Mr. Toad's Wild Ride

It's never easy to know the right thing to do when you are an ADHD parent. Okay may be good enough, but doesn't there always seem to be something better out there?

Like most kids with ADHD, Dylan has been on a variety of medications since he was first diagnosed. Daytrana, Metadate, Focalin, and Vyvanse. He was actually on Vyvanse twice. The first time we tried it, he had terrible letdown when the meds wore off. This time, it seemed to have worked adequately well. Not as well as the first month of Metadate, but that's a nirvana we will probably never see again.

So the Vyvanse would keep him relatively focused and lasted a fair amount of the day, but something was still missing. His math and social studies grades have remained in the D-F range, and his recall for what goes on in class has been minimal.

Now, I fully realize there is no drug to address executive function deficits, but I cannot help wondering if he could just focus better and longer, maybe he could remember a bit more and better understand what he learns.

Finding a psychiatrist has been something of a challenge. Our pediatrician, whom I love, didn't seem too enthusiastic about