ADHD Update

Last week, I attended a parent-teacher-speech pathologist meeting with Ellie in tow.  For over an hour, my typically hyperactive, unfocused little girl sat in the corner with a group of baby dolls and played.  Relatively quiet.  She sat.  She engaged in pretend play.  She did not try to run out of the room once.   Two weeks ago, this was a distant, unrealistic dream of mine.

This picture says a thousand words.

We had a snow day (I know!  "Snow" in Austin.  Hell hath frozen over.  The world has ended).  I set Ellie up with paint, brushes, paper and a table.  Look closely at this photo and you shall notice the following:

1. Ellie is sitting.

2. There is no paint in or around her mouth

3. The paint cups are in their upright position.  As in not dumped onto the table or floor by an impulsive little girl.

4. She is wearing a princess dress under her paint shirt (okay that is not important but I know Ellie would want me to point out her awesome clothing choices)

5. She is painting.

Let me reiterate.  She is sitting and painting appropriately.  There is nothing in her mouth!  She did not throw anything!  Ellie painted like this for 30 minutes.  THIRTY minutes.  Practicing those fine motor skills and focusing.  

In my last post [Denied Entry], I bemoaned the fact that Ellie's private summer preschool was refusing to let her attend this summer due to their fear of choking.  I explained that she no longer mouths.  I know that this is hard to believe.  I can scarcely believe it myself.  For well over two years, I have written post after post about Ellie's obsessive mouthing.  How she couldn't even use a writing implement because she was fixated on mouthing.  How she couldn't play because she was mouthing.  How other kids didn't want to play with her because she chewed on their toys.

Ellie playing in her sandbox.  She played for 2 [TWO!!!] hours

What happened?  Did I glue her mouth shut?  Did I feed her an exclusive diet of tree bark to make her oral avoidant?  Have I resorted to duct taping and strapping Ellie to a chair?

One word.

Adderall.  

Some of you may be thinking "it is about freakin' time!" while others may think "she is too young" or "there are more natural, better ways".  

After my last post about Ellie and ADHD, Andrew and I had to make some tough decisions.  If you want to read other methods for the management of ADHD, read through this blog or read this post.  I have written about most of them.  If you think she is too young, like I did, peruse the AAP guidelines for the treatment of ADHD in the 4-6 year-old age group and then consult the Lexi Comp Pediatric dosage handbook for methylphenidate and amphetamine salts (actually don't do that, the side effects are scary).  Anyway, short-acting stimulants are approved for children down to age four. My mama bear opinion was that she is too young and stimulants are scary and I am going to do behavior therapy and sensory integration until it kills me. . . except, it wasn't working for our daughter.

To wrap my brain around the concept of placing my baby on a stimulant medication, I asked myself the following questions many times in the past few months:

What if my daughter had diabetes?  What if her pancreas was malfunctioning and not able to produce enough insulin for her body?  Would I refuse to treat her with insulin?  There are risks to any medication you know.  

My daughter has ADHD.  Her brain is not working correctly.  The neurotransmitters of dopamine/norepinephrine are not functioning properly when exposed to stimuli and various neuro-pathways are not functioning properly.   Would I treat her with a medication to help regulate these neurotransmitters and pathways?

Photo: Scientific American

Yes.

I will tell you that it has not been a walk in the park.  Each person responds differently to medications and there is trial and error to find the right one.  

We tried Ritalin.  We saw nothing with the first dose.  When we bumped it up and I helplessly watched my daughter lay on the floor crying and screaming for 4 hours--the exact amount of time it took for the medication to leave her system.  It was horrifying and I was back to questioning my judgement.  

We then switched to a different class of stimulants and tried a tiny dose of Adderall and saw. . . nothing.  We then increased the dose and saw. . . nothing.  

We increased the dose again and saw. . . appetite suppression (a common side effect) and no behavior changes.  We increased one more time and BINGO!  A light switch turned on in Ellie's brain.  

My Ellie could focus.  She could focus for very long periods for activities that she is interested in.  She can focus very well on escaping activities that she does not want to do such as going to ST at school or going down for quiet time. She is a little less impulsive (think a 7 out of 10 instead of 10 out of 10).  She still gets distracted for following directions when it comes to hanging up her back pack, putting on her shoes, or toileting, but she requires a little less redirection.  The most surprising and completely unexpected effect was the cessation of her mouthing.  It just stopped.  I even sent her to therapy without her chewy tube *gasp*.  

The biggest side effect we have seen is her lack of appetite.  She barely eats until the late afternoon/evening.  It appears that she has lost a little weight.  We are trying to increase the caloric content of different foods and we have learned to only offer her small bits at a time, at frequent intervals.  We are also discussing a "drug holiday" on the weekends.

Adderall is not a miracle drug.  There are still several behavior issues that we are working on Ellie with, but we are excited to see her play and paint and color.  

This photo has nothing to do with ADHD.  I just wanted to prove that it did indeed get cold here.  Oh and prove that Ellie owns a coat!