typical path for exploring meds?

[ceratops]

DS with ADHD (background described here:
millermom.proboards.com/thread/13521/new-appreciate-comments-test-results)
started with Metadate CD 10 mg earlier this month. We didn't notice much, if any, effect. He thought he was doing a little better at working with others at school; I thought he was maybe a bit grouchier and more obnoxious in the evening, after the med wore off. On advice of psychiatrist, he went up to 20 mg dose daily, as of last Thursday. We're still not seeing much effect. He was taking the higher dose this past weekend, and seemed pretty much the same as usual. No improvement in behavior or focus, that I could see. Maybe a bit more obnoxious toward his parents than usual, but nothing noteworthy.

My question really is about the next step. It's my impression that many/most kids who have success with Metadate end up on a dose higher than 20 mg. At our last appointment with the psychiatrist, however, she was already talking about switching and trying something else (maybe Concerta) if the 20 mg dose doesn't work. That surprised me, since I assumed we'd go higher with this med first before trying the next one...

Should we be seeing something with the lower doses, if Metadate is going to work for him in the long run? Or am I correct in thinking it is too early to jump to the next thing? I don't know much yet about ADHD meds, but I thought dose response isn't linear with most of these medications -- i.e. it may appear to do nothing at a lower dose, but still have the hoped-for effect at a higher dose?

[hsmom]

My son was diagnosed with ADHD combined and LD-NOS (poor working memory and slow processing speed which affected his performance in all academic areas at age 9). In fact, he was 2 years behind in reading, writing, and math at that time. We held off on medication for a year, but by the time he was 10 we were convinced that he needed it.

In our case, his doctor started him on Concerta as it lasted longer (10-12 hours). We thought he would need it for after dinner homework time. However, with my son, it lasted too long. He was not hungry at lunch nor at dinner time and it was not until just before his bedtime that he would eat. Concerta was in his system for over 12 hours. Thus, we chose with his doctor to try him on Metadate CD which was reported to last 8 hours and had gentler, smoother let down. Metadate CD releases 30% of the dose when first taken and the rest is released after four hours. He started with 30 mg which was effective for 2 years and increased to 40 mg when he was 12. He is still at this dose at 15 and it does get him through afternoon athletics and after dinner study hall.

I would ask to try 30 mg of Metadate CD before changing to Concerta. This is just my opinion. However, as you may know from reading on this forum, even within the same class of ADHD medication such as Methyphenidate (e.g. Ritalin, Metadate, Concerta, etc.), different children react differently to them so you do not yet know which medication ultimately will be the best for your son. 

[michellea]

My son has been on Concerta in various doses for 8 years. Like hsmom - initially it reduced his appetite significantly and we could tell when it wore off at about 7:00 pm and he would begin eating! That said, the 12 hour release has worked well for him managing homework and sports. In the summer, he would take short acting ritilan when he needed medication for tutoring, golf or other activities that required concentration.

As far as how to find the correct med - we were lucky and Concerta 18 mg worked from the start. So, I am not sure whether it is more common to change medications or tweek dosage to find the best solution.

I do want to caution you though on certain generic forms of Concerta. Concerta is a methylphenidate, like metadate and ritalin. It is unique from the others in the same drug class in its delivery system. Concerta uses osmotic pressure to deliver methylphenidate HCl at a controlled rate - and this accounts for the smooth delivery and reduces some of the let down effects. The system, which resembles a conventional tablet in appearance, is what makes Concerta, Concerta. When comparing generics, some use the concerta delivery/release system (Watson) and retain the AZRA stamp on the capsule. These generics are the same as the original by most accounts. Some of the newer generics to hit the market use a different release that is comparable to the delivery system as Ritilan LA - NOT the osmotic system that Concerta uses. Thus, with the newer generics (from Mallinckcrodt) you are not getting Concerta - because Concerta is the combination of the DRUG and the Delivery system.

Generic versions without the OROS are essentially Ritilan LA. This is not bad - you just need to know that you are not really using Concerta.  

