Reply To: Evening "Med Crash" Struggles

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We live in Canada. We too adopted and ended up with alphabet soup. ADHD, ODD, RAD, FASD, and more…

Our 9 year old son has the same effects, crashing after his Concerta wears off and falling and staying asleep.

We started with Intuniv, it was OK. No major side effects, but we knew he could be better at school if we could help him further. Increasing the dosage didn’t do much.

We switched to Vyvanse. That was so horrible. He didn’t sleep for a week, way too stimulated and more impulsive. We didn’t sleep either!

We changed to Concerta and have had one dosage increase. It has helped enormously with attention, impulsivity and he has been able to learn at school. A lot of that also has to do with the quality of teaching, small class sizes, and support from administration.

Mornings can be a bit rough, but if we get up early enough, keep a strict sequence of activities and don’t rush things, it seems to work out. Plus, if he gets things done early there is iPad time as a reward. Some people like to give medication to their child an hour or so before they get up, in order for the medication to start when they get up. Our problem is then it wears off too early.

The draw back has been his appetite. He would skip lunch if it was up to him. We ensure that new teachers know this and they watch him. We also pack a nutritional supplement like Ensure for those days that he just can’t eat, he still gets calories. We find it important to ensure that he does get food in as his Concerta wears off around 2-3 pm. He is voraciously hungry at night. He can have supper, and then snack until bedtime which again happens more likely when he doesn’t get food at lunch.

For his aggression we give him Risperidone three times a day, one when he gets up, one at lunch at school, and one when he gets home.

For sleep, he used to be a kid that would take forever to get settled for sleep, sleep three hours and then be up. A few things have happened over time. One, we knew he had a small head (microcephaly), but after getting a lung function test done, we found out he had asthma. Getting him on puffers has helped. He showed no symptoms and the doctor ordered the test on a hunch. He is also on a nasal spray Omnaris at night. As he’s gotten older he is able to tell us more, but when he was younger, we never wanted to sleep with him as he kicks, lashes out with his arms and sits up and flops over into a new position. About an hour before bedtime, we give him Gabapentin, this is to help him sleep longer and supposedly to help with the restlessness. It seems to be working. We also give him Clonidine. This is new, he used to be on a high dose of Trazadone, but it looks like he will be diagnosed with a genetic disorder that lists Trazadone as risky. Then 10 minutes before sleep, we give him Melatonin.

I know this seems like a lot of medicine. We feel the same, but we do have a boy who gets rest at night now. So do we! He can get 10 hours straight now. More rest means happier boy!

The best advise is to see a psychiatrist. I know the wait time is long, but it is worth it. We also have a sleep doctor for him too.

I don’t know where you live in Canada, but in Alberta, there is FSCD, Family supports for Children with Disabilities, there is funding that you can apply for to pay for respite, over night care and other things.

Not like you need more things to do in your crazy life, but I find Jeff Noble an excellent resource for FASD. Ross Greene is an excellent resource for behavior. His philosophy is that all kids want to do good, but don’t have the skills. So instead of punishing them, help them.

Hope this helps!