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Shall we up the dosage?


My 10 year old son thrived in academics and sports when we started Concerta a little over a year ago.
His end of year test score was off the chart, and became nationally ranked athlete in two sports.
However, we noticed his sliding past two months.
Shall we up the dosage? 
My husband thinks we should get him off completely and hop he can get it together.
Son already has side effect of Concerta.

Replies

Look into alternatives as an adjunct to, or instead of, meds. Do you have a good pediatrician who will guide you in trying appropriate levels of omega-3’s, diet change, etc. (the standard things to try).  Both changes helped our ADHD 7 year old.  We have also been recently very pleased with neurofeedback (in Michigan, theneurocore.com is a practice that many insurances have started to pay for).  Do your research about upping or discontinuing meds - you are your child’s best advocate.

Posted by Katherine85 on Feb 05, 2014 at 5:43pm

So at age 9 he started taking Concerta and you saw improvements in both academics and athletics (or was he already doing pretty well in both)?  What dose did he start on & was that dose ever increased?  If so, when & by how much?

You mention he “already has side effects” but what side-effects are they, and when did they begin?

Now it is a new school year, he is now 10 yrs old.  The “novelty” of taking a stimulant has worn off, and the “novelty” of a new school year has also worn off; you notice there is an associated decreased level of performance academically & athletically. 

How much bigger is he than last year?  Height, weight, etc.  School systems are so different so there’s no way to know what, if anything, has changed there.  Was there a move from a primary school to a secondary school? 

You say your husband is leaning toward stopping Concerta altogether.  What are his reasons for that?

You are considering increasing the Concerta; what are your reasons for that?

Have these differing viewpoints the two of you have on that matter become subjects of “debate” or contention either only between the two of you or between the two of you and your child (ie is your child aware of these differing opinions)?

Posted by BC on Feb 05, 2014 at 6:19pm

Before Concerta, he was a good athlete but nothing extra ordinally.
He struggled in school.  Daydreaming and was sloppy and had a habit of answering the problem before finishing the question.
Diagnosed with ADHD in November 2012 and started Concerta in December.  18 mg, 27, 36 and settled at 45 in May.  His new focus helped him with study and sports. 

He is growing at 50% percentile.  Is in 4th grade.

Appetite was low and hard time sleeping for several months but he got over it in summer.

Side effects are: nail picking/biting and teeth grinding.
Occasional tick.  It breaks my heart to see his hands and feet.  He has no nails.  His night guard gets chewed up so badly.

My husband and I talked about taking him to Drake Institute for brain mapping but we had financial setback a few years back, we have no credit thus can’t afford it.
Also Concerta has been working well so we felt we just stick with meds.

Mid December 2013, he started going back to the pre meds days. 
I’m considering upping the dosage to 54 before he falls far behind in school.  His athletic performance slid off, too.

My husband wants to ween him off all together because he thinks our son has become too dependent and it’s time for him to take responsibility.
I think he is too young.

He’s aware that we have debate.

Posted by Babales on Feb 05, 2014 at 7:46pm

First & foremost, you say he has occasional tics.  Do you know for sure it is technically (neurologically, by definition) an actual tic (because occasionally even health care professionals can MIS-label something as a tic when it is not)?  If the answer is yes, the next question is did he have it before starting Concerta?

Posted by BC on Feb 05, 2014 at 8:14pm

Oh no.  I never thought about that.
I’m making an appointment with his pediatrician right now. 
The doctor is a believer of medication. 

Fish oil didn’t do much if not at all.

Posted by Babales on Feb 05, 2014 at 8:56pm

FYI - if you used children’s brand gummy fish oil, you only got about a quarter or third of the daily dose needed to have an affect, if it’s going to.  Nordic Naturals Artic Cod Liver Oil was what was recommended by our specialist MD.  After a while (and it helping both my kids) I became concerned with the high levels of (non water soluble) vitamin A, so we switched to Carlson.

