ADDclasses.com

Some time ago, I stumbled onto this website and found it to be immensely helpful in our continuing quest to treat and manage ADHD. ADDClasses.com offers virtual support and continuing education in the field of Attention Deficit Disorder. The teleseminars are free for a period of time (registration is required) and also for a period of time, you can download the mp3 recordings of the seminar for a nominal fee. Not only can I store it on my computer for future reference, but I can burn a CD so that my husband can use his workday commute to keep up with the information and direction that David and I are trying to incorporate in our homeschool and our daily lives. A huge thumbs up for this one!

I recently listened to a teleseminar hosted by ADDClasses.com and the guest speaker was Laurie Dupar of Coaching for ADHD. Her topic was "The Top Three 

ADD/ADHD Medication Pitfalls and How to Avoid Them." Not only did she offer a wealth of information about medications, she also offered a couple of tools to the seminar participants. One is a list of key questions to ask the prescribing doctor for ADD/ADHD medications. The other is a medication log to assess the effectiveness of a change in medication. Since we are in a medication evaluation mode right now, these tools will be invaluable!

I thought I would pass this along. Hope you find it helpful :)


Cheers,

leapinlily

Mother Knows Best

They are the professionals but you are the expert.

About eight months ago, I wrote a post about changing David's medication. This is an update to that post. At that time, we were switching David to Methylin ER, a generic six-hour medication that was to deliver a level, longer acting effect and reduce the occurrence of rebound. It did, in fact, deliver a level, longer acting effect and reduced the occurrence of rebound. It was cheap and always in stock. It also produced a deleterious side effect that quickly escalated to alarming.

David began to have movement issues. I don't know how to describe it. He called it shifty. "I feel shifty," he would say. While seated he would half stand up and down, not just once or twice but over and over. To look at him, one would think his tail bone was itching and he was using the chair back to scratch it. While trying to settle down for sleep in his bed, his legs would move and move and move. He could not lie still.

I have a friend with a son who was treated for ADHD and ended up with Tourettes Syndrome as a result of medication. My cause for concern was huge. I researched Tourettes, Restless Leg Syndrome and tics. The shifty symptom had presented itself with the introduction of the Methylin ER. However, the picture was complicated by the fact that we had increased his dose of Paxil and Trazodone at the same time. It was extremely difficult to determine which factor might be responsible for the new side effect.

During the course of my Internet research, I came across a forum of ADHD medication users. The discussion centered on the difference between generic and brand Ritlin. For the most part, this group of people espoused the superiority of the brand Ritalin over the generic, with the brand delivering a much "cleaner" effect than the generic.

Highly intrigued, I took the question to the psychiatrist that is prescribing David's meds. The doctor said that there is no difference between the brand and the generic except the price. The active ingredient is the same. Next, I took the question to the pharmacist that dispenses David's meds. The pharmacist said that there is no difference between the two except the price. The active ingredient is the same. The question was now changing to who do I believe, the professionals or the people who actually use the medication?

The prescribing doctor and I kept David on the Methylin ER for another month. In the meantime, we also saw David's therapist and I posed the generic vs. brand question to her. Her response was immediate and sincere.

"Oh, yes, there is a big difference."

"You know this because of people that you personally know are using it?" I asked.

"Yes."

The next question was for David himself. I asked him that if he had to choose, would he choose shiftiness or rebound. His response was immediate.

Rebound

That was it for me. I decided that we had nothing to lose by making a change. At this point, the doc was suggesting yet another medication to treat the restless leg syndrome. I was determined that David was not going to take on a fourth medication, especially to treat a side effect! I put all my research together and formulated the plan.

First, he would switch to brand Ritalin in the dose that I had determined would be a pill splitting dose as so manu of the people on the forum people talked about this factor. We would go back to designer dosing and only use the short-acting brand Ritalin when he needed it, which is usually only mornings. Second, he would take the Paxil at night instead of the morning and we would dump the Trazodone all together.

Two meds, not four!

Within a month, the shiftiness had greatly diminished. I am happy to report that it is now completely gone. He is sleeping through the night without the Trazodone. David is less medicated and his situation is much improved.

Win-win

Years ago, my oldest daughter's speech development was delayed because of chronic ear infections. Initial testing determined a delay but not enough of one to qualify her for a speech therapist. Six months later, I sensed that she was going backwards in her speech development. I again asked for testing and she qualified for services. The speech therapist said this at our first appointment - "We are the professionals but you are the expert." I never forgot it.

We, the people, patients and parents, ultimately bear the final responsibility for our health and well being. Not the doctors. The doctor/patient relationship is a partnership and the balance of power belongs to the patient (and his parents.) The doctor is the employee and I am the employer. The doctor is the professional and I am the expert. The doctor can only do so much and the patient (and his parents) must do their part. Ulitimately, there is more to treatment than medication. But, that is for another post.

