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Dreading the evenings


Hi all,
I’ve got a 7 year old who has been on concerta since he was 4. He’s extremely emotional and we’ve upped his dosage to 36mg last year along with adding 2 mg of Intuniv. Things are going reasonably well at school, with just the occasional email with the laundry list of complaints: kicked the trash can today, called a boy stupid, etc.

Our real problems are right before bed. Every night, he spends between 30 and 60 minutes screaming and crying at the top of his lungs. He’s inconsolable, irrational, and destructive. Trying to find out what’s wrong, he will say “I need a bandaid” but when offered a bandaid, he freaks out and says “No, I need Neosporin.” When Neosporin is presented, he runs away saying we are being mean to him. All of this is done at his loudest volume while he is throwing anything within reach.

Then he may say “You go away! I want dad!” so dad comes over and he runs away screaming that dad hurt him, although dad hasn’t even gotten within 5 feet. It’s like he’s insane. And I say that in the nicest way possible. Up until the freak out, he’s kind and cuddly, then it’s like a switch flips.

Anyone else out there dealt with something like this? We are at our wits end and don’t have a clue how to help him.

Replies

What does his psychopharmacologist say? I would definitely speak with the doctor about this. Wish I could be more helpful. Wishing you luck. I know this stuff is seriously challenging.

Posted by Clever1 on Nov 13, 2013 at 5:22pm

My son was on 2 mg of intuniv.  I won’t say that he acted like this, but he definitely was more grumpy, unhappy, agitated and even anxious.  He is being treated for anxiety as well.  HIs psychiatrist dropped his dose to 1 mg and he is doing much better.  He just had a bad reaction to the 2 mg dose.  You should ask your doctor if his behavior could be linked to the medication. Sorry to hear that he is having these difficulties.

Posted by americangothic95 on Nov 13, 2013 at 5:31pm

Thanks for your thoughts. His doctor in charge of meds had us add a small, short acting dose of concerta at night because he thought it might be the drop of meds in his system. This made things even worse and he couldn’t get to sleep at all. As is, after he pitches his nightly fit, he falls asleep easily.

Interesting feedback on the Intuniv. We added it because he was so emotional. Everything was the end of the world and it seemed to help when we added it, but maybe that’s the one that needs changed. Our dr talked about upping it, but was concerned he would be too tired with more than 2mg.

Posted by mom2-4 on Nov 13, 2013 at 5:39pm

My son also had similar behaviors when he was younger. When I could stay calm, I reminded myself that everything with him was multiplied by an infinite number. When he hurt, he REALLY hurt, when he was sad, he was REALLY sad, etc. When my son was tired he didn’t know what to do with all of this feelings and they just came exploding out. I also noticed that right before he got sick, his behaviors at home were AWFUL!  Nope, school never, ever saw a meltdown.  He saved them for mom and dad. Days later when he was sick, I’d remember that we’d had a rough night and go, “Oh yeah”.  He’s 15 now and I am still surprised when that happened.  He rarely melts down now (there is hope, I promise! but did over homework the other night.  The next morning, lo and behold, he work up feeling sick and got worse over the weekend.  “Oh yeah” I said again.

Posted by Nemo on Nov 13, 2013 at 5:44pm

I agree with Clever1 that this should be evaluated by a doctor who is very knowledgeable about the medications and their side-effects, including coming down off the meds at night.  If your doc doesn’t know enough, ask for a referral to a specialist. 

Having said that, is there any way that you can switch up your routine?  Do the hysterics go away only once he’s asleep, or does it just last for 30-60 minutes and then end before bed?  Is there any way that you can just “schedule in” time for his fits and just know that absolutely nothing productive will happen during this time?  Can you adjust his sleep time to earlier or later, either before or after he has a fit? 

I’d bet that if he could control this, he certainly would, so all of you are having a tough time with this, including your son.  Until you are able to see a doc, can you talk with your son during a calmer time about these times of the evening and acknowledge how tough they are for everyone, himself included?  Empathizing with how he feels, and letting him know that you are there if he needs you, might help a little.  I know that for my son, empathizing that he’s doing his best during a tough time really helped him to calm down when he got upset as he really wanted to be understood more than anything else.  He needed to be reassured that I will always be there for him and will always love him, though sometimes I may not like his behavior (and I shared that with him exactly as I wrote it).  I think my son got scared that his behavior, that he couldn’t control, would somehow drive his family away from him.

