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Hi. I have a 9 year old boy. He has never been dx with anything except speech issues. He has some autism traits, ocd, and adhd. He has always wanted to control things, has anger issues, social issues. Lately he has been stealing, he only has a couple of friends. He has been seeing a ped. psychologist for years. He gets angry so easily and says whatever. He has no filter. He does ok in school. He had a playdate on Saturday and they were playing Minecraft. My son kept killing his friends animals but when his friend did it to him he got so angry. Said he hated him, didn’t want to ever play with him again. He is always so sorry after he has a episode like this. My husband and I talk to him and try to help him. We don’t know what to do anymore. The Dr. put him on Prozac last summer, we have not seen a change now they are talking about a adhd med. I guess my question is what is a good med for anger and impulsive issues?? Just needing feedback! Thank you!

Replies

A good med for anger and impulsivity issues for a kid with ADHD is an ADHD med.  Why? because anger and impulsivity are symptoms of ADHD.

That sounds a little flip, I’m fairly sure, so I hope you’ll look past that.  A bit more information would be helpful, I think.

Why was Prozac started?  Why were ADHD meds NOT started?  Since the Prozac was started you say you don’t really see much change.  Change in what?  And since the Prozac was started have you noticed an INCREASE in impulsivity?

Posted by BC on Feb 24, 2014 at 10:01am

ADHD medication is correct. ADHD children struggle desperately with controlling impulsivity and emotional control on their own. ADHD is a medical condition that needs the proper ADHD medication to treat the condition.

No matter how much your son may try, how much you may encourage him, or what kind of psychological treatment he may receive, although that is very important, ADHD children physically will not be able to behave as we’d hope without their symptoms being treated. It can take a little while to find just the right one, but it’s out there.

It’s wonderful that you are looking out for your son the way you have. I think that once your son’s pediatrician treats the condition correctly you’ll find that his behavior will improve substantially because he’ll be able to control his impulsive and emotions much better.

Posted by Havebeenthere on Feb 24, 2014 at 1:37pm

If they haven’t already,ask them to administer a Connors III which will require your input and teacher input to test for the presence of ADHD/ADD,ODD etc. it is a paper test. Meds are not a magic bullet,but require the use of other strategies such as consistency and routine to ensure full effectiveness.

Posted by Speduc8r on Feb 24, 2014 at 5:32pm

I’m curious why the Prozac (an SSRI) was started.  In ADHD, one of the biochemical deficiencies involved is low dopamine activity in the pre-frontal cortex which is responsible for that lack of inhibition (what we call impulsivity).  Stimulants increase dopamine levels, which in turn allows the pre-frontal cortex to function better (inhibiting certain behaviors).

SSRIs increase serotonin levels and decrease dopamine levels, so giving someone with ADHD an unopposed SSRI (meaning the SSRI that is not given WITH some other ADHD med) can lead to an even greater dopamine deficiency than they already had.

You can read about that here http://www.corepsych.com/2006/12/kids-and-antidepressants-why-they-dont-mix/

The title sounds as if it suggests kids shouldn’t take antidepressants but that is not the actual gist of it.  It is a warning from Dr. Charles Parker that one theoretical reason for the increased levels of suicide in kids given SSRI antidepressants could be what it does in the brain of any child whose depression is being treated with an SSRI but whose ADHD is unrecognized.

Posted by BC on Feb 24, 2014 at 6:47pm

I agree with BC. Why Prozac? At age 7 my son tried Strattera. It did nothing for him. When my son was about 8 and we weren’t sure if he had ADHD a doctor told me that if he tries Ritalin and there is a noticeable change then we know he has ADHD. It helped him a lot. Vyvance in middle school made him angry. Ritalin or Concerta works best for my son with least side effects.

Posted by leslie 1 on Feb 24, 2014 at 7:12pm

I don’t agree with putting children on any kind of SSRI as, according to the FDA, these medications may cause mania in people under 25. Unlike Prozac, stimulants have been used for over 50 years to treat symptoms associated with ADHD such as impulsivity and hyperactivity.

My son takes a stimulant and he is much less impulsive and more task oriented. He is on a new preparation, the Daytrona patch. The difference is like night and day. I can give him a task to do, such as a school project, and he will actually sit down and do it. I don’t even have to sit with him. He sits down and gets it done. Until we tried this med, that NEVER happened.

I think its worth a try. Have you considered seeking out the services of a developmental pediatrician. That’s the kind of doc we see and I think its worth seeking one out.

Hope this is helpful.
Susan in PC, Ohio

Posted by SueH on Feb 24, 2014 at 7:51pm

Susan:

Could you please post a link to where the FDA says SSRIs can “cause” mania in people “under 25.”

SSRIs (and any/all antidepressants for that matter) can induce mania or hypo-mania when they are given to people under 25 (as well as over 25) who have undiagnosed/unrecognized bipolar depression. 

This concept is one that has been known about for many, many years, btw.  For anyone who is given an antidepressant of any kind but who has a particular atypical reaction to it—what has been termed “hypomanic” or “manic conversion”—the presumed underlying diagnosis becomes bipolar depression.

Posted by BC on Feb 24, 2014 at 8:25pm

I think my big question is why are they putting him on medication when he hasn’t been diagnosed with anything?!?

Posted by Rai0414 on Feb 24, 2014 at 9:44pm

My son has been diagnosed with ADHD and ODD and had some anxiety issues.  He’s started taking methylphenadate when he was 7 and it made a world of difference in his behavior.  When he’s medicated he’s no longer argumentative or impulsive and he can sit still in class and at home long enough to do homework.  For the anxiety, he takes a small dose of clonidine in the morning and a larger dose just before bed…this allows him fall asleep instead of laying there with his brain racing all night.  I am grateful for these medicines.  Without them I would have a horrible relationship with my son filled with arguments and shouting.  When he’s medicated, he’s a sweetheart.

