Awful week at school...what to do?

[Eliserose]

Hi
Its been a bad week here. Our 9 yo dd fourth grade on metadate and ritalin booster for ADHD just lost it this week at school with anxiety and obsessing over her handwriting to the point of not being able to get homework done.
She has been back at school for 4 weeks, but this was the first week where the homework really kicked in and school expectations too. It has really thrown me for a loop, thought that we had things somewhat under control, but apparently not. Her anxiety regarding tests and performing well is huge. And the stims I am sure are making things better in terms of focusing but worse interms of anxiety. For her the stims have always been both a blessing and a curse, they do help with focusing but she can not tolerate much of a dose because they cause her irritability and anxiety. I wonder now if the missing piece of the puzzle for her is anxiety and that is why we have never been totally succesfull with stimulants alone. I could use some words of wisdom here from those of you who have gone through similar circumstances with your child. I have an appointment with her psych on Monday to figure out where to go from here. I am certain she will recommend a second med. Any one with thoughts on this too? By the way she has a 504, and the school has been supportive, both teacher and guidance counselor. There are days that I feel like taking her out of the situation and looking into private options that would be less stressful....maybe she wouldnt need all the meds in a different envornment.
Thanks
nancy

[RobbysMom]

Hi!

You know the combo we've been on here! Have you considered adding Strattera to the Metadate? All in all, I do not like having my ds on Strattera, but after his first year on stims with high irritability, anger issues and anxiety, I think the Strattera has been the key to his success. We never really considered our ds having anxiety, but after seeking help from an ADHD therapist, we realized just how much anxiety he does have. The anti-depressant qualities Strattera has really has helped him tolerate Concerta better. I'm always temped to try another stim to see if he'll have the same negative effects, but I haven't yet!

We also looked into private schools and he was accepted into a Montessori elementary school last year, but we stuck it out with the public school and he just blossomed last school year. His 3rd grade teacher saw so much potential in him that she had him tested for the gifted and talented program and he made it in. If you have a supportive school -- teacher, guidance counselor, and 504 plan, you may want to give it at least this school year so you don't change schools in the middle of the year.

Has you dd tried Focalin? I'm going to talk to our pdoc about trying Focalin on the weekends and maybe leading into Focalin XR with a Focalin booster for longer coverage. If he seems to tolerate it well, I would like to see how he does on the med without the Strattera.

I hope you and dd have an anxiety-free weekend! Go play outside, get some ice cream, rent a movie and just RELAX!

[VaMom]

Nancy,

Your dd and my ds sound a lot alike. We have not found a stim he can tolerate (granted we have not tried them all). He takes Strattera -- not perfect, but it helps and he can tolerate it, and he also takes a small dose of Lexapro for anxiety.

However, there are couple of things, not med-related, I would like you to consider.
ADHD and problems with handwriting go together more often than not. If she has a 504, you need to be in talking with the school about this ASAP. What can be done to help with this problem? Can she dictate to you? Can she get an Alpha-Smart? There has to be something. She can't have her life wrecked over handwriting. This is the computer age. If she can sign her name, she'll be fine as an adult -- she'll do everything else on the computer. Tackle the handwriting issue ASAP.

My ds has been in a social skills group overseen by a wonderful therapist since the end of first grade. (he is also 9, in the fourth grade.) This summer they had some individual sessions. They did cognitive behavioral therapy, which targets anxiety. Can you consider this for your dd? It makes a difference.

I'm not saying you may not have to change meds, or add a med, I'm not a doctor. But I would urge you to look at these other things as well.

Good luck.

[d]

4th grade is a big year academically - more responsibility, shift in schoolwork like instead of learning to read, reading to learn, etc.

Also, to put it in perspective it's not uncommon for kids to be dx'd in 1st, 4th, first year of middle school - all critical years when school functioning requirements change.