Posted by Katherine85 on Feb 05, 2014 at 9:46pm

So, I take it the “tic” is new (only started after taking Concerta)?  If that IS the case, is the doctor who prescribed the Concerta aware of it also?  (And I don’t know if the pediatrician you’re making an appointment with is the one who also prescribed the Concerta, btw).

Lots more to add to the discussion but without making assumptions, can’t really add much else right now.

Except to say that your husband apparently doesn’t really understand ADHD if he thinks that even the most “responsible” (& fully grown adult) who takes medication for it is doing that INSTEAD of “taking responsibility for” it.  That mentality is a huge red flag to me that indicates your husband has expectations of your child which are totally unreasonable (and therefore are expectations your child will NEVER be able to live up to).  Regardless of how effective the Concerta was (or possibly still may be) when kids OR adults have somebody in their life who constantly sends the message that they are taking the easy way out (relying too heavily on medication instead of just double-getting it and “fixing” a neurological problem through nothing but will-power and sheer determination) then the natural course of events tends to be the child or adult with ADHD labellling themself as a failure (and only because they’ve failed to meet someone’s expectations that are too high & are expectations nobody could meet).  When 10 year olds get labelled these ways one option is for them to stop even trying to “measure up” because no matter how hard they’re trying they never will.

I would STRONGLY encourage your husband to learn more about ADHD and how that kind of highly negative mentality can be the thing that makes medication—and effort—fairly useless.

Posted by BC on Feb 05, 2014 at 10:00pm

He may need to change meds.  That would be up to you and your doctor.  You may want to involve your son in some of these discussions.  Get his input as to why he thinks things have changed.  He may have no idea and that’s fine.  But before long he will be a teenager and needing to be responsible for his own behavior, actions, chores and homework, and eventually himself in a job.  I understand some of your husband’s concerns.  He doesn’t want a boy who uses ADHD as an excuse for everything.  I agree with BC, that he needs to understand ADHD better.  If your son was diabetic would he ask him to control his blood sugar by will power?  I doubt it.  He would have him take insulin and learn to handle life’s responsibilities.  I would propose the same idea for ADHD.  Have your husband look up what the purpose of stimulants are and why stimulants have the opposite effect on ADD’ers than neurotypical people. Encourage him to educate himself.  With your doctor find the med or meds that work, and which dose, and how often.  Then hold him to the same standards you would if he didn’t have ADHD.  All kids have to learn how to filter the words that come out of their mouth, do their chores and homework when they are supposed to, turn the homework in, be respectful of adults, etc.

My son is 21.  He was on a med in early middle school.  He chose to go off.  He tried again in early college, but the process of getting meds was too difficult and he did not continue.  I believe his advice would be to make sure he is in a school with other gifted kids.  That made a huge impact on my son through out his growing up years. 

In the end, do what you think is best.  You and your husband know your son the best.  Advocate for him and encourage him to do his best.  Ask him why he thinks things are different.  There could be so many answers-doesn’t like his teacher, a subject becomes hard when he’s used to everything being pretty easy, someone bullying him, a friend moves away, or combinations of multiple things.  Good luck and keep trying.  You are making a difference in his life.

Posted by whizinc on Feb 06, 2014 at 12:33am

The effect of Concerta may depend on his height and weight, and when it wears off during the day.
I have a very skinny 13 year old boy who is about 5 feet 2 inches in height and is on 36mg which he takes at about 6.30am. He feels it wear off at school by early afternoon so has a top up with Methylphenidate 10mg (Ritalin) - this has made a difference and gets him through until about maybe 6pm.
What does your son think? Does he want to continue with meds? In the end, I think that if it’s making their life better they will tell you, and you and your husband have to cope with your own feelings.
My son has occasional weekend or holiday days when he doesn’t take the Concerta, but by and large he does not like himself without it and prefers to take it.
We did have a short spell where he thought it was no good, but that was when he was growing and was a bit under-dosed. Your boy may be big and actually need more - drug responses can be such an individual thing depending on metabolism, genetics, etc.
Good luck!

Posted by EnglishADDboy'sMum on Feb 06, 2014 at 10:03pm

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