Since January 2013, some pharmacies are now only selling the bogus version. I found out at my last refill that CVS would no longer be using the "good" generic from Watson (capsule stamped with ALZA) and CVS has switched to Mallinckcrodt to supply their generic Concerta. I had to call around and finally found a Walgreens that carried the "original" Concerta generic with the proper OROS delivery system and the ALZA stamp on the capsule.  I am not sure how much of a trouble this will be going forward.  

If you decide to try Concerta, talk to your physician about this. If you must buy a generic, perhaps he/she will specify the generic with the OROS delivery system. (I plan on having a conversation about this at the next appointment)  Caution - some doctors and pharmacists maintain that the two drugs are the same. They are not - remember - what makes concerta concerta is the combination of the methylphenidate and the OROS delivery system.

Two blogs I felt helpful:

www.addconnect.com/groups/topic/Mallinckrodt_generic_concerta_does_NOT_work/
adhdrollercoaster.org/the-basics/whats-up-with-generic-concerta/#.UpTCOihOg04

[hsmom]

Metadate CD which for the longest time had no generic now has two, one made by Kremers Urban which is an “authorized generic” in that it is the actual brand-name medication made by UCB that is just packaged and sold under a generic name and one made by Teva. My son's experience with Metadate CD has been with the brand-name version made by UCB. His doctor was able to get approval from our insurance company for the brand-name when they wanted him to change to the generic this spring as he had been doing so well for a long time with it. It sometimes take time to get it; I usually phone the pharmacy ahead of time telling them that I am bringing in a prescription for Metadate CD.

I know that Mayleng's son did not do well on generic Metadate CD.

[Mayleng]

My son was on 30mgs Metadate CD for 11 yrs, and we upped it to 40mgs when he turned 16 and he has been on it since. He is now 18. All was well until a year ago, when the pharmacy changed it to Generic Metadate unbeknownst to me. He started having anger issues and appetite problems. But since we have gone back to brandname this year, he has gone back to "normal". My advise is to try a higher dose (40mgs is the highest they make), and see if it works. Concerta at a higher dose did not work for my son except to give him side effects.

[ceratops]

Thank you all for your feedback, and for cautions/information about generics!

DS is taking brand-name Metadate CD; psychiatrist had thought we would end up with generic, but pharmacist told me that the insurance will pay for name brand but not for generic in this case (I have no idea why, but I wasn't arguing).

After 5 days at 20 mg dose, I asked DS to take 30 mg one day, to see if that would make any noticeable difference. At the end of the day, he said he didn't notice much, if any, difference. However, he also said he thought he was faster taking a timed test at school that day, but wasn't really sure. I've asked his teachers for feedback, but haven't heard anything yet.

The psychiatrist had asked that we call her after a few days at the 20 mg dose of Metadate CD, to tell her how things were going, so I did that. After telling her what we had (or hadn't) seen with 20 mg, and with the one day at 30 mg, she, rather vaguely, suggested that we try Aderall (sp?) next. At DS's last appointment she was talking about Concerta as a next step, so this new suggestion really surprised me. I asked whether she really thought it was time to leave the methylphenidates already, and she seemed to change her mind right away. After a bit more thought she suggested Focalin, and is now sending us a prescription for an extended release version of Focalin. The whole thing just seemed very ad hoc and wishy washy. I had the distinct impression that she would have followed my suggestion on what to prescribe next (she actually said, "it's up to you..." at one point). That's great if you know what you want to have prescribed; not so great if you're almost a total novice at this stuff, and relying on the doctor for professional guidance. Regarding effect, or lack of effect, of the Metadate CD at the doses DS has tried, she made a comment that he might not be the best observer of the effects... but still, we're moving on apparently.

I guess Focalin sounds OK as a next step (there's my opinion, based on very little information), but I'm still surprised that the doctor didn't titrate up to higher doses on the Metadate CD first. Also, her general vagueness about what to prescribe next, with changing suggestions from one conversation to the next, is perplexing. She also said the extended-release Focalin is longer lasting than Metadate CD. I don't think that's right, is it?