By the end of 4th grade my dd was experiencing "anxiety-like" symptoms and she is not an anxious child by nature. The school demands taxed her weak areas plus she put a lot of pressure on herself. We went through similar - had a psych and ped neuro consulting with each other - trying to figure out if what was driving what (stims, school, internal pressure, etc.). So if your dd was anxious before 4th grade, 4th grade may be exacerbating her anxiety. By comparison, 5th grade was a dream vacation for us but it got rough again in 6th, the first year of middle school.

Regardless, you've got to deal with where she is now. A strattera/stim combo sounds viable. I'd also talk to the school and see what supports they can offer or their suggestions as to how they can take pressure off her. It's good that they're supportive. I had talked to my dd's school and the unfortunate thing was my dd refused to take advantage of most of the relief the teacher offered (e.g., setting a time limit on homework, print vs cursive, every other math problem, etc.).

Definitely go have a vacation day with her this weekend - unplanned spontaneous fun. No chores, errands, worries, hurrying or talk about school for either of you allowed.

[Eliserose]

Thanks all for your thoughts and words of wisdom. It really helps me to hear others perspectives because I have a tendency to get so caught up in it that I can not see the forest for the trees.
Robbys mom, I have Straterra on my list to discuss with the doctor on Monday. I do believe that I am ready to add in a second med because after more than a year of trying to tweak the stimulant doses and find sucess we still have not found a stim or dose that doesn't cause irritability, anxiousness and edginess. She must have stims to focus at school so we are going to proceed down that path. Now with the anxiety and obsessive tendencies coming out I dont know whether her psych will recommend an SSRI. I know Remeron has come up before too, guess we will just have to see. I know that Remeron is known to cause wt gain so that might be a plus since our dd is still soooo thin with appetite issues.We did try Focalin when we started her back up on meds for school but it caused the same side effects even at a really low dose. For her it seemed much more potent then Ritalin.
DId you ever try any of the SSRI, I thought I had seen where you tried Paxil once with your son? I am so glad that you found the right med combo, I am hoping for the same with our dd.

d, how did you all treat the anxiety with your dd. Did you try medication. What meds is she on now? I appreciate your thoughts on the bigger picture.

vamom, I agree that the handwriting shouldn't ruin her life. For the time being we have decided that she can just dictate to me until we figure out where all the anxiety is coming from and maybe add meds in. I am assuming that the hand writing is just a symptom of something bigger going on. Although, I do know writing is hard for her. How has your son done with Lexapro, any side effects?
Thanks again everyone, by the way, we are having a very relaxing weekend and I am tryign my best to not dwell on the problems and just enjoy my daughter.
Nancy

[swmom]

As you know if you've been reading, we were being treated for ADHD for 3 years - first with stims which she couldn't tolerate because they made her very intense and angry then with Strattera which helpled alot with focus but not with impulsivity - then a few months ago we were told she didn't have ADHD, only anxiety. Strattera worked we think because it reduced her anxiety enough so she could focus. Now, we're on Zoloft for her OCD-like symptoms and anxiety, Clonidine for impulsivity. It's working pretty well.

Re: the handwriting. Our dd we discovered wasn't using the right muscles in her arm when handwriting. She was using her shoulder and elbow instead of her hand muscles. It caused her much difficulty in handwriting. Our previous said that this could be one of the contributing factors to her anxiety, struggling to write while all the kids seem to do it effortlessly.

Also, she has an auditory processing deficit which our previous said could also be causing the anxiety.

In addition to the meds, we're working with a psych to help dd reduce the anxiety she feels.

Good luck! It's tough to have a child whose anxious.

[d]

My dd is on Concerta - she's 12 now and has been on since age 7.

We were reluctant to treat the anxiety-"like" symptoms until we had a better handle on what was causing them. It just didn't sound right to us bc she was never an anxious child. Ped neuro said could be caused by the stims - but regardless of source should be dealt with so wanted to add on an SSRI. Also, Strattera was suggested as a good alternative bc it helps anxiety-"like" symptoms, but we didn't want to try that so fast bc back then it was new and we wanted to know what was driving the anxiety first. That's when we consulted with a child psych to navigate it.

