Too Fast, Too Much, Too Loud

Can I have my rubber room now?

Plays piano too fast. Eats food too fast. Uses too much ketchup, syrup, salt, Parmesan cheese, you name it. Bursts in the door talking at the top of his lungs without finding out what he might be interrupting. The excesses of ADHD. I can hear him gulping down everything he drinks, gasping for air in between gulps or chews or whatever else is going on in his mouth as he tries to breathe at the same time.

Sometimes I think I will go mad. He doesn't have a clue. The body is moving faster than the brain. The body is moving in one direction and the brain is going in the other.

Oprah talks about mindful living, identified as deliberate and thoughtful execution of whatever one may be doing. This admonition is not qualified by disorder or a lack thereof. She's speaking to people in general, not to ADHDers in particular. The ADHDer is equipped with a compromised executive function. The ADHD child can't even begin to wrap his head around mindful living. The ADHD executive function can be improved with medication but only to a point. Teaching mindful living to the ADHD child rests with the coach.

 
There are many types of coaches. There are football coaches, Olympic coaches, executive coaches, career coaches and the list goes on. An ADHD child will benefit from a life coach.

That would be me.

 
A fundamental difference between the other types of coaches and a parent coach is that the parent coach is coaching ALL! THE! TIME!! It doesn't end. The limits of my patience are tested from morning to night, sometimes in the middle of the night, day in and day out. In all of this, I must not lose sight of the limits of David's executive function. If I can keep that in mind - a disability perspective - then I can handle it.

But, I have more duties, responsibilities and, yes, desires, than teaching and coaching my son. I, too, have limits. Life in the 21st century is stretched to the limits. When it all becomes more than I can handle, I have found that honesty works. I don't try to be something that I can't be, like, uh, superhuman. There are times when my needs supersede his. I tell David what I need. I need quiet, I need a moment, I need a room with a closed door. If I can tell him what I need without exasperation, irritation and annoyance or the big whammo, anger, it's as good as it gets. I don't wig out. He learns consideration for other people.

Win-win.

BUT! If all else fails and there HAS to be a loser, let it be the Barbies!

Best regards,

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 :)