Before the evening goes downhill, anticipating his needs and making sure he knows where, for example, the bandaids and neosporin are so he can help himself to them, might be helpful too.  Although if your son is like mine, he’ll always find something that I haven’t thought of to fixate on. grin

For my son, the empathy thing went a long way toward making our family work better, but your son’s meds may very well need adjusting as part of the puzzle for making your family better.  Best of luck to you.

Posted by MendelZ on Nov 13, 2013 at 5:45pm

My daughter had a few episodes like that when she was in elementary school.  But it was not every night.  So as far as shared experiences go, I’m not sure this qualifies.  Nevertheless…  grin ... I’ll talk about my experience anyway!  lol

We knew she was a good kid, a sweet and loving person, and that she was tired and at *her* wit’s end too after a long, exhausting day of doing everything wrong.  So we did what made sense to us as a bedtime routine (bath, brush teeth, pajamas) and of course, if it is an absolute physical confrontation, then forget it.  We put her in her room and did our best to keep her in there and did not engage with her.  We made sure she was physically safe, that was about all we could do.  We closed the door and stood outside of it and let her wail.  Basically she would have a tantrum.  It was horrific and heartbreaking and I hated every second of it.

The next day, my sweet girl was back, and we said, “Last night was unnecessary.  Do not do that again.”

And because it was morning (which means she was reasonable again and loving and affectionate and cooperative) and because *she* had also not enjoyed her evening, she would agree that it was a pretty awful way to spend an evening.

One time, when she was VERY little (still in diapers), she could NOT be consoled for hours and hours.  She finally calmed down when we took off the pajamas she was wearing.  So, that might be worth a look.  He may be reacting to a physical irritant, like a mild allergic reaction that drives him nuts, maybe something against his skin that literally rubs him the wrong way?  And it is so EVERYWHERE, all over him, that he can’t verbalize what the exact problem is?  Just throwing out a wild reach of a guess.

Nobody WANTS to be upset like that, right?  I mean, c’mon, he obviously needs something changed, I would imagine.  Figuring out just what exactly that is, yeah…it can drive the entire family over the edge!

Also, he may be overstimulated to the point of hysteria.  Melatonin helps my daughter change gears at night, but we didn’t start giving it to her until 3rd or 4th grade (8 or 9 years old).  Check with his pediatrician about ways to help him unwind and calm down for sleep, would be another suggestion.

My heart goes out to you and your family.  Good luck.  It helps to remember that he is not the bad guy.  I say that because I sometimes blamed my daughter and I struggled with feeling like she was purposely trying to be a problem just because.  He’s probably just as frustrated as the rest of you.

Posted by hitwcidb on Nov 13, 2013 at 5:46pm

You need to talk with the doctor or better yet find a new doctor who specializes in an all natural approach of vitamins, exercise and protein, feed his brain what nature intended.  Start him in some type of night time sport or take him walking or something to get some energy out.  Not everyone can handle those strong medications, He sounds like I use to feel when my Adderall would wear off, I just wanted to scream or cry (I was 45 when I stopped taking meds) Doctor said some people have allergic reactions and respond this way to meds, makes us feel crazy and confused.

My heart goes out to you and your family, heartbreaking.  Good Luck, it’ll get better as she grows up

Posted by BexIssues on Nov 13, 2013 at 6:03pm

This is probably rebound.

Posted by Jakes dad on Nov 13, 2013 at 6:05pm

I have a 7yr old son, diagnosed ADD treated for anxiety w Zoloft and we’re treating some of his impulsive behaviors with guanfacine 1mg (tenex). We’re still trying different meds for his inattention and he took concerta for 10 days. The concerta made him wacky!  His behavior became very odd, doing things he had never done before and it brought out severe OCD behaviors. We stopped it right away and the odd/OCD behaviors stopped immediately. Meds work differently on every person so this may not be a good one for you. Only problems we’ve had with guanfacine are extreme sleepiness but he seems to be adjusting after a couple of months and is no longer so tired.

Posted by brlk13 on Nov 13, 2013 at 7:06pm

Just one thing I thought I’d mention from my own experience is that fatigue makes ADHD 1,000x worse than it already is. On days when my son may be tired for some reason I have to brace myself because I know I’m in for a very bumpy ride.

When he was that age I could not get him to go to bed - even after 10:00pm. I thought I’d just lose it completely. Since they struggle so much with impulse control being tired can make it impossible for them to behave when tired. At some point he started asking me to just ‘give him a sleeping pill!’ because he was so frustrated as well. That’s when we started with Melatonin and it was a lifesaver. Children with ADHD often time have very serious issues with sleeping and if he’s fatigued your son may just not know what to do with himself by that time of night. They have to exhaust themselves to the point where they can finally fall asleep. I don’t know if you’ve tried Melatonin but most parents with ADHD swear by it. Including me.