The child psych recommended we take her off the Concerta and see what happens. Initially, the anxiety symptoms disappeared as well as any semblance of inhibition. She started getting uptight again after a few weeks of being off the Concerta - e.g., in school she couldn't keep up, behavior not up to classroom expectations, etc. She walked around apologizing for herself all the time - a deer in headlights look - that absolutely killed me. So we had our answer and tried Strattera. Strattera was great for her inhibition - but not enough for school focus.

So we wound up doing a lower level of Concerta plus the Strattera - which I have to tell you was GREAT. That lasted for about 3-4 months (after the 2 month ramp-up period needed for Strattera). Unfortunately, we had to take her off of the combo. Strattera does affect appetite for some and we knew the Concerta affected it. She lost more than 10% of her weight in 3 months and was a scarecrow to begin with - she could not afford to have lost that weight.

So, we went back to Concerta only which continued to work fine. By then she was in 5th grade and the pressures of 4th grade were gone.

I should also add that my dd has learning differences. She had a lot of remediation for reading, writing and math up until 4th grade. 4th grade was when the benefits of all that remediation came together for her - she could read and write very well - although still tenous and coming together for her she put pressures on herself that she was going to succeed. Add on increased functioning requirements in 4th grade. We did not have any more issues with meltdowns, anxiety, etc. until we hit the first year of middle school - another big functioning requirement change and she was floundering. Sure enough, she's back to getting school help for that and she's fine again.

Good luck sorting it through.

[d]

forgot to add this - out of all the methylphenidate meds, Concerta is the only one that is acceptable for my dd. We went through the short-acting Ritalin and Ritalin SR - had awful rebound on both. Concerta has been much smoother for her, no rebound. Never tried Ritalin LA. May try Focalin but that is TBD.

And I have no idea why but Metadate doesn't work good enough on her focus - we tried that one twice. Others here have been experiencing good success with Metadate but it is not my dd.

[VaMom]

Nancy,

We've done well with the Lexapro. No side effects at all, and he only needs a small dose to take the edge off his anxiety.

We did try Zoloft before that, and it did not go well. Things seemed good for the first two weeks and then he became such a space cadet that he couldn't focus on anything for even 30 seconds. It was very alarming -- and he was only on a tiny dose of that as well. Fortunately, he bounced right back as soon as we took him off.

Definitely showed me that the SSRIs are NOT all the same, at least not for my ds.

I'm glad you're doing the dictating for now, at least. I hope it gives her one less thing to worry about.

[wetmores]

My husband and I have also found lexapro works well for anxiety and depression. I have ADHD too and have been taking ritalin for years. I also take a tryciclite antiD but it has had little effect on my anxiety in recent years.

peace,
marge
www.net-haven.net

[TexasMom]

Fourth grade is often when a previously undiagnosed learning disability can really surface. This is especially true in extremely intelligent children because they have basically been able to "fake" it up until now. It is possible that the handwriting problem could be a manifestation of an LD. If there is an LD, it could be very difficult for your child to process all the information and get it out to paper in a logical, coherant manner. That would cause anxiety for anyone, especially one who doesn't understand why it is so difficult for her to just write something down.

Just a thought.

[Eliserose]

Thank you all for your suggestions. Trying to figure this out is not easy but we have an appointment with her doc today. Wish us luck.
Thanks
Nancy

[Eliserose]

Update
We had the appointment with the pscy and she really felt like we needed to add in another med. So, we are trying Remeron to help with the anxiety, sleep and eating issues. Only been on for 2 days but it does help with eating and sleeping, way too soon to see if it helps anxiety yet.
Robbys mom, what was your sons experience with Paxil and why did the doc presribe it? Just curious. Was your son anxious on the stims like my daughter?
I think I would have preferred to stry Strat again but the doc thought we should give this a try first.
Keep fingers crossed. I just hate so much that my daughter has to take a second med but I am up against a wall.
Nancy