Question:
Dear. Dr. Heller,
I have just found your site and it has been very helpful. If anything, it has helped me to see that I am not alone in dealing with these types of problems.
This has been a frustrating, heart-breaking journey for us. We have an adopted son who is now 12 years old. We also have two older "normal" sons. At age 1, I knew something was different about David. He ran instead of walking, often bumping into things. He couldn't wait his turn and had difficulty making friends because of his inability to share. He went from one activity to another always leaving a mess behind him. He had a very low frustration level and acted impulsively. At 5, he was given Ritalin which seemed to work at first. Then symptoms would reappear which resulted in increased doses which would again work and then the ADHD behaviors came back. To date, he has been on Ritalin, desoxin, regular Adderall in combination with Wellbutrin. He had psychological testing when he was 10 which revealed severe ADHD and possible bipolar.
He has a very low frustration level and had a very hard time hearing "no." His worst reaction would be running from room to room slamming doors and pulling over lamps in his room, etc.
For the past year he has been on Concerta. He started out with 18mg, then 38, then 54. He also took 250mg of Depakote 2x a day. His behavior would fluctuate but we never had consistency with him.
He also has a real carbohydrate craving. He will sometimes get up in the middle of the night, or up early in the morning to grab any kind of bread, buns, etc. and devour them. Before his medication kicks in, he displays what I would call "drunken" behavior.
Recently, we switched to another psychiatrist at a mood-disorder clinic. The first thing he did was to increase the Depakote to 250mg 3x and added Risperdal .25 1x. At 7:00 pm he gets the Risperdal, .15 of Clonidine and 500mg Depakote. We had to discontinue the Concerta because he was getting up in the middle of the night and roaming around the house and sometimes staying up most of the night.
To test the theory that it was the stimulant, we took him off the stimulant for the day and that night he slept without incident. It was almost scary seeing him off his stimulant. He was spitting, disrespectful, using foul language, sneaky, mean and behaved in an drunken manner (very clumsy and at times slurred speech). He is now on Adderall XR. He started with 10mg in the AM 5 days ago. By 1:00 his behavior began to decline and by evening it was like he was unmedicated. Yesterday, we increased the dosage to 20mg in AM. He had a much better day but for about 1-1/2 hours in the late evening he became very hyper. He eventually fell asleep but this morning said that he was up 20 times for a few minutes and then went back to sleep.
Dr. Heller, I have a few questions. Do you think that we are dealing with just ADHD? We adopted him at 4 days old and has been provided a loving home. The only background info we have of note is that his maternal grandfather is an alcoholic. Our therapist believes that all this behavior is due to ADHD and cautions us not to read too much into this behavior and end up over medicating him. The new psychiatrist thinks that it might be depression or bipolar inaddition to ADHD. I question bipolar. He has these outbursts but they are over some event - usually when he does not get what he wants. They don't last very long. I have never seen any pattern of mania and depression. Also, with Adderall, his reaction is now more with crying and sadness rather than anger. Of course, this is only after 6 days. I would appreciate any input.
Thanks for all the information you provide to parents.
Dr. Heller's Answer:
Clearly ADHD is a huge problem, but there’s more than ADHD going on. Bipolar is possible, you can get more information on it at http://www.BiologicalUnhappiness.com/BiPlrKid.htm
If he fits a high percentage of symptoms, read the book "The Bipolar Child" by Dr. Papolos. The Depakote and Risperdal did not seem to help him.
He sounds depressed and very oversensitive to rejection. 30% of ADHD kids are depressed. Prozac can often be a miracle medication for these children.
There are other things that can help with these kids:
1) Nutritional - eat lots of fruits and vegetables and avoid partially hydrogenated oils like the poison they are. Fast foods are full of them. Not only do they cause cancer and heart attacks, but they markedly lower blood flow and can worsen ADHD symptoms.
2) look for other medical diagnoses as well. The most common are:
A) acid reflux
B) sleep disturbances
C) enlarged tonsils and/or adenoids that are interfering with breathing and sleep
D) iron deficiency (can be checked with the following blood tests: CBC, ferritin, iron, TIBC)
E) Low thyroid and low B12
3) I’d also recommend considering other diagnoses such as the generalized anxiety disorder, particularly the cognitive component and OCPD - obsessive compulsive personality disorder. People with OCPD and ADHD are "disorganized perfectionists" - which is very stressful and overwhelming. High doses of Prozac combined with ADHD treatment can have a huge impact here.
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