Everyone here always has great advice, I can only say that from my experience making sure my son can get to sleep - 3mg Melatonin - has made a world of difference in his behavior at night and the following day. Best of luck in finding something that helps!!!

Posted by Havebeenthere on Nov 13, 2013 at 7:17pm

Thanks everyone for your replies. It’s very lonely at 10pm when you feel like your child is the only one who has ever acted this way. grin

We try to keep in mind that his feelings are real and he actually is devastated when he can’t choose between Neosporin and a bandaid. The first 15 minutes or so, it’s easier to help him. After 30 minutes, I’d sell him for cheap. Turns out I have about 20 minutes of reserve empathy, then I wish he’d just be quiet. He’s got three older brothers and I’m sure our neighbors can hear him screaming. We bumped up bedtime so he’s in bed at 8, that way his fit can last until 8:30 and he’ll still get 11 hours of sleep.

I just wish there was a safe way to contain him. He throws things and breaks things and I’m afraid he’s going to hurt himself. We tried holding him in a hug to calm him, but first you have to catch him - which is a joke because you can’t really run like an idiot through the house, chasing him. Then once you catch him, it’s like holding an octopus.

We did a week trial of melatonin. I think it was 2mg but he was waking up at 1am and screaming then. I guess if I have to choose, I’d rather he scream at 8pm than 1am. Maybe a higher dose of melatonin?

I hate to switch away from concerta because it’s helping him at school and during the day. It’s such a challenge to find a drug that works. Others we tried gave him tics, so I’d love to find something to do and be able to keep the concerta. I even got chewy vitamins to use as a placebo. I told him they would make him calm and he would fall asleep more easily. We’ve tried those twice and so far my placebo experiment has failed.

Lack of sleep. Yes. It’s exhausting just listening to him scream and cry. I can’t imagine how tiring it is to actually be the one doing it. He was so tired at bed time last night and we had talked and talked through the day how it was silly for him to freak out at night and he said he wasn’t going to do that anymore. Then he went to bed. And freaked out. 45 minutes later, he is calm and says “sorry I was freaking out, mom.” sigh.

Again, though, it feels good to know there are loopy kids out there and they will eventually get better. By the time he’s 35, he probably won’t scream before he goes to bed. wink

Posted by mom2-4 on Nov 14, 2013 at 1:10am

As others have said, I would start with checking with his doctor regarding his meds.  My son takes Focalin XR and gets wound up in the evenings.  Through trial and error, we have come up with an evening routine that works for us.  Homework is done as soon as he comes home from school (we found that if he has down time when he comes home, he is quickly out of “school” mode and has trouble getting homework completed).  Next, a little down time, followed by dinner, and then some type of physical activity.  If he doesn’t have a game or practice (lots of sports for our son), we do something at home—rake leaves, bike ride, walk the dogs.  Then, a relaxing shower or bath, and the rest of the evening is devoted to calm time.  No TV or video games, only reading and/or listening to music.  He also takes a small dose of Melatonin, so by the time his bedtime comes around, he’s in a calm, relaxed state and ready for bed.  I’m not sure if it’s all the things we do or if it’s just the routine, but after a couple weeks we noticed a lot calmer, more pleasant evening in our home.  I guess my point would be to try different things that you think my help your son.  Give it a few days and if you don’t notice any improvement, try something else.  If there’s one thing I’ve learned about children and ADHD is that what works for one doesn’t always work for another.  Good luck!

Posted by Machelle B on Nov 14, 2013 at 5:02pm

His current dr says it’s rebound and to add a small, short acting dose of concerta at night but a week trial of that caused him to not be able to go to sleep at all.

We added melatonin back into his evenings and the first night, he just needed tucked back into bed a few times, then he slept all night. His complaint was “I don’t know how to fall asleep.” Sounds like what some of you said, he’s just so tired he doesn’t know what to do with himself. We moved bedtime up half an hour and last night - well, I don’t want to jinx it, but he went to bed and slept all night. No screaming/crying! I actually feel like I got to sleep so now I can be a better parent, too.

Thanks so much for all of your help and input! I hope the melatonin continues to work and we can look back and say “Whew, that was a rough patch that we got through.”