I need a 'head-scratching' icon...

[Mayleng]

If I were you, I would be the one in control. (I took control of my son's medication trials because my son's Peds honestly told me they just prescribe whatever the Pharma Reps push to them, and I know for a fact many do not read the prescribing info. It worked out well that I was in charged and the Peds was willing to work with me, rather than forcing a medication that I did not agree with). It seems your son's Psychiatrist has no basis for the way she is having you find the right med and the right dose. Give the 30mgs a try for a week, if you see no difference then go up to 40mgs. What is there to lose? If they don't work, then move on to the next medication. With whichever one you try, start low and work you way up. Most times your son would not know the difference, you and the teachers will have to be the ones to keep an eye on him, and write down what you notice on what dosage etc.

[healthy11]

My son doesn't have experience with Metadate or Concerta, so I haven't responded to your post up to this point, but I do concur with Mayleng that you would probably be better off ensuring that one medication isn't effective before switching to another. I've attended a number of seminars with speakers who are psychiatrists that even do research in ADHD meds, and that is also what they say. Everyone's metabolism is different. You shouldn't automatically assume that a particular medication won't work, if you haven't tried its full range. It doesn't sound like your son is having bad side effects with the Metadate CD, so gradually increasing the dosage until you see an effect, or reach the maximum, would be a logical next step.

[ceratops]

Thank you Mayleng and healthy11. You're both confirming my discomfort with the psychiatrist's unsystematic-looking approach. I just hadn't expected such lack of guidance from her, so I wasn't prepared to give a strong opinion of my own... other than saying I thought it was much too soon to decide that the methylphenidates weren't going to work for DS. Even with the Metadate CD, DS was on the 20 mg dose for 5 days, and then had just one day at 30 mg before the Thanksgiving break. I haven't yet gotten any feedback from the teachers on whether they see any changes. I haven't yet filled the new Focalin prescription (don't even have it in hand yet), so maybe I should call the psychiatrist again, and ask to go up some more on the Metadate CD, and also suggest that we wait to talk to DS's teachers before moving on to a different medication. Do you think that sounds reasonable?

DS's situation seems a bit more complicated than average to me, because he has sleep problems, and also has a history of depression (along with the ADHD that we hope these medications will target). That complexity is one of the main reasons we went to a psychiatrist to help guide us through the medication trials (rather than just turning to DS's pediatrician, whom I know and trust). Unfortunately, I'm not seeing a lot of guidance so far.

[Mayleng]

ceratops, yes it is reasonable to get input from the teachers before changing to another medication. Like I said, metadate cd only goes up to 40mgs anyway, so you only have 2 more dosages to try before changing to another medication. There needs to be a systematic approach to finding the right medication as well as the right DOSAGE. If the lowest dose will work all the time, why then do they make higher dosages? As long as you do not see side effects that are bad, it does not make sense to stop.

Be brave, this is your child, and only you have his total best interest at heart. So fight for him (even with the doctors).

[hsmom]

When we increased my son's dose of Metadate CD from 30 mg to 40 mg, it was his teachers who noticed the difference, not my son.

Metadate CD actually goes up to 60 mg. Below are links to the UCB website and MetadateCD prescribing information:

www.ucb.com/products/product-list/cns/metadate

www.ucb.com/_up/ucb_com_products/documents/Metadate_CD_06_2013.pdf


Below is also a link to the Parents Medication Guides put out by the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry.

www.parentsmedguide.org/

[michellea]

Just want to chime in - when we were working with the pediatrician, I found that I was more aware of some of the dosage options as he. We were at a point where concerta 36 was too light, but the next dose (54) was way too much ( found out by trying it, and my son was so "flat" it scared me). From this board, I knew that there was a 27mg capsule and suggested to the doc that we try a combo of the 18+27= for a 45mg dose. If I had not suggested this, I don't think he would have. It was at this point that we got a referral to a developmental neurologist to manage the the ADHD because I wanted someone with more specific experience and proactive guidance.