Posted by stacys2peas on Feb 24, 2014 at 10:08pm

Emotional impulsivity is one of the most destructive parts of ADHD.  It doesn’t get better on its own and you can’t talk kids out of it either.  So its good that you are talking to him after he’s had an incident, but make sure it isn’t a set up.  What I mean is, if you talk to him and then expect him to be able to behave differently next time, then it is a set up to fail.  You could no sooner talk to a diabetic about making their pancreas work better!  So don’t expect things from him he is not capable of.

Talking to him is great to help him understand why he doesn’t have control, how that makes him feel, what he can do to make up to friends or explain to them that he has no control.  But you don’t want to add to an already rocky self esteem picture!  Untreated or poorly managed ADHD leads to poor self esteem and this can be very difficult to fix in later years.

So good for you for looking into treatments.  You will know pretty much immediately if the meds are right.  Good luck.

Posted by YellaRyan on Feb 25, 2014 at 12:11am

My son has never been dx with adhd but has some of the symptoms but no dx. He also has anxiety so that is why they started him on Prozac. The doctors were hoping if some of his anxiety was treated that the anger might improve. He also has some autism traits and some ocd. Never enough to be dx according to their tests. He is not your typical hyper bouncing off the wall kind of kid. His biggest issues are anger and impulse issues. I just want to get him help. I know there are alot of meds out there. I was just wondering if one is better for anger and impulse issues. He is a very picky eater and I am worried about side effects. I plan on getting him off of the Prozac. Thanks for your help!

Posted by Cubbybear on Feb 25, 2014 at 2:50am

My son is apparently as close as they come to a “typical case of ADHD”.  And his biggest issues are impulsivity, anger and concentration (I mostly see the anger at home, his teachers mostly see the concentration issues at school).  After being diagnosed, and then trying two years of everything else, he went on medication this Christmas.  Since being on medication his teacher has remarked how much his anxiety has dropped!  She’s really quite amazed.  I really didn’t see him as anxious overall, but she’s got a background in special education and has dealt with many anxious kids in the past so I’ll take her word on it.  It’s our theory that the anxiety comes from his frustrations at school.  He was getting into trouble and not doing well.  He was getting frustrated and trying and still failing.

Before you decide what to do though, I’d have him diagnosed properly and then learn as much as you can about ADHD (or whatever he might be diagnosed with) and go from there.

Posted by Rai0414 on Feb 25, 2014 at 4:48am

Thanks for that clarification—makes much more sense now.  If his doctors are contemplating starting ADHD meds, and as you say ADHD hasn’t yet been officially diagnosed (ruled in or ruled out) that means ADHD is at least pretty high on what is known as their differential diagnosis. 

If they’re now entertaining the thought of trying some ADHD meds I’m willing to bet that on his tests he’s come fairly close to qualifying for the diagnosis, just not quite.  It does tend to be much easier to “diagnose” kids who have the classic hyperactivity component than those who don’t (by the same token that also makes it easier to over-diagnose anything “hyper” as being presumptive ADHD).

Based only on what you’ve provided here I will say that if I HAD to pick one way or the other (again—based only on this small amount of information) I’d have to pick “yes” (there’s a really good chance he has ADHD).  Sometimes the best way to find out is to try a stimulant and see what happens.  Because the effects of stimulants take effect quickly and last less than 24 hours that is less risky & potentially a lot less time consuming than trying an antidepressant for anxiety and seeing what if anything happens to the anger.

His doctors, however, did do the “right thing” medically in that they decided against giving a stimulant to someone who definitely had anxiety issues, but who did NOT definitively have ADHD.

Already being a picky eater, I can see where you would not be too thrilled about the potential side-effects of stimulants though.

It IS a tough call but because there ARE lots of times when the first stimulant tried obviously helps (and if it doesn’t the other class of stimulants can be tried) just having a better idea if ADHD is or is NOT in the picture seems worth it to me. 

If I was in your position and had to pick between trying a stimulant or trying anything else out there that may work for anger/impulse issues (including the non-stimulant for ADHD guanfacine which they might suggest), I would pick trying a stimulant, hands down.

If I was in your position I would also contemplate getting a second opinion about the diagnosis OR simply going back over the questionnaires with them again to see if some of the answers given back then have possibly changed (making his ADHD score either higher or lower, but more definitive). Also, if there is someone else who was not asked the complete an ADHD rating scale questionnaire, such as another teacher or a close relative or friend, sometimes that will shed a lot of light on an otherwise “borderline” diagnosis.

For example when I scored myself I scored either right at or 1-2 points above the cut-off mark; my psychiatrist completed his end and concurred with the diagnosis, but for various reasons I just didn’t feel good about starting a new med with his answer as yes and mine as “yes, technically, but just barely.”  I asked if I could just think about it some more.  I had my husband fill it out with zero input from me.  He scored me WELL above the cutoff mark because of only one single answer he marked “yes” that I had marked as “No.”  It was something about how I deal with things I’m not interested in or how well I deal with things that are of zero interest to me;  I had put something like “not a problem at all” but only after I saw his answer did I really think about that some more and only for a brief split second—DUH, I just had managed as an adult to be able to avoid anything and everything that falls into that category quite often. Now I understood more about my very adamant Do-Not-Like-That-Sam-I-Am…so-if-there’s-any-way-to-get-out-of-it-I-will mentality.

Posted by BC on Feb 25, 2014 at 6:32am

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