My son was just diagnosed with ADHD | ADHD Information

My son was just diagnosed with ADHD about 1 month ago.  We tried clonidine, but it made him cry all the time.  Today I picked up a prescription of Risperdal .25 mg.  I read up on this drug and I am a little nervous giving it to him.  My son is almost 3.  I knew he was difficult, but I had no clue.  His doctor told me that he was one of the worst cases that he has seen.  He told me that finding a drug that would work was going to be trial and error.  He said it was going to be very difficult due to the size of my son.  He is 43 lbs and is 40 inches tall.  He is that size of a 4-5 year old boy.  I guess that I am just scared.  I have been around a lot of children and never one that has acted like my son.  If anyone has any support or information please email me.  Thanks, Lisa  lrwalker78@yahoo.com

 

You certainly have reason to be nervous.

I am sure that I will not be the only parent to suggest seeking another opinion.  What kind of doctor diagnosed your son?  Even though my son was evaluated at 3, because of how ADHD is diagnosed, a definite diagnosis was not given until age 5 per a comprehensive neuropsychological examination--which, for testing reasons cannot be undertaken until age 5--they need to be capable of undertaking certain tasks (i.e. holding a pencil and drawing a circle) which most 3 year olds cannot perform.

I would add that my son is also an extreme case--processing speed 7%, verbal IQ 98%.

Also keep in mind, that no one suggested treating my son with medication until he was 6 years old.  I am shocked that your doctor has prescribed medication so soon.

You might also want to seek an occupational therapy evaluation at this time-- O.T. can be very helpful for young children.

Has your doctor precribed other behaviorial therapies-ABA, O.T., P.T., social skills, positive reward systems?  Generally these are implemented along with medication.

Trust your instincts--ask around--find a good child psychologist to evaluate your son.  And research the prescribing physician/psychiatrist/developmental pediatrician--are they conservative, do they take the medication route slowly, do they offer additional therapies?

Good luck.

Giving meds like this for a 2 year old is unusual. A suggestion, if you live near a big city you might check out the major teaching hospitals and med schools for clinics or at least someone who can help. One idea...call the med school and ask who is on their faculty who works with this type of problem . At the very least a faculty doc will be up on the latest.

Don't let this go by. You are going to need the best help you can get. 2 year old children are difficult to diagnose correctly due to developmental issues. (Think about trying to diagnose a reading disorder in an 18 month old to see what I mean). It may be a while before you can find out what is actually going on.  in the meantime keep plugging. It is important for both you and your child.

Get some sort of support system going. Friends, relatives, support groups and forums like this. There is support out there if you reach out. Find those who do not judge but will listen.

 Behavior management can help at least to some degree. Find a therapist or psychologist who is experienced in working with this age child and this type of disorder, not all are. Learn methods of helping your child manage at least to some degree his feelings Again important for both you and your child.

One of the most helpless feelings is to have a child hurting and not being able to do something to help.

I have been there. You can't do it alone.

Diz

I agree with the above. Who diagnosed? I think you are very right in your hesitation on these meds for a 2 year old. Please go get another opinion. A good childrens hospital is a great suggestion. Even if there is not one close by drive there. No one can correctly diagnose ADHD at age 2. This does not mean at all that there is no issue at hand, obviously there is and you need help, but trying meds this young sort of "blindly" is a little bit scary.

OT is really a great thought too. Kids with sensory processing issues mimic ADHD and there are things you can do that really really help. I did a lot of snesory exercises with my 5 year old when she was 3 and difficult to control, they really saved us.

The Out Of Sync Child is a great book on sensory processing disorders. Even if he does not have it, the excercies are fun and jumping on a trampoline or spiining around doesnt have any side effects. No harm if it doesnt work.

 

Please keep us posted. And I am so glad you are asking about all this and looking for a clearer view.

Please know that the parents gave this child too much Clonidine. It's such a fine line. Obviously (well I guess not that obviou) is to always, always under every circumstance to use medication ONLY as directed.

I do not doubt children as well as adults are overdiagnosed and overmedicated. I hate that is has to be this way and because of that, it makes the children out there who need this treatment suffer yet again.