Cheers,

leapinlily

PS to Monday's Post

David expressed his profound and sincere gratitude more than several times for the way we handled the medication mix-up. He went to bed early and is now getting a good night's sleep :)

Medication Mix-up

Don't make a bad situation worse.

It's Monday morning. David is in bed and will most likely be there for a while. We had a big mix up last night. We are certain that he took a dose of methylin (a long acting stimulant medication for ADHD) when he should have taken trazodone (sleep and anxiety medication). He was already in bed when he became very disoriented and confused. While the methylin doesn't have this sort of effect on him during the day, I witnessed a wild-eyed agitation that could not be the result of trazodone. In the kitchen, I found the methylin bottle sitting apart from the rest. I counted the pills and it came up short - by one. How could this have happened? Well, for one thing, the two medications look alike - round, white pills of a nearly identical size. They come in the same size and color container from the same pharmacy. While I always check the label to make sure that I am getting the right one, David just grabbed one, opened it up, saw that it looked like the right one, and swallowed it down. The methylin is a new medication for his ADHD and looks different than the previous one. This would not have happened with the old medication.

So, there we were! We had stayed up to watch the closing ceremonies of the Olympics. He had spent a good portion of that time playing a demo of a game that we vetoed because of it's questionable imagery. He was on the computer doing one thing or another until bedtime, a practice that stirs up his brain instead of calming it down. And, finally, he took the stimulant medication instead of the sleep one. End result? David is going to be up all night. And, probably, so will I.

I struggled to keep my own composure because, quite frankly, I was angry. I was angry that my own sleep was now going to be compromised. David's anxiety can be overwhelming for him. He's phobic, with scary sights and sounds being the core component of his phobia. So, I was angry that I didn't monitor what he doing on the computer and angry that he didn't monitor himself. I was angry that he didn't stop for one second and make sure of what he was doing with the medication. Mostly I was tired at the end of a long weekend and frustrated by the impending situation.

My first challenge was to decide what to do with myself. I could not allow my feelings about this situation overwhelm me and then propel me to make a bad situation worse. How could I make it worse? By making my feelings and my frustration the focus of the situation. By hammering on David for making such a stupid mistake. By letting him take full responsibility for the sleepless night I was about have. By leaving him to deal with the consequences of his actions while I go on my way to get my sleep. The possibilities for self centered thinking were nearly endless.

Truth is, David was not responsible for the mistake. ADHD is a disorder of brain function. The main components of the disorder are distractability, impulsiveness and the inability to attend. He does not choose to operate the way he does and the grief and frustration that he feels over the manifestations his disorder are profound. No good will come out of making him responsible for things that are simply out of his control.

After a moment of silence, a deep breath, and a long, hard look at the suffering child in front of me, I sideline my own feelings and fatigue and start to think win-win. I set up David on the living room couch with the tv remote. He can watch the rerun of the closing ceremonies. I get Otis to keep him company. I gently quiet him as he makes his 50th apology for being such a bone head and tell him not to worry. It was a mistake anyone could have made if they were not reading labels and we would initial the caps of his medicine bottles so he wouldn't make the mistake again. I reassure him that I am in the next room if he needs me. He becomes calm and I begin to turn my attention to getting some badly needed sleep.

Win-win thinking entails beginning with the end in mind. In the end, I want to get some sleep (David may not be able to until the meds wear off). I want a strategy to ensure that no medication mix up occurs again. Mostly I want David's self esteem to incur no further damage in this situation. ADHD is a killer of self esteem. I am his coach. My job is to find the errors of execution and figure out ways to fix them. If they can't be fixed, then I figure out how to get around them. Effective coaches build up, not tear down. As his mom, teacher, coach and one who loves him with all of her heart, my first responsibility is to do no harm. Dr. Laura Markham expressed this concept in heartwarming detail in her article Stop, Drop and Listen.

It is morning. I got my sleep and am now enjoying some some quiet time to myself while David gets his sleep. He will not wake up and remember that I was angry. He will remember that we solved the problem.

Win-win.

Best regards,

leapinlily

Medication Changes

It was several years ago when we decided to consider medication for David's ADHD. Most parents don't want their child on medication and we were no exception. However, something that his first grade teacher said during one of our conversations about his probable ADHD hit a nerve. She made reference to medication giving David relief. That comment brought it home that this was not about the frustration with the constant disruption that the disorder brings to the family and the classroom. It was about David. The word relief crystallized the realization that the disorder caused the most frustration and disruption to the life of the disordered person and all others were secondary. Dad and I relinquished our position and moved forward with medication. There is victory in surrender.