Wanna play doctor?

Excellent. The patient is my son.

JP is 9-years old. At the age of 6 he was diagnosed with ADHD and anxiety disorder. It’s worth noting that JP’s symptoms increased significantly after he was assaulted by another (Kindergarten) student about 6-months prior to the formal diagnosis.

He’s been medicated since April 2009. The meds list is as extensive as it is frustrating. We tried on meds like a high school senior tries on prom dresses. He’s cycled through most of the usual ADHD meds like this: try a new one (low to medium dose) have it work for a couple of weeks. Effectiveness starts to wane by the month mark, increase incrementally until it’s not possible to increase any more. Switch to new medicine, repeat the cycle.

Antidepressants came into the picture in second grade (Spring 2010). JP became increasingly anxious in the classroom crying, refusing to answer questions. It was easy to regard him as a young fatalist. Give JP a scenario and, no matter how positive you try to spin it, the child could worry until it was The Worst Possible Outcome.

Prior to this incident this was his medication list:

Concerta ER 2- 54 mg tablets (108 mg total) once daily (generic, morning)
Prozac 20 mg capsule once daily (generic, morning)
Oxcarbazepine 300 mg twice daily (morning/ bedtime)
Intuniv 3 mg tablet once daily (bedtime)
Benadryl 2- 25 mg tablets (generic, bedtime)

Then his psychiatrist decided to do this:

Stay on the Concerta
Wean him off the Prozac- he’s taking 10 mg once daily (generic, morning) for 10 days and then off it entirely.
Drop the Oxcarbazepine.
Stay on the Intuniv.
Stay on the Benadryl if still needed.
Add Risperdal 0.25 mg twice daily (morning/ bedtime).

He’s been off since the day after his first dose of Risperdal. Nothing marked, just not entirely himself. I chalked it up to that period of adjustment that comes when a new med is on board.

And then Saturday happened. My JP did not wake-up. A Pod Person JP did. If he were a teenager I would suspect him high or hungover. But he’s 9 and while there are some 9-year old addicts and alcoholics, my son is not among them.

He was listless. Wandering. Hazy. Lethargic. He took a 3 hour nap in the late afternoon and then went to bed at 8 pm.

Then he started complaining of chest pains. He was a little wheezy and, while he doesn’t have asthma, his sister does so I went ahead and gave him a nebulizer treatment.

Sunday was a carbon copy of Saturday.

Monday was more of the same. He stayed home from school. I saw no point in sending him. He’ll be home again tomorrow. In fact, I’m keeping him home until the Risperdal is out of his system.

Since dropping the mood stabilizer (oxcarbazepine), backing off the Prozac, and starting the Risperdal I’ve seen a significant reduction in his picking at his fingers and lips. He seems more…comfortable in his own skin.

On Saturday (because we didn’t get his prescription picked-up in time) he didn’t take his Concerta at all and was fine. I was GOBSMACKED when Mr. G told me he wasn’t medicated.

Those^^^are the facts.

Here’s what I think:

I think he has Asperger’s. High functioning, but I think he has it. I also think his intelligence has helped mask the Asperger’s. The older he gets, the more convinced I am that he is missing a key part of his diagnosis- mostly because he doesn’t fit socially.

I think he has ADHD but I am not convinced that the behavior we’ve seen is wholly and entirely a result of ADHD. I think he’s trying to overcompensate for his social ineptitude with what he thinks is “cool” behavior. Unfortunately, social cues are often lost on Jack.

I think his anxiety is worse than the ADHD and that his inappropriate behavior is driven by anxiety.

Here’s what I don’t know:

Where we go next. What medications we should try or not try. How to help him. What the magic formula is.

I’m scared, angry, frustrated because I don’t know how the hell to start. Or where to start. Or what to do. I’m open to any and all observations, suggestions…anything.

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12 thoughts on “Wanna play doctor?

  1. Wish I had an answer. Not sure if this will help, but I am heading into what may become a very acrimonious meeting at Nate’s school regarding his needs and serves for next year and am uncertain about the other participants’ motives. Wish I could help. You all don’t deserve this. (hugs)

  2. That is a lot of medication for a short person. I am assuming you have a pediatric psychiatrist treating him and not a general peditrician. If not, that would be the first place I would go. Anxiety can be a lot of this. I am not a professional, only a student heading toward that goal. And I will not go as far as to presume I know anything about your child. BUT even though the risperidal made him zombie-like, you did not notice his Concerta lack. It may be that his dosage is too high, or he is adjusting. I know you are in hell. I am sorry. I am praying and have been since your twitter post last week. But to make that many medication changes all at once, it is hard to know what is causing which change. Even titrating down or slowly bulding up can cause things like the sleeping and such. Good luck!

    • We’ve been seeing a board certified pediatric psychiatrist for not quite a year. We go back on Friday and, of course, while I was at the pediatrician, she called back. Ugh. We did 1/2 dose of the Rispridal this morning and he’s not as foggy. Yay?

  3. Kids diagnosed as having extreme ADHD usually actually have High Functioning Asperger’s, in my experience. I believe he has HF Asperger’s. Without a doubt.

    Suggestions: Brain Balance. Seriously, call them at least for the assessment. 913-627-9400. Ask for Karen Rosetti or Rebecca. Both know me as “Michelle Worley from Shelterwood”. Please call them. They can help. They will suggest an assessment and Protandim (natural supplement they’ll tell you about-take it yourself and have JP start it…I’m starting it this week myself).

    Play therapy/Sand tray therapy. JP is SMART. Talk therapy will actually not be as helpful to him as play therapy. Make sure the therapist is a licensed play therapist, not just someone who does play therapy techniques.

    Call me for any other info you need. I’ll help however I can.

    • I’ll call touch base with them tomorrow. I have to pick up SG from school soon and then we have fencing and ballet so I won’t be home/ available to be on the phone.

  4. Yes to Brain Balance!!! My friend took her son there…….she was happy! I think just the supplements alone helped her son!
    I have much more to say but not enough time to say it…….in a nutshell…..my twin brother has ADHD, depression, learning disabilities. And um yeah, can’t read emotions, social cues, etc, along with many other ‘spectrum’ indicators. At 38yrs old though, he won’t go back to a pediatric psychiatrist or psychologist to get an official diagnosis.

  5. I shared this information with some other teachers and a good friend of mine who has a daughter with special needs. Everyone was in agreement that they thought JP was on the spectrum (probably high functioning Asperger’s). My friend takes her daughter to Dr. David Dunn at Riley’s Children’s Hospital here in Indianapolis. She said that he is a pediatric neuropsychiatrist who is excellent. Are there any pediatric neuropsychiatrists in your area? My friend thought that if you called his office they might be able to point you in the direction of resources and possibly someone to contact in your area. She told me that Dr. Dunn would say that 108mg of Concerta is way too much! Her child has been on Concerta in the past.

    In my own experiences as a teacher working with many families, my gut feeling is that you are not being given the right medication plan from your psychiatrist. It seems as if it is too much medication. I also completely agree with you that his anxiety is probably worse. The behaviors that we label as ADHD often have root in another issue.

    It is heart wrenching to know what you have to deal with right now. Praying that all the professionals involved in working with your family are able to figure out how to help JP. Be strong and continue to be your son’s advocate. You’re a great mom!

    Here is Dr. Dunn’s profile.
    http://www.iuhealth.net/portal/IUH/findadoctor?paf_gear_id=6900001&paf_dm=full&paf_gm=content&task_name=displayBio&contactId=83493&history=1

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