Like Diane V, my son's behavior was horrible at ages 2, 3, and 4. Some days I was pretty unhappy. I never brought him to a play area that was not completely enclosed until he turned 4. Still, I don't regret not medicating. So many of the behaviors went away by age 5, and now at age 8 even more are disappearing. What I seem to be left with is ADD. It's becoming very clear with time. Distractibility is the core issue.

The early intervention preschool is a great idea. If he's turning 3 soon, he'll probably be ready.

Bethann  and NoTelling suggested Early Childhood Intervention (ECI in Texas). This is usually on a state basis and can be very helpful. I can only speak on the one in Texas. They work up to age three and will come out to your home and do evaluations.  My past experiences with them has been very positive.  If you decide to use them move on it as they cut off at age three.  It can't hurt and is normally free of charge.

Good luck.

Diz

TO EVERYONE WHO HAS POSTED, Thanks

I appreciate everyone who has responded.  I have taken him to different doctors and they have done several tests with him.   My son is very advanced at his age.  He is almost 3 and he can draw different shapes and I started writing ABC's with him, but he is very impossible to handle.  NO daycare or preschool will take him.  After 1 day with him I receive a call to come and get him.  He tries to hurt the other kids.  Me and my husband have a farm and he tries to hurt the animals.  We are also doing family counseling to try and help resolve the problem.  My biggest concern is that my son is very bright and can be a loving child, but it does not happen very often.  All the physicians and pychologist are working together to help us.   I believe that this is the entire famllies problem just not my sons problem.  The doctors are trying the meds for only a month.  My son is getting ready to have two different surgeries.  He has been very sick for the past year.  They want to help him get through this next month and then see how he does after both surgeries have been performed.  It does make me nervous to give him this medicine.  I am praying that this is not going to have to be a everyday thing.  I will keep everyone posted on how things come out.  His first surgery is Thursday.  Aug 2 I will find out when his second surgery will be.  The doctors are afraid that the infections might be causing his aggression and his behavior.  He is very closely monitored due to his age.  I appreciate the support.  Thanks again,

Lisa  

Hi Lisa,

I agree that giving a child this young this type of med is very unusual, however, please don't take that as I am judging you by doing so.  You need to do what is best for your son given the advice of the professionals.  You need to realize that giving a child of 2 an anti psychotic med is quite controversial and being hotly debated in the field of psychiatry.   I am pasting below an article from a recent issue of "ADHD in the News".     Okiemom
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The Boston Globe
June 17, 2007 Sunday
Backlash on bipolar diagnoses in children MGH psychiatrist's work stirs debate
BYLINE: Scott Allen Globe Staff

No one has done more to convince Americans that even small children can suffer the dangerous mood swings of bipolar disorder than Dr. Joseph Biederman of Massachusetts General Hospital.

From his perch as one of the world's most influential child psychiatrists, Biederman has spread far and wide his conviction that the emotional roller coaster of bipolar disorder can start "from the moment the child opened his eyes" at birth. Psychiatrists used to regard bipolar disorder as a disease that begins in young adulthood, but now some diagnose it in children scarcely out of diapers, treating them with powerful antipsychotic medications based on Biederman's work.

"We need to treat these children. They are in a desperate state," Biederman said in an interview, producing a video clip of a tearful mother describing the way her preschool daughter assaulted her before the child began treatment for bipolar disorder. The chief of pediatric psychopharmacology at Mass. General, he compares his work to scientific breakthroughs of the past such as the first vaccinations against disease.

But the death in December of a 4-year-old Hull girl from an overdose of drugs prescribed to treat bipolar disorder and attention deficit hyperactivity disorder has triggered a growing backlash against Biederman and his followers. Rebecca Riley's parents have been charged with deliberately giving the child overdoses of Clonidine, a medication sometimes used to calm aggressive children. Still, many wondered why a girl so young was being treated in the first place with Clonidine and two other psychiatric drugs, including one not approved for children's use. Riley's psychiatrist has said she was influenced by the work of Biederman and his protege, Dr. Janet Wozniak.

"They are by far the leading lights in terms of providing leadership in the treatment of children who have disorders such as bipolar," said J. W. Carney Jr., lawyer for Dr. Kayoko Kifuji, a Tufts-New England Medical Center psychiatrist who temporarily gave up her medical license after Riley died on Dec. 13, 2006. "Dr. Kifuji subscribes to the views of the Mass. General team."

