spoke with psychiatrist)

[sheryl]

OK, my dd had such a terrible weekend that Mon morning I called her psychiatrist. Psy said that we (dh and I) go back and forth on giving/withholding meds. That we need to give 6 months on these meds to see an improvement. WHAT!!??!!??

It's true we switched from adderall xr to regular adderall thanks to hsbaby's post and the replies of many of you as well as a personal friend who did the SAME THING FOR THE SAME REASONS. Her son is doing much better NOT on xr anything.

So, I gave my dd reg add and risperdal on Monday and she was a joy. Tuesday (yesterday) I did NOT give her add or risperdal and SHE WAS A JOY! This morning I've given her add only and NO resp and she's a JOY!
????????????????????????????????????????????

BTW, I did NOT purposfully withhold meds this week....my intention was to give it to her after snack, after lunch "with food" and time ran out. OK, poor excuse, but it's the truth.

So, the dr is just NOT receptive to much of what I have to say. Should I tell her the meds given this week and the fact that "different" formats of meds were given, but behavior remained the same?

Or, is there something I'm not understanding???? :confused:

[specialmama]

Generally speaking, when collecting data regarding behaviour, it is good to chart for a period of time. For meds which do not stay in the system long, like many ADHD meds, you could keep track for 30 days. I would stick to one med for 30 days, record everything. Then a different med for 30 days, record everything. Maybe combine them for 30 days, record everything. Then do a random trial for 30 days and record everything. Medical and psychological people look at hard data, not just a mom who says something after only a few days. I know it stinks :glare: as we've been there, done that... but you need to see it from their point of view too. There are too many variables in a day to consistently know without a fair amount of time to analyze. Kwim?

[Catherine]

That may account for what you've observed. Day to day variations are to be expected in anyone's behavior for any number of reasons. As a doctor myself, I'd have to agree that day to day changes in medicating will no allow anyone to see a true picture of the effectiveness of the meds or the child's overall behavior. Maybe not six months, but certainly more than one day.

[sheryl]

That may account for what you've observed. Day to day variations are to be expected in anyone's behavior for any number of reasons. As a doctor myself, I'd have to agree that day to day changes in medicating will no allow anyone to see a true picture of the effectiveness of the meds or the child's overall behavior. Maybe not six months, but certainly more than one day.

Catherine, I hear what you are saying.....manifestations of behavior have many sources. That's true with my dd, but we keep a pretty even keel here. She was on R for several weeks and seemingly more agressive. The Add does work....especially the regular A, NOT xr...that is hard stuff. The pharmacist told us that the xr's peak at 3, but remain in the system tapering off "to" 18 hours. Today she's had Add and 1/2 R and she's a joy and delight. She had her BEST day ever today. The R was not given until this afternoon "after school". I feel I must now give benefit of the doubt to these meds and combine your reply with Karyn's....keep a consistent med schedule and document it all.



Generally speaking, when collecting data regarding behaviour, it is good to chart for a period of time. For meds which do not stay in the system long, like many ADHD meds, you could keep track for 30 days. I would stick to one med for 30 days, record everything. Then a different med for 30 days, record everything. Maybe combine them for 30 days, record everything. Then do a random trial for 30 days and record everything. Medical and psychological people look at hard data, not just a mom who says something after only a few days. I know it stinks :glare: as we've been there, done that... but you need to see it from their point of view too. There are too many variables in a day to consistently know without a fair amount of time to analyze. Kwim?

Karyn, Yes, I should have been documenting. I grew tired of that when I had to document her seizures. She's seizure-free now and I don't do that anymore, but I remember how hard that was to "keep" current info. Read my reply to Catherine. I'm going to take both of your suggestions and see what's next.

Thanks to both! Sheryl <><

[EKS]

My son has ADD and we can have good days (and weeks) on medication and good days (and weeks) off medication. There are generally more good days on meds than off and generally more bad (school) days when he doesn't have the meds.

I also noticed (and finally documented) that my son's behavior seemed to cycle between good and bad and that the cycle seemed to span about a month. Lo and behold, I discovered that his cycle corresponded with *my* cycle.

My point here is that I am convinced that what I bring to my interactions with my son have just as much to do with whether he has a "good" day or not as his medication/neurological status. I think my mood, expectations, and perceptions have a lot to do with whether or not I think a medication or other intervention is "working".

All of this is to say that I would be a consistent as possible for at least two weeks--a month would be better--before deciding that a medication or lack of medication for ADHD is working.

[asta]

Risperdal has a mean elimination half life of about 20 hours.

This means that, after 20 hours, approximately half of the drug will have been eliminated from your body. After another 20 hours, half of what was left will be gone. And so on and so forth.

In other words, your daughter having skipped her Risperdal for one day was essentially meaningless from a pharmacological standpoint.

When a person has been on meds for quite some time, the medication is not only in their blood stream, it is also in their organs. Even though the medication may leave the bloodstream according to the half life guidelines, it can take many weeks for it to completely leave the organs.

As an example, I was once on a drug with a half life of 25 hours. I was not completely "clear" of it for 8 weeks.

Good luck with whatever you choose to do.


asta

[sheryl]

Risperdal has a mean elimination half life of about 20 hours.

This means that, after 20 hours, approximately half of the drug will have been eliminated from your body. After another 20 hours, half of what was left will be gone. And so on and so forth.

In other words, your daughter having skipped her Risperdal for one day was essentially meaningless from a pharmacological standpoint.

When a person has been on meds for quite some time, the medication is not only in their blood stream, it is also in their organs. Even though the medication may leave the bloodstream according to the half life guidelines, it can take many weeks for it to completely leave the organs.

As an example, I was once on a drug with a half life of 25 hours. I was not completely "clear" of it for 8 weeks.

Good luck with whatever you choose to do.


asta

Thanks Asta. I feel like I'm complaining at this point and I don't mean to. My error is to prescribe logic to the symptoms or lack there of in the use of meds. I'm going to do what (forgot who, but responded above) "poster" suggested and give 1 med/adderall at a time, keep journal. If necessary then introduce R after a month or whatnot. It seems these meds can "enter" the bloodstream quickly, but take weeks to clear....no?