Next Steps

I'm a mom, first and foremost. And as a mom, I worry about my kids. It's kind of my job, along with making sure they are safe, happy and taken care of. But when your kid has issues like mine has issues, that worry can kick your ass.

My kid is severely ADHD. He's also diagnosed ODD (Oppositional Defiant Disorder) and SID (Sensory Integration Disorder, aka SPD (Sensory Processing Disorder). ODD is very commonly found as a comorbid diagnosis with ADHD. In my opinion, it's also a very harmful diagnosis to acquire, or at least it can be.

Why, you ask, is ODD a harmful diagnosis? Just read the two major players in the name of the disorder. OPPOSITIONAL. DEFIANT. Pretty negative way to describe someone, isn't it? Do you feel sympathetic to someone who is labeled oppositional and defiant? Does it make you want to help them? Or do you find yourself looking at these oppositional and defiant people as troublemakers and people who are going to cause problems for you?

Long ago, when I first started this journey with my child of trying to help him with his issues, I decided that whatever labels were given to him were fine by me...as long as they help him get the services and assistance he needs. Read that again. As long as they help him get the services and assistance he needs. What I've found is that a diagnosis of Oppositional Defiant Disorder gets him nothing but looked upon as someone who is, by definition, oppositional and defiant, and by extension, a troublemaker and someone upon whom many, many things can be blamed.

Here is the definition of Oppositional Defiant Disorder:

* Actively does not follow adults' requests
* Angry and resentful of others
* Argues with adults
* Blames others for own mistakes
* Has few or no friends or has lost friends
* Is in constant trouble in school
* Loses temper
* Spiteful or seeks revenge
* Touchy or easily annoyed

Am I saying that my child does none of these things? No, clearly he does them or he would not have qualified for this diagnosis 5 years ago. But as a layperson, teacher or someone otherwise involved in my child's life in a non-medical, non-psychological way, having a child labeled ODD is harmful. Humans as a rule want to put people into metaphorical boxes so that we understand how each person is "supposed" to act. When you expect someone to act a certain way, you start looking at their behavior through that lens...and it can very easily become habit to look for the negatives, or even the not-good-enoughs, instead of seeing the efforts that person makes, and even the good behaviors, outside of the label you gave them.

Right now, my child is facing a diagnosis of depression, an adjustment disorder w/depression, and maybe an anxiety disorder...in addition to ADHD, ODD and SID. He's 9. I am worried for my child.

He doesn't want to open up and talk about his peer relationships with his therapist, the person who did the extensive testing back in March, or even with me. That's new...and it's weird. So says me...and the professionals. Hence, the adjustment disorder. He is clearly going through some emotional trauma and feels unsafe or upset talking about his friends, or lack thereof. What was the impetus for this? I can guess it was something that was fairly devastating to him that happened a school a while back. I could be wrong.

I love my kid. My kid is a pain in the ass. My kid is a stellar little guy with a HUGE heart and a great smile. He has a special ability to piss people off. I'm glad for the person he is, and I sincerely hope that his trials at such an early age will make him stronger, not broken.

The next step is a meeting with all professionals involved in his treatment so we can brainstorm and come up with viable treatment options, be they medical, pharmacological, or therapeutic in nature. In addition, at the end of April, our wonderful psychologist will be accompanying my husband and I to an IEP review/revision meeting at the school to talk about the results of the testing done in March, and what the resulting changes in his IEP will be. After that? No idea...I just know that we will keep plugging along, trying to help him as much as we can.

Can we ever win?

Doesn't seem like we can.

The first week at school that M was on his new medication, it seemed to be working well. Now it seems that it isn't working so well...she says that from 10/13 to present, his behavior has deteriorated. And she filled out a new Conners rating scale and some stuff is WORSE than it was at the beginning of Sept. I wonder if she was in a bad mood when she filled out the scale or if this is accurately represented...I just don't know anymore.

I can't believe a medication can lose its efficacy that quickly. Maybe there is no satisfying this teacher. Maybe this *still* isn't the right dose. Maybe this isn't even the right medication.

I *think* it's working better than the Vyvanse was, but maybe not. At least he seemed to be even with the Vyvanse.

We see the psychiatrist this week, so I'm sure we'll be on the next dose up starting soon.

Have I mentioned how much I hate ADHD? It really sucks.

Day Five...Concerta

Color me surprised. M on 18mg of Concerta for 2 days wasn't the hellish experience I was expecting. He was actually pretty ok.

Today is day 3 of 27mg, so tomorrow we start on the 36mg dose that we've been building up to.

The only real negative I'm seeing is a reemergence of facial tics. But I don't feel too worried about that as we've seen transient facial tics with almost every medication he's been on. They seem to be mostly related to him feeling stressed or tired, and today he is *definitely* worn out. Not only that, but he's not in his normal routine this week, which always makes him feel more stressed than usual.

Overall I don't have a feeling about the Concerta one way or the other. It doesn't seem to be *that* much better than Vyvanse, but we also aren't on the therapeutic dose yet. We may see that 36mg is fantastic as compared to the 50mg of Vyvanse we were on before.

Day One...Concerta

Today is day one of trying M on Concerta. Things aren't going great at school, and the psychiatrist is worried about lots of things after seeing the Conners rating scale the teacher filled out.

M unmedicated is not a pretty thing. Since we're starting at 18mg of Concerta, I think the next 2 to 3 days are going to suck for all of us royally. I don't mean to be negative, but we've been through medication changes before and they weren't pretty.

What I'm hoping is that the Concerta, even though we've tried it before, will hit different receptors in his brain than the Vyvanse did, and that we'll see some of the behaviors that are causing school/friend/etc issues will lessen.

This is a work in process, as is any ADHD medication. Today and tomorrow we'll do 18mg, then Sunday or Monday we'll go up to 27mg. Two to three days on 27mg and then it's up to 36mg for the next 10 days. After that, school will be back in and the real test will begin. We'll see in which areas the meds are helping and which they aren't. We'll decide whether to increase the dose to 45mg or 54mg. We'll also see if we need to tweak the times he gets his meds. There's the possibility that we'll do a short acting in the morning and the long acting at lunch...but for now, we're trying the long acting in the morning and continuing with the short acting in the afternoon as usual.

Wish us luck.

If Concerta doesn't work, we go back to Vyvanse until school lets out again in December...then it's on to Focalin.

Have I mentioned how I much I hate having my kid on meds? It drives me nuts. I hate that he has to take medication to make him "socially acceptable." But I continue the meds because I believe there are children in this world who need medication to function...and children aren't equipped to not be accepted by others. And if this helps him function and gain acceptance from his peers, then this is what we'll do. We've tried everything else...diet, exercise, behavior modification...and on their own, the ends don't justify the means.

While I hate any child to be on medication, I also believe that it's not just about the child. It's about the family. If having a child (or parent) on medication is what's best for the family AND the child, then so be it. We have medications available to us for a reason.