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.