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Thread : Is it anger or perfectionism?  
20 Sep 2011 @ 12:05 PM
shortpants Join Date: Tue 20th Sep 2011
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Is it anger or perfectionism?

Our 12 yr old severe ADHD, Asperger son, says he keeps having "anger issues". Is it a problem of undermedicated, where he has trouble paying attention, is it getting teased because of impulsive actions, or perfectionism, wanting to "be normal" or is it he's calling it anger when it is something else? He is on 54 mg generic Concerta, 10 mg Mehylphenidate before school and at noon on school days. The school reports he'll tremor, makes fists or walk up the stairs with a heavy step when he gets frustrated. He is 5'6", 185#. He has been on Respridol and Abilify which caused tremendous weight gain and not any help with the "anger". What should be investigated, what has been tried or what are the possiblities? Sorry about being so wordy lol.

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21 Sep 2011 @ 3:34 PM Reply # 1
ADDDOC Join Date: Wed 21st Sep 2011
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wonder about his medication

Although I'm not a child, and my youngest is 23 years old, Imust wonder about medication. I found myself being more aggressive on higher doses of medications, and on what I'm on now - including Concerta 54mg, Bupropion 300mg, L-tyrosine 1000mg/d, and Intuniv 3mg every day - I have hand and head/neck tremors, verbal tics (my constant humming drives my stepdaughter nuts) and neck muscle spasms. On a higher dose of Vyvanse (in the past), I lost it one afternoon with my secretary (who in retrospect has TERRIBLE UNDIAGNOSED ADD - and who was killing me with un-done assignments) and when my boss asked why, I realized it was not-me, and asked for a medicine switch shortly. (The secretary didn't get better, but my tolerance for him jumped up dramatically. Still I was glad he was let go.) Again, kids are different, but I wonder if lowering his stimulant dose and adding a nonstimulant (Intuniv/guanfacine or Strattera) or even herbal supplement would be worth a try. Likely he has a long journey ahead of him, and if a doctor runs out of options or wants to stick with a medicine regimen that's not working, it's time for a new doc. It has taken a LOT of medicines and dose changes to FINALLY have me optimistic about my future with ADD (the rest of my life). BTW, anger is a reaction/emotion, which can CERTAINLY be triggered by the way one thinks, especially perfectionistically. There is no room for error in PERFECTIONISM, so ERROR can EVOKE anger in a perfectionist. ANGRY people can have a poor tolerance for error, too. My question is: Is he ONLY angry when something should've been done PERFECTLY (his way) or is he angry otherwise (when you call him and he's busy, when you correct him or remind him, or during simple conversation)? Of course, then there's Aspergers - a probably-not-uncommon-comorbidity. In my niece with Asperger's, blatant emotional displays are common, but I don't really see anger being one of them. And my sister FREQUENTLY frustrates her with firm or flexible boundaries, but I don't see anger as her response. She's been bullied at school, too, but I don't hear anger as a response. My sister and bro-in-law refuse to medicate her, but her behavioral improvements have been DRAMATIC with CONSISTENCY alone. She is stubborn, determined, but NOT perfectionistic or angry. I'm also assuming oppositional-defiant disorder is not an issue.

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Last edited by ADDDOC : 21 Sep 2011 @ 3:41 PM. Reason: forgot to address Aspergers diagnosis
22 Sep 2011 @ 1:50 PM Reply # 2
shortpants Join Date: Tue 20th Sep 2011
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thank you

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ADDDOC said: Although I'm not a child, and my youngest is 23 years old, Imust wonder about medication. I found myself being more aggressive on higher doses of medications, and on what I'm on now - including Concerta 54mg, Bupropion 300mg, L-tyrosine 1000mg/d, and Intuniv 3mg every day - I have hand and head/neck tremors, verbal tics (my constant humming drives my stepdaughter nuts) and neck muscle spasms. On a higher dose of Vyvanse (in the past), I lost it one afternoon with my secretary (who in retrospect has TERRIBLE UNDIAGNOSED ADD - and who was killing me with un-done assignments) and when my boss asked why, I realized it was not-me, and asked for a medicine switch shortly. (The secretary didn't get better, but my tolerance for him jumped up dramatically. Still I was glad he was let go.) Again, kids are different, but I wonder if lowering his stimulant dose and adding a nonstimulant (Intuniv/guanfacine or Strattera) or even herbal supplement would be worth a try. Likely he has a long journey ahead of him, and if a doctor runs out of options or wants to stick with a medicine regimen that's not working, it's time for a new doc. It has taken a LOT of medicines and dose changes to FINALLY have me optimistic about my future with ADD (the rest of my life). BTW, anger is a reaction/emotion, which can CERTAINLY be triggered by the way one thinks, especially perfectionistically. There is no room for error in PERFECTIONISM, so ERROR can EVOKE anger in a perfectionist. ANGRY people can have a poor tolerance for error, too. My question is: Is he ONLY angry when something should've been done PERFECTLY (his way) or is he angry otherwise (when you call him and he's busy, when you correct him or remind him, or during simple conversation)? Of course, then there's Aspergers - a probably-not-uncommon-comorbidity. In my niece with Asperger's, blatant emotional displays are common, but I don't really see anger being one of them. And my sister FREQUENTLY frustrates her with firm or flexible boundaries, but I don't see anger as her response. She's been bullied at school, too, but I don't hear anger as a response. My sister and bro-in-law refuse to medicate her, but her behavioral improvements have been DRAMATIC with CONSISTENCY alone. She is stubborn, determined, but NOT perfectionistic or angry. I'm also assuming oppositional-defiant disorder is not an issue.
Thank you ADDDOC, meds are definitely something we are looking into. He was on 39 mg generic Concerta all summer and didn't see the anger issues, but summer is low keyed. He will "push the envelop" with me at home, but I've learned to not be manipulated by him. Helps that he knows he won't pit mom and dad against each other. 7th grade is when our school district starts middle school. That was why I wondered if it was anger, perfectionism or trying to adjust to new school, routine, people and seeing "how much he can get away with". As you described perfectionism, I'm not using the right word. He is more of a "get it done fast, so you can be done with it" kind of kid. He wants it "right" the first time when he draws (one of his hobbies)he'll get frustrated if it isn't exactly how he envisioned it the first time, but personally I don't think anymore than anyone else that has a vision of the end results. We had thought that a combo of Concerta and Strattera would help quiet the emotions and help with the impulsivity. And yes we have changed dr. New dr. seems to listen to us and our observation more than "the meds worked last year" thoughts. I'm also making sure I am more consistent with him. Your comment about many changes to get you optimistic with your life with ADD, I wonder if that may be also part of it. We have been working on his ADHD for almost 6 years, a long time for a preteen (or ever an 51 yr old mom) to still have it be an art not a science. You mentioned herbal alternatives, any suggestions? I appreciate all your transparency, suggestions and encouragement. We couldn't be lucky enough to have you practicing in the Chicago area, could we? Looking forward to your reply, learning more ever day. Blessings,

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