And yes, as Mayleng says, be an advocate - you have his best interests in mind like nobody else!!

[healthy11]

I don't know where you live, but I'm fortunate to be in a large metropolitan area where there are a number of different ADHD and mental health support groups and medical professionals to chose, including child/adolescent psychiatrists. At the time my husband and I decided to try medication for our son's ADHD, I attended several CHADD meetings, where some of the speakers were doctors. Between hearing their presentations and getting recommendations from other parents at the meetings, I felt more comfortable picking a psychiatrist for my son to see. It's been almost 15 years now that my son has been going to the same guy for med. management. Even though he's no longer in the same network and out of our insurance plan, we feel it's still worth maintaining the relationship.

I wonder if there are CHADD meetings/ other parents you can talk to and network with in your area, who might provide good referrals to a different psychiatrist, if the current woman doesn't seem to be sensitive to your concerns. (In addition, as your son gets older, it might be easier for him to relate to a male; at least my son has found that to be the case.)

[hsmom]

Ceratops,

I want to go back to what you said in one of your posts here, "DS's situation seems a bit more complicated than average to me, because he has sleep problems, and also has a history of depression ..."

I didn't catch this before, but I know the complication well as I have a history of depression and sleep problems which as you probably know are intricately interwoven. My depression is well controlled by antidepressant medication and have been for many years, but whenever I start to lose sleep over anxiety or any other reason, depression can come back and then medication needs to be increased or added to. I have always relied on a psychiatrist with excellent knowledge of mood disorders and medication to get me through. In your son's case, I would want him to see a child or adolescent psychiatrist with good knowledge of treating both depression/sleep problems and ADHD. And, they do exist.

[ceratops]

Thank you all for the advice and comments. I decided to go ahead, for the moment, with the Focalin XR (since it's at least along similar lines, being a long-lasting med in the methylphenidate family). We'll keep in mind that we may want to revisit the Metadate CD, since what we did so far was not a very comprehensive or complete trial on that initial medication.

Also, I asked DS's teachers whether they had seen any changes since he started on medication. Initially, I had thought it would be more scientifically valid if the teachers noticed changes without being clued in on whether/when DS was taking anything. However, since none of the teachers had volunteered anything, I finally went ahead and solicited feedback from them. Several of the teachers responded promptly -- one said she had not noticed anything, but would now pay closer attention and see if anything was apparent. The others who responded all said they had seen positive changes -- more focus, being quicker to start tasks, staying on task, participating more in class discussion, and being more helpful to fellow students. Those comments were all based on the period when DS was taking the Metadate (I happened to ask the teachers for comments just one day before DS switched from Metadate to Focalin). Assuming that some of these teacher observations are meaningful, that's pretty interesting -- at home I didn't really notice any positive effects from the Metadate -- what we saw in the evenings was negative rather than positive (an increase in silly, goofy, and obnoxious behaviors after the med wore off).

DS has been taking Focalin XR (10 mg) for 4 days so far, and the late afternoon behavior at home seems better. I don't know yet about school. DS's self reports (on both meds) have been somewhat vague. He says he notices something, but can't describe it very clearly, and doesn't want to talk about it very much. One day last weekend, when he didn't take anything (this was still during the Metadate CD period) he said he felt more hyper and more depressed because he hadn't taken anything that day. The 'hyper' part sort of makes sense, but the mention of 'more depressed' concerns me, especially since DS has a clinical history of depression.

All of this vagueness, and the difference in the reports of adults at school versus our observations at home demonstrates that this medication trial business is not a simple thing at all. Is there any more objective way to go about this? Since the psychiatrist doesn't seem very organized about the whole thing, I'm trying to figure out what I should be doing in terms of collecting and evaluating data. I feel like sending the teachers a questionnaire every time DS changes medication or dosage; however, I doubt that would be welcome, as they have 100+ students to deal with every day... Is it typical, though, to "observe" (and I use the term very loosely) the effect of meds in this totally ad hoc way??

