Name: margalit
Location: Massachusetts, United States Professional writer, educational advocate, opinionated ultra liberal mother of 18 year old twins, living life in the slow lane due to hypertrophic cardiomyopathy, congestive heart failure, and diabetes.

email: margalitc at yahoo dot com

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Thursday, November 03, 2005

Bouncing off the ceiling

The Boy has pretty severe ADHD. It's not like just a plain active kid, he is really hyper and impulsive and there are days where I just want to sob because it is so hard to live with day in and day out. One of the most depressing things about severe ADHD is that there is a rebound effect when medication wears off. ADHD meds don't last very long. The Boy takes Concerta, which is ritalin in a unique pump-like pill. It is supposed to last up to 8 hours, and for the most part it does, but we have a severe witching hour here, around 5 pm, where he just goes bonkers. The last time we saw the psychopharmacologist he prescibed regular ritalin pills for late afternoon to help with the rebound. That usually helps out with the worst of the rebound effect and they last until bedtime.

Today, the Boy went to a friend's house after school. He had "forgotten" that we had a family therapy appointment later this afternoon, just as he had "forgotten" that he had a therapy appointment yesterday. I reminded him, believe me I did. But this is a kid that just will not remember what he doesn't want to, and will do impulsive things like go to a friend's house without telling me, or his bus driver. He did call about 1.5 hours after school was out, and I told I absolutely needed him home at a certain time for the family therapy (she comes to the house). He did make it home, but he had not taken his afternoon medication, so he was flying.

L, our therapist, wasn't thrilled to see his behavior, especially when he pretended to kick his sister in the face. He was jumping on furniture, kicking the oriental rug over, singing to himself, and in general being his usually non-medicated annoying self. But she had never seen him non-medicated and she started freaking out. Great, this is ALL I need. At one point I gave him two warnings, and then took his XBox controllers away for a week. He got mad, ripped the controllers out of the Xbox and tossed them across the room, losing them for yet another week. Then he marched upstairs and started tossing stuff up there. He came down a while later, but didn't see the need to give a sincere apology, and then continued acting up. I had to theaten to take away his guitar and set the parental controls on the TV before he started to realize I was serious.

Later, when the evening dose kicked in and he was rational again, I talked to him about how it was a really bad idea to act like this in front of a mandated reporter and how it was not in anyone's best interest to observe him acting like such a jackass. He said he was sorry, but he can't control it. I talked to the therapist and explained about the rebound effect and how he just can't behave during this time, but the deal is, it's not a good excuse. He needs to learn through behavior management that he can't keep pretending to slug or hit his sister, or be so annoying as to interrupt a family meeting. This isn't acceptable behavior and he knows it, but knowing it and controlling it are two different things.

I'm caught between a rock and a hard place. I understand after living with this kid for 13 years that this is what he's like in the afternoon, and for the most part I can deal with it even though it's horribly frustrating. Most of the time he's fine and cooperative and a great kid, but during the witching hour he sucks lemons. On the other hand, I know that the therapist has the entire family's interests at heart and she needs to see safe behavior in order to feel like we're making progress. We see her precisely to deal with the Boy's issues and the focus is on his behavior much of the time (although the Girl has her moments, believe me!) so it's important for her to see progress. I don't want him to lose his personality, which I find delightful about 90% of the time, but I do want him to be in more control of himself when the meds are worn off.

We're going to see the psychopharmacologist next week and we'll be discussing what to do next.

For those of you who are against medication, and don't believe that ADHD exists, I'm happy to rent out the Boy for a weekend unmedicated. Any weekend. Just call and we'll make plans.
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Blogger blackbird said...

...and don't you love the professionals who suggest that he take the summer off from the meds?
I used to say "no way!" in the summer, he's mine all day!

3/11/05 7:24 AM  
Blogger Happy Mama to Three said...

It's amazing the "professionals" and "experts" who have never lived with, interected with on a daily basis, or had to handle any child who truly needs medication for more than a few hours at a time. Having had a brother who truly needed medication, and only survived being a teenager thanks to medications and a counselor who understood. Hang in there Marj!!


3/11/05 8:49 PM  

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