Posted by mom2-4 on Nov 15, 2013 at 2:40pm

My 10 yo son had similar problems, everything was overblown and he would have a first class hurricane style fit. His doctor prescribed Abilify this summer stating it is a mood stabilizer (read: antipsychotic-but don’t be scared by the term like I was…). The Abilify worked within a month and now we still have some tantrums, but nothing like we had, and according to my sister, these tantrums are very very similar to the tantrums her 11 yo nt son has. Abilify has some serious side-effects, but it worked for us. I know they have other drugs on the market to stabilize mood, especially while on a stimulant medication which can most definitely cause mood swings and aggression.

I’m glad to hear the melatonin is helping! It helped my son a bit for a while, but… then, not so much. Good luck!

Posted by BlinkinsMom on Nov 15, 2013 at 3:18pm

What are the “serious side effects” of Abilify?  I ask because, uh…er…well…honestly, I think *I* am struggling with bouts of aggression/irritability in the evenings (I’m on Strattera and Focalin) and my daughter asked me this morning, mom what is up with you the last few evenings?  You have been picking fights and arguing over little things.  What’s going on?  So maybe something like Abilify would be worth trying.  But first…what side effects are you talking about, please?

Posted by hitwcidb on Nov 15, 2013 at 5:26pm

My son is doing similar things between 4pm - 5pm.  He takes a drug called dexamphetamine (we live in New Zealand) and it has had the least amount of come down out of everything we have tried so far.  But still he gets very agressive.  The world is ending if his brother looks at him the wrong way.

As far as Melatonin goes, it’s a godsend for us.  We use a long acting version of melatonin that lasts for 12 hours.  The short acting melatonin also had my son waking after four hours screaming.  Happy to say that at least he is sleeping through the night for the first time since born (7 years ago).

I find it very difficult to stay calm during his agressive outsburst.  I also walk on egg shells from the time I pick him up from school till the time he falls asleep at night.

Posted by Hayley on Nov 16, 2013 at 3:05am

Hi there we went through this for years until I increased his transition time. We had “alone time” for 15-20 minutes prior to bed, tried dimming the lights in a low stimulus environment and did some kid yoga (some great DVDs out there) or would listen to a relaxation cd meant for kids (again some really great ones for kids with anxiety) and then we were told to give him liquid melatonin as well to combat that “coming down” effect. It works fast and we found we had a small window of opportunity to use it’s effects to our advantage so we give it to him when he brushes his teeth. Keeping. Schedule with pictures of a nightly breakdown minute by minute helped as well. He is 9 and This has helped for nearly a year and we now have gone from - hour of fits and me pulling my hair out to 45 minutes of a calmer routine where I can maintain patience longer and he has more control . Good luck and you are not alone!

Posted by Kmlkmw on Nov 18, 2013 at 8:15pm

This has been the story of my life with my 10 1/2 year old.  It was at it’s all-time worse when the various medical professionals had him taking stimulant-ADHD meds.  Melatonin was recommended and helped for a while, but then he started having trouble waking in the middle of the night with nightmares. It became much better when he was put on Kapvay (a non-stimulant) for his ADHD, but we continued to have trouble at bedtime.  We have just begun adding in Abilify (for his “mood disorder” on top of his ADHD), and bedtime has been much smoother most days, and there have been no emails or calls from school (a first).  We’re not quite there yet, but I think I see the light at the end of the tunnel.  In your situation, I recommend talking with your child’s medical professional as ADHD can go hand in hand with mood disorders, and ADD-stimulants can actually make things worse, if not right away, then over time.

Posted by ADD.ODD.Dep.Anx on Nov 19, 2013 at 2:07pm

My son who is 8 has ADHD, and symptoms started very early in life around age 2. He would scream for no reason, and be uncontrollable at times. He was diagnosed at age 6, and is now taking Adderall in the morning, and Cyproheptadine at night. My son has had issues sleeping ever since we started the stimulant medication, and then he started having night terrors. The Psychiatrist put him on the Cyproheptadine to suppress the dreams and to help him go to sleep. It has worked well, but we do have the occassional setback which I feel is normal.It does seem, however, that every 6 months or so the medication stops working so well. Maybe he needs something for nighttime, or a change in prescription? We also do add the Melatonin at night as well. I would suggest a Psychiatrist visit. When my son has a meltdown, it is always in the evening before bed when the stimulant has worn off. I let him know that I will be happy to talk to him once he has calmed down. Sometimes it can take hours, but it is important to be calm and not engage them unless they actually need you for something. Necessary consequences can be relayed in the morning.