I'm also concerned about sleep issues. DS has been taking melatonin at night since last summer, and that has made a significant difference, in terms of falling asleep quickly and staying asleep at night. Earlier in the school year, he was doing pretty well at getting up in the morning and getting going with the day's routine. I have the impression that the melatonin has also helped him with quality of sleep -- he reported that he used to wake up and have trouble falling asleep again in the middle of the night -- that got better after starting on melatonin.

Now, in the last month or so (coinciding with starting on the ADHD meds, although I can't say that it coincided to the day or anything obvious like that) we're back to having battles about getting up, every morning. DS regularly misses the school bus, and getting him up and to school is a miserable stressful experience, morning after morning. He's still taking melatonin in the evening, and still seems to fall asleep fairly quickly and efficiently, so I think the melatonin is still doing something. It makes me wonder, though, if the stimulant medication could somehow be interfering with his quality of sleep? Theoretically, shouldn't it be entirely out of his system by bedtime (14+ hours after he takes the med in the morning)?

hsmom, I know what you mean about the interaction of depression with inadequate sleep. I have a history of depression myself (never medically diagnosed, but I'm confident the label is accurate), and I can feel it creeping up closer to me when I'm short on sleep. For DS, yes, I would like to have him seeing a child/adolescent psychiatrist with knowledge about sleep problems and depression. This current doctor is a child/adolescent psychiatrist, and she certainly has been told of DS's issues with sleep problems and his history of depression. Whether she takes all this seriously enough, and whether she is skilled in dealing with these issues, remains to be seen, IMO. The scatter-gun approach to meds, thus far, is not impressing me much.

I should look into support groups, and referrals from other parents -- as several of you have suggested.

Thanks again for all the comments!

[hsmom]

How long a certain medication lasts in your son's body will depend on how fast or slow his body metabolizes it. I know that my son seems to be a slow metabolizer as Concerta which is said to be effective for 8-12 hrs lasted close to 14 hrs and Metadate CD which is effective for 4-8 hrs can carry him through 10-12 hrs. He had more problems with sleep and appetite on Concerta than on Metadate CD. But, even with Metadate CD, his appetite was affected for close to a year and he lost weight during the first year on medication. His doctor finally told him that he had eat at least a sandwich and a piece of fruit for lunch even if he wasn't hungry. 

I see from a chart I have, that the effective duration of Metadate CD is 4-8 hrs while that of Focalin XR is 8-12 hrs. Have you noticed any difference in how your son is when he wakes up when he was taking Metadate CD and now Focalin XR?  Or, is it the case that both medications are having similar effect on his sleep? See:

www.ncbi.nlm.nih.gov/pmc/articles/PMC2695228/table/t2-ndt-5-171/


The above chart comes from:

www.ncbi.nlm.nih.gov/pmc/articles/PMC2695228/?report=classic



If sleep continues to be a problem, there are non-stimulant medications for ADHD: 

www.webmd.com/add-adhd/guide/adhd-nonstimulant-drugs-therapy

I would, however, want to be seeing a psychiatrist who has experience using these medication were I to go this route.



I have used David Rabiner's two-page weekly monitoring report (given to me by his doctor) when asking for teacher feedback. His teachers at his private ld school were cooperative in filling them out.  

www.helpforadd.com/monitor.pdf



To me the positive behavior your son's teachers were seeing in school while he was on Metadate CD shows that the medication was effective while he was in school. However, by the time he came home, the medication had not only worn off, but he was experiencing a rebound effect and you were seeing a much worse behavior. And, with Focalin XR which lasts longer, you are seeing better behavior from him at home as well. Whether or not you use the monitoring report, you will probably want to know what kinds of behavior his teachers are seeing at school now, whether they continue to see positive effects. 



