update on my 16 year old with ADHD, and medication question

[verona]

Hello,

My son was diagnosed with ADHD, mostly inattentive, when he was 11. He tried medication in grades 6 and 7 (Concerta), but stopped because we weren`t sure that we were seeing much improvement, and he wasn`t eating well (appetite loss). He is very bright, so was able to do OK in primary and middle-school.

His grades started slipping and were very bad by grade 9. At that age, he started to realize that he couldn`t pay attention in school, even if he wanted to (prior to this I think he lacked the self-perception and maturity to understand this). So he tried Concerta again in grade 10 (last year). He took it from September to December, and did really well on his first report card. However, he stopped taking it after Christmas because he said he was never hungry and felt nauseous much of the time. He didn`t think the improvement in his grades was ``worth it``. His grades dropped after he stopped taking the medication, and were pretty bad by the end of the year. He has refused to try the Concerta again, although that was our doctor`s intial suggestion.

So, he`s 16 now and about to start a new school year and is willing to try a different medication. Our doctor prescribed Vyvanse (starting at 20 mg, going up to 30 mg after a week). From what I`ve read, the typical side effects sound similar to Concerta. It`s only been a few days, but he is not at all hungry during the day and seems unable or unwilling to force himself to eat. We`ll give it a try for a few weeks to see if his appetite improves, but I`m not hopeful.

Is there another class of medication he could try? Our doctor (not a specialist) doesn`t have much to suggest, except that since he is growing and seems healthy, he should keep on the meds even if it causes appetite loss. He didn`t think Strattera would be a good choice, and said he hasn`t seen many young people who do well on it.

Thanks for any insights or suggestions.

[healthy11]

Verona, can I ask what your son's height/weight are? My son has ADHD combined-type, and we were concerned about appetite suppression when he initially started medication (Adderall), because he's always been slender. Even now, in his 20's, he's 6 ft. tall, and only weighs around 145 lbs. His psychiatrist said the same thing as your doctor, which is that since he was growing and otherwise seemed healthy, don't worry so much about the reduced appetite.

Although it's more of a hassle to take a "regular" shorter-acting medication a couple of times each day, versus an extended release type, my son felt that it was better since he could take it for classes in the morning, then as it would wear off, he would be willing to eat something during his lunch period, and take another med. dose to last throughout his afternoon classes. He'd often snack or have an early dinner when he came home from school, then take another (shorter-acting) medication dose to get his homework done, which would carry through the evening. Oftentimes, he would eat another substantial snack before heading to bed. While not a perfect situation, this kind of arrangement enabled him to fulfill his nutritional needs, and also get his school work done in a way that reflected his high intelligence, rather than performing below his capabilities.

Has you son given any indication of what kind of career he might eventually want to go into? If college is a requirement, then he's wise to be reconsidering what he can do to improve his grades now. On the other hand, if he isn't sure what he wants to do, or his grades down the road don't allow him immediate admission into the university of his dreams, then he could still consider obtaining an associate's degree from a community college, and transferring to a 4-year school later.

[verona]

Hi Healthy, My son is just over 6 feet and weighs 130 pounds. After a couple of days, he is liking the Vyvanse better than the Concerta - still no appetite for lunch, but doens`t feel as nauseous. He`s only on 20 mg of Vyvanse right now, but says that he feels attentive, so that`s good. I`m afraid the appetite loss and nausea might increase when he goes up to 30 mg. Taking the short acting stimulants twice a day could be an option - I will talk to him about that.

He does want to go to university - and in the longer term wants to go into science of some kind, so I am imagining grad school too. He is very intelligent (would consider him 2E), but his grades don`t reflect his IQ. First term last year he had most grades around 80% or better (while on meds), dipping down to 70s and some 60s and a few 80s by the end of the year (no meds, but also less effort especially towards the end of the year).

He doesn`t like the fact that he feels different (attentive, but less creative and zen according to him) when he takes the stimulants, and doesn`t want to take them on weekends, although us (his parents) and his doctor thinks he should. One reason is that he thinks that the meds are addictive. If you have any articles about this that I could share with him, I`d appreciate it . . .

[healthy11]

I don't know how many posts you might have read about my son when he was in school, but my son and yours sound like they have a number of similarities! My son is definitely 2E, and he has also said that he doesn't feel as "creative" or "fun to be around" when he takes medication, but he acknowledged that it helps with his attention.

In my son's case, he did not like to take medication on weekends, either, and would only do it (taking short-acting regular Adderall) if he had a big project to work on, or a big test on Monday that he had to study for. When my son is not taking medication, his appetite is HUGE, so an "upside" to his not using medication on weekends is that he eats more then. (And though college is still a few years away for your son, there can also be benefits to not medicating on weekends if he ends up in a situation where drinking alcohol takes place...I will never forget my son describing to the psychiatrist how he went to a party after his finals one semester, and he forgot he had taken Adderall a short time before, so meds were still in his system...after a couple of drinks, he imagined that his hand was "detached" from his arm. The doctor essentially said, "you're not the first person it's happened to, but it would be better not to do it again.") My son didn't get the best grades, but he graduated with his electrical engineering degree, and has been working at an aerospace company for 3 years, so I'm keeping my fingers crossed that he's learned how to maintain a work-life balance.

I'm glad to hear that your son is feeling physically better on the Vyvanse, as far as no nausea. Some people take longer than others to adjust to new meds, and so if your son does have more negative side effects when the dose is increased, I'd still encourage him to give it a few more days before deciding to stop taking it...At the very least, he should be able to return to the 20 mg. dose he's on now, since it sounds like it's somewhat helping his attention already. For now, it's encouraging that your son is at least able to recognize the benefits he's getting on school days. Hopefully, it will translate into improved academic work and better grades, so that he can achieve whatever his dreams are down the road.