Part of the criticism of Biederman speaks to a deeper issue in psychiatry: the extensive financial ties between the drug industry and researchers. Biederman has received research funding from 15 drug companies and serves as a paid speaker or adviser to seven of them, including Eli Lilly & Co. and Janssen Pharmaceuticals, which make the multibillion-dollar antipsychotic drugs Zyprexa and Risperdal, respectively. Though not much money was earmarked for bipolar research, critics say the resources help him advance his aggressive drug treatment philosophy.

Numerous psychiatrists say Riley's overdose suggests that bipolar disorder is becoming a psychiatric fad, leaving thousands of children on risky medications based on symptoms such as chronic irritability and aggressiveness that could have other causes. Riley's father, for example, had only recently returned to the home after being accused of child abuse, according to police. Since the girl's death, state officials have stepped up a review of the 8,343 children taking the latest antipsychotic medications under the Medicaid program for conditions including bipolar disorder, to be sure the treatment is appropriate.

Psychiatrists too often prescribe these medications, which carry side effects such as weight gain and heart disease risk, without addressing problems in the children's lives, said Dr. Gordon Harper, director of child and adolescent services at the state Department of Mental Health. He likened the approach to "tuning the piano while the subway is going by."

Aggressive treatment

Biederman's critics chide him for not speaking out against misuses of a diagnosis that he has helped inspire. Among leading authorities on bipolar disorder, the Mass. General team has proposed the most aggressive treatment for the broadest group of children, they say, and Biederman should take responsibility when treatment goes wrong. At a conference on bipolar disorder at Pittsburgh's Point Park University last weekend, one speaker, Dr. Lawrence Diller, a California behavioral pediatrician, contended that Biederman bears some blame for Riley's death.

"I find Biederman and his group to be morally responsible in part," said Diller, whose popular book, "Running on Ritalin," accused psychiatrists of overtreating another childhood condition, attention deficit hyperactivity disorder. "He didn't write the prescription, but he provided all the, quote, scientific justification to address a public health issue by drugging little kids."

Biederman rejects the idea that Riley's death is a cautionary tale, accusing critics of exploiting a tragedy to fan fears about psychiatry, a profession that has long faced prejudice. "The fact that she had XY drug or XY treatment is irrelevant to what happened. ... If this child had the same outcome from treatment for asthma or seizures, we wouldn't have this frenzy," said Biederman in an interview at Mass. General's Cambridge mental health clinic.

Though Biederman acknowledges that distinguishing bipolar disorder from ordinary crankiness and flights of fancy in young children is challenging, he insists there is no ambiguity in the patients at his practice. "People have to wait a long time to see me or my colleagues. ... It's not that somebody comes to me after their child has a temper tantrum. They do things for years that are dangerous. These are things that profoundly affect the child," said Biederman, putting them at risk of academic failure or even suicide.

Biederman dismisses most critics, saying that they cannot match his scientific credentials as coauthor of 30 scientific papers a year and director of a major research program at the psychiatry department that is top-ranked in the "US News & World Report" ratings.

The critics "are not on the same level. We are not debating as to whether [a critic] likes brownies and I like hot dogs. In medicine and science, not all opinions are created equal," said Biederman, a native of Czechoslovakia who came to Mass. General in 1979 after medical training in Argentina and Israel. He now lives in Brookline.

Struggle for research funds

Biederman's thinking on bipolar disorder grew out of his work in the early 1990s, when he observed that many children referred to Mass. General's psychiatric clinic seemed to have periods where they were extremely aggressive, deeply depressed, or angry. And they were not getting better from taking medications such as Ritalin, which is prescribed for attention deficit hyperactivity disorder.

At the time, psychiatrists considered bipolar disorder a condition that typically revealed itself around age 20, and rarely in children under 12, but Biederman believed that many of his patients met the definition normally applied to adults. Working with Wozniak, he published an influential paper in 1995 reporting that one out of six children at his clinic might be bipolar and that the rate was even higher among children with ADHD.