Posted by scchoron on Nov 19, 2013 at 4:29pm

I have a 14 year old daughter who was diagnosed with ADHD at age 4. I too had issues with outburst, meltdowns, etc. Regulating and finding the right meds can help. She is on Adderall and was taking Clonidine to sleep, but no longer needs it.

This may sound strange, but I learned my best technique for dealing with these issue from the Dog Whisperer. I noticed she fed off my energy. when I was stressed, she would accelerate, even though I didn’t say or do anything. I had to come into the situation calm and assertive. The behavior was not acceptable and I wasn’t going to participate. She can throw a fit all she wants, but she was the only one feeding the aggression.Her episodes would last maybe 2 minutes, 5 at the most. There was no one to control. It’s not easy and takes lots of practice. I sometimes couldn’t stop myself from getting into the battle, but that’s when my husband would take over. Teamwork smile

I still use the technique today. She’s a great debater and in the old days I could get into battles with her that didn’t end well. Mostly we start laughing when she tried to one up me. She recognizes when shes doing it and she knows gets more from me when she’s calmed down. It doesn’t go away, just changes as they get older.

Posted by ckservices on Nov 19, 2013 at 5:20pm

We used to have more of a problem in the morning just prior to and just after my 7 year old son took his medication. We were also at our wits end. We started to get him up a half our earlier (6:30) and we leave the house at 8:30. After he gets his med we let him play or read or sit on the heater for a half hour (timed by the microwave) he must get his clothes on before leaving his room, and have breakfast and med before he gets his play time. If we make no demands on him during this time he seems to be more compliant with washing hands and face, brushing teeth and packing his back pack. I also cover the bathroom mirror with paper so he can’t see himself. This helps to focus him. The evenings after 5:30 are still a disaster . He is increasingly aggressive and bent on provoking a reaction at any cost. One hole plugged another spouts. School seems to be going ok. Wish I could have some of that teacher bliss time:)

Posted by Justina on Nov 19, 2013 at 6:55pm

Justina, you made me laugh!

“If we make no demands on him during this time he seems to be more compliant”

Oh boy, Wouldn’t we all be more compliant with no demands. grin That’s also when we run into trouble. I’ll say Let’s brush your teeth and he acts like I’ve suggested a very painful way to die. We turn on one light for him to go to sleep and that’s suddenly the wrong light. We turn that off and his requested light on, which, ten minutes later, is also the wrong light. I so agree with your statement One hole plugged another spouts.

This blanket is too hot. This pillow is too fluffy. The cat is too close to me. I can hear the wind outside. I need a band aid. I HATE BAND AIDS! The complaints go on. Does anyone think he’s just spoiled and this doesn’t have anything to do with ADHD? Our entire family is held hostage each night, trying to find just the right combination of conditions that will allow him to finally lie down and go to sleep.

BTW, how much melatonin can I give him? Is it by weight? I’m giving him half of a 3mg dissolving pill and he weighs about 40 pounds.

Oh, and I’m a huge dog whisperer fan! I love how he lets them work out their energy and he just stands there calmly. Turns out I have about 25 minutes of calm in me, then I want to snap and throw my own fit. My husband, ADHD, has about 2 minutes of calm in him. But oddly, sometimes once my hubby snaps and starts yelling, my son immediately calms down. It’s like someone in our house has to yell for everyone to go to sleep.

Posted by mom2-4 on Nov 20, 2013 at 5:43pm

hahaha!!! you made me laugh too:) I meant to say that he is more compliant later, when we DO make demands on him. Yup me too. I have an amazing amount of patience ....until I don’t:)

Posted by Justina on Nov 20, 2013 at 5:52pm

We have recently started letting him read at night with a camping lanturn under his blankets for 15 minutes (preceded by a shooter of melatonin and warm milk, seems to be working well.)

Posted by Justina on Nov 20, 2013 at 5:55pm

Reading through this thread sure makes me feel better!  Bedtime is horrible for us, my son is so wound up!  He is 8 and just diagnosed this past summer.  He takes Vyvanse which is helping him during the day.  He, like someone else wrote, never has behavior issues at school, he saves them all for us!  I tend to agree with some of the comments above, when he is tired or feeling any other emotion it is multiplied due to ADHD.  I have never heard of Melatonin for bedtime.  If we can’t find a way to improve that part of our day I may look into it.  And I too am so patient…until I go over the edge!  Every morning I wake up with a “today is a new day” attitude…thank goodness.

Posted by sbatchen on Nov 23, 2013 at 7:48pm

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