I know that this process of finding the right medication and dose can be difficult, but is so worth it in the end. It made a difference for my son in that he was better able to focus in class.

[Mayleng]

Sometimes, initial side effects will settle down after a few months on the medication, sleep and appetite issues are common.

[ceratops]

Well, I am back to update again. DS was on Focalin XR (10 mg) for about two and a half weeks. Toward the end of that time it became increasingly clear that the negative side effects were outweighing possible benefits for him, and we discontinued the med. He lost his appetite while the medication was in his system; interestingly, he hadn't had this effect on the Metadate. More importantly, his behavior and mood went way downhill while he was home in the evening -- angry, snotty, sullen, sarcastic, emotions on a hair trigger... He said, "I hate you!" to me about half a dozen times in a two day period (yes, he has occasionally said this before during his life, but the recent frequency was very atypical). Moreover, he also believed the emotion was reciprocated -- e.g. "you must hate me" and "you act as if you hate me!" Toward the end of the time on Focalin, he announced that he hated this medication, and refused to take it any longer. He is not very insightful (or, perhaps, not very open) in his descriptions of how he feels; all he really said was that he felt "very hyper" when coming off the med.

I've communicated further with school staff, including the school nurse, about the need for more objective feedback about how DS is doing at school. She said she would distribute a form to the teachers periodically (every few weeks and/or when I tell her that he's had a medication change). I think the first round of forms went out to the teaching staff while DS was on the Focalin, although I haven't yet received the results.

One interesting thing was that DS's behavior did not really return to normal right after discontinuing the Focalin. He said he felt better the next day, but still seemed more angry, obnoxious, and scattered than is typical for him. I know that theoretically the med should be out of his system, but he doesn't really seem back to normal yet, for whatever reason.

Since he has underlying sleep issues, I wonder if some of the behavior and mood problems we saw were not directly a result of the medication, but perhaps a secondary effect of sleep disturbance from the meds? In the past, we've certainly noticed that his behavior really suffers when he is short on sleep.

As it happened, a few days after we discontinued the Focalin, DS had another scheduled appointment with the psychiatrist. After listening to us, she suggested not taking anything for a while (over Christmas break, and a few weeks into the new school year) to let things settle down, and to get a feeling for where DS is without the meds. We'll also get a round of teacher feedback while he is unmedicated -- makes a lot of sense to me, as a baseline for comparison. I suggested that we start again with Metadate CD after the time off, and get some better feedback from the teacher the next time around. Although we didn't really notice any good effects from the Metadate at home, the anecdotal comments from DS's teachers (a few weeks ago) suggested that there was some improvement in his behavior at school. Moreover, we didn't see the same kind of negative side effects that we saw more recently with the Focalin.

One interesting thing I realized after leaving the psychiatrist's office -- when I described DS's behaviors in the afternoons/evenings coming off Focalin, she summarized that he was "more irritable" -- I think that's what she put in her notes. I don't really think that's an adequate description though. He was angry, disrespectful, sarcastic, nasty... I don't think the word "irritable" really covers what we were seeing.

This process certainly isn't easy to navigate. Some people apparently have immediate clear good effects from the first med they try. However, we seem to have a more complicated path in front of us.

[healthy11]

I have to admit my son has acted rude, irritable, and generally obnoxious to me ever since he was able to talk (years before he was diagnosed with ADHD or used medication for it) so in his case, it's hard to know what's "rebound," versus what's his innate personality. Your son's situation does sound significantly different, and I think the psychiatrist's suggestion about "taking a break" from all meds over winter break seems like an appropriate thing to do. Unfortunately, his behaviors may not be all medication related. I know I get irritable without sleep, and that's a possibility for your son, but at 12 1/2, your son is also at an age where he may very well be starting to encounter fluctuating hormone levels, and he's probably being exposed to other kids with sarcastic mouths in middle school, so if impulse control is a problem for him, he could me "mouthing off" without really even stopping and thinking before he acts/talks. (Adolescence is a challenge even for parents of "neurotypical" kids, and having ADHD doesn't make it easier, but hang in there ~ you WILL get through it!)