Biederman was already quite successful as an ADHD researcher, establishing close ties with companies that manufactured drugs such as Ritalin to fund research projects that the federal government would not pay for. He also received payments for giving speeches about mental health issues and serving on scientific advisory boards that typically meet a few times annually to discuss research. He declined to say how much he receives, but said that all of the income was approved by both Harvard Medical School and the hospital.

Biederman's boss said he does not believe the money affects Biederman's judgment.

"I think a pharma person would not dare to tell Joe what to say," wrote Dr. Jerrold Rosenbaum, chief of psychiatry at Mass. General, in an e-mail. "And if they made that mistake, it would be only once. ... For Joe, it is his ideas and mission that drive him, not the fees."

Biederman said he quickly discovered that drug companies were less interested in bipolar disorder than the more established ADHD. He and Wozniak, who did not respond to a request for an interview, struggled to get funding for research on bipolar children. "The more controversial a diagnosis is, the harder it is to get funding from conventional sources," he explained.

Contrasting viewpoints

Occasionally, they received small grants from drug companies or private philanthropies to test drugs on children, but Biederman admits these studies are not enough to prove the drugs are safe and effective. Nonetheless, the Mass. General studies were enormously influential: their 2001 study, in which 23 children diagnosed as bipolar received the drug Zyprexa for eight weeks, became one of the most frequently quoted articles in the history of the Journal of Child and Adolescent Psychopharmacology. The study showed that the drug eased outbreaks of aggression, though children typically gained more than 10 pounds.

Biederman was disappointed that he could not do more comprehensive studies, but he saw no reason to delay treatment. "At least the line of drugs I'm talking about gives some relief," he said. "The only way to understand the side effects is in the context of the seriousness of the illness."

As bipolar disorder received increasing media attention, Biederman and Wozniak's research was often cited as the scientific rationale for diagnosing and treating the disease aggressively. Another leading researcher, Dr. Barbara Geller of Washington University in St. Louis, adopted a more restrictive view, requiring that children have a series of specific symptoms such as reduced need for sleep before she would diagnose the disorder. But the Mass. General team used broader categories, saying that children who are extremely irritable or aggressive might be bipolar. Skeptics said those symptoms were too common, leaving too much room for dispute over who is really sick.

Dr. Biederman's staff "can do the same diagnostic interview on 100 children and come up with five or 20 bipolar disorders, and I might do the same thing and find only one or none," said Dr. Jon McClellan, a psychiatrist at the University of Washington who chaired a panel of the American Academy of Child and Adolescent Psychiatry that recently concluded there is no proof that children under 6 can be diagnosed with the disorder. He says he has received no money from the pharmaceutical industry for years.

A surge in diagnoses

Biederman's work helped fuel a surge in the number of children diagnosed with bipolar disorder over the past 15 years. A national study of community hospitals found that the percentage of mentally ill children diagnosed as bipolar quadrupled from 1990 to 2000.

The rapid rise raised concerns at the National Institute of Mental Health, prompting its top officials to convene leading specialists, including Biederman, to urge them to come up with diagnosis and treatment standards. The resulting guidelines, released in 2001, acknowledged that Biederman was right: Bipolar disorder can strike before puberty. However, the guidelines also stated that identifying the disease among children is challenging because normal children are prone to be irritable, aggressive, or giddy.

Dr. Steven Hyman, who was then director of the mental health institute and is now provost at Harvard University, said he remains very concerned about the growing use of "big gun" antipsychotic drugs such as Zyprexa, Risperdal, and Seroquel on children. In the Massachusetts Medicaid program, the number of people under 18 receiving at least one of the "atypical antipsychotic" drugs rose from 6,943 in 2002 to 9,123 in 2005, a 31 percent jump, before declining to 8,343 in 2006. Hyman says that none of the drugs has the approval of the Food and Drug Administration for use in bipolar children, and doctors prescribe them based on their individual judgment.

"We don't know the first thing about safety and efficacy of these drugs even by themselves in these young ages, let alone when they are mixed together," said Hyman.

Rebecca Riley's treatment

Kifuji was careful in treating Rebecca Riley, meeting the child six times before diagnosing bipolar disorder, according to Carney. Based on the child's behavior and family history, Kifuji prescribed three drugs to the 3-year-old child, including the antipsychotic medication Seroquel and Clonidine, a high blood pressure medicine that is often prescribed to calm aggressive children. Last year, Clonidine was prescribed to 1,195 children under age 7 served by the Massachusetts Medicaid program, including Riley.

Police charge that her parents, Carolyn and Michael Riley, repeatedly convinced Kifuji to give them extra Clonidine, ultimately accumulating dozens of extra pills that they used to control the little girl. Long before the child finally died on the floor beside her parents' bed, the police report said, teachers and school nurses noticed that she had become lethargic like a "floppy doll" on a nurse's lap.

Carney said his client, who is not practicing while the investigation continues, did nothing wrong in writing the prescriptions for the girl. Although some were shocked that the child was taking so much medication, Carney said Kifuji was practicing mainstream psychiatry for a very troubled child. He observed that Biederman's "research and teaching validates Dr. Kifuji's work with patients."

Scott Allen can be reached at allen@globe.com

I agree with the others as well.

I'm pretty sure that the American Academy of Pediatrics recommends not diagnosing ADHD until age 6 because many of these behaviors are developmentally normal before then. Don't worry that this is supposedly the worst case your doctor has seen --- mild, moderate, severe --- these descriptions are totally subjective and vary based on the particular environment.

Is there a reason that you want to medicate so soon? Is he that challenging at home? Or is he in a preschool where his behavior is problamatic? A lot of parents just ride the wave and try different things until the condition is really causing problems-- like when school starts. I noticed that you only described him as difficult, not completely impossible to deal with.

You might want to just sit back and relax; many behaviors will go away on their own by age 4 or 5, and things will become clearer with time. I'm sure I'll get some flack for this, but if his behavior is not impossible I would not even seek out a diagnosis yet -- the younger they are, the more likely that the diagnosis will be wrong or incomplete.

I have to input a little more because I am worried about all this with a 2 year old. I really agree with No Tellin about waiting this out, if you can.

 My daughter age 5 and 1/2 now was horrible at age 3. 2,3 and 4 I thought I would go OUT OF MY MIND. This is not my ADHD child, so I already had an ADHD child and this one just put me to the wall. I took a breath did all the discipline stuff and waited it out. Amazingly after age 5 she has completely turned a corner, I really believe them now that SO much of this is that end of normal. I did have  a school eval because she has a fine motor delay so I requested a full CORE eval, and we will re eval AFTER age 6, but the change over the past 6 months has been so dramatic. Believe me, she is still VERY independant and very, very much her own person, but I do not think she is ADHD or probably anything any more.  If you can get by with waiting this out and trying all the great discipline tactics out there, try things for sensory processing and "strong willed" children, do it. Whether there is anything there or not these things will help anyway.................

I would questtion the diagnosis, and think VERY hard about giving an anti psychotic to a 2yo. I honestly have never ever heard of a child this young being diagnosed by a Psychiatrist in his /her right mind.

Was there bloodwork done to rule out other things?

Was an EKG done? An EEG?

Who diagnosed? A pediatrician or a psych?

Hi lrwalker78, welcome to the board.

We treat my son with diet, OT and supplements only and his symptoms have greatly improved.  He is 9 and never been on medication, although he was never worst case scenario ADHD. At two I would certainly consider alternate treatments before giving anti psychotics to a two year old.  And I would go for a second opinion as there are so many conditions that present with the same symptoms as ADHD, has the doc done enough tests to be sure it IS ADHD?

I agree. Your son is too young for medication. He is not yet 3. Does your state have Early Intervation? If so, call them. They can also direct you to preschools for your son.

Early Intervention can also help with finding the right professionals to diagnose conditions for children. They begin when the child is an infant.

My son was ADHD at the same age as yours. However, we went through all the other methods of working with him before medication.

I wish I had medicated him around 5, but not 2-3. My son is severly adhd with hyperactivity and impulsiveness. He also has sensory integration and a speech delay.

We also sent our son to an integrated preschool where children with these types of disabilities attend and cannot be kicked out for their behavior. Early Intervention helped direct us to the right program. Then you need to work on special education plans when he is old enough to help his education.

Medication has done wonders for him. I worry about his meds at his age of 10. I would never have been comfortable giving him meds at your son's age.