[ceratops]

Yes, that had occurred to me also -- i.e. that DS is really on the verge of teenager hormones and behaviors, which throws another likely factor into the mix. Thanks for the reassurance that we will get through all this. I sometimes feel pretty down myself, probably because I don't know all the answers (heck, I feel as though I don't know a lot of the questions yet at this point) and because being in conflict with my child and worried about his future is stressful.

DS is seeing a therapist also (different person than the psychiatrist prescribing the meds) -- hopefully that will help with navigating this process. However, the relationship with the therapist is still pretty new, so I don't feel as though there's much traction as yet. I've mentioned to the therapist that I, as a parent, could really use some help also in better responding to DS, especially when he is being really unpleasant and obnoxious toward me.

[healthy11]

Ceratops, many of us have experienced the same concerns/doubts/feelings as you. My husband and I also went with our son to a family therapist for awhile when he was a teen, and I suspect it did more for us than our son, just to have a "neutral 3rd party" listening to the conversation. Our son has always been more polite in the company of others than when it's just us, but back home, he exhibits much lower frustration tolerance (especially with me) and so it's hard to know if there were any long-term benefits. (Ironically, my elderly aunt, who had not seen our son in months, commented to me at Christmas that, "you probably don't see it because you're his parents and are around him more often, but he's really matured a lot over the past year." Again, I think he's much less patient with me, but I guess any improvement is better than none!)

If you haven't already heard of this book, I highly recommend reading "Get Out of My Life" by Anthony Wolf, PhD www.anthonywolf.com/index.php?page=correcting

[ceratops]

Thank you; I will look for the recommended book.

[ceratops]

Well, I'm checking in again, and see that three months have passed since my last post.

In the meantime, DS took a break from meds for a month or so, and we asked his teachers to rate his classroom behavior during that time. He then started back on Metadate CD 10mg for about another month, and we asked for teacher feedback again -- some reported slight improvements, but, in general, they didn't seem to see much effect. He's now on Metadate CD 20mg, and we're about to ask for school feedback at that dose. We honestly haven't seen much difference at home, but at least we're not seeing the really negative behaviors/mood that came out when he was Focalin. His appetite is down a bit. DS does sometimes ask to take his medication on weekend days when he has to do schoolwork, or even when he needs to concentrate on a project at home, so perhaps he does perceive an improvement. When asked directly what he notices from the med, he is very vague in his answers. In addition to the Metadate, the psychiatrist gave us a prescription for Ritalin (short acting, small dose) that DS can take in the afternoon if he needs it for homework.

So, I guess we're plugging away. It's not clear yet that we're making progress, but we are trying to be patient.

I just borrowed the book that healthy recommended back in December -- my 9 y.o. cracked up when he read the title, and said, "that must be about 'D' [his older brother]!"

[healthy11]

Ceratops, I smiled when reading about your 9 y.o. ~ you might just tell him that when he's a teenager, it will pertain to him, too!! (The book isn't specifically about LD kids!)

[forrestgirl94]

I have a question. Its kind of URGENT! I have a friend with ADHD and shes taking 1 concerta 36 mg. However, her sister takes 1 concerta 54 mg. She took 11 of her 54 mg... which equals to 594 mg of concerta. She has NEVER done ANYTHING like this before. She said her heart is pounding and her blood pressure is 157/105. Can someone PLEASE tell me if this is dangerous or not? I mean, I kno its dangerous to take medicine thats not prescribed to you. But what im asking is, could she die or what are the possible side effects? Plz! Anyone!?

[healthy11]

We aren't doctors, but any dose beyond what is normally prescribed could have unintended consequences. I would urge you to call your state's poison control hotline, else call 911 and ask for their professional advice in this situation. They will know what to do. www.poison.org/actFast/1800.asp (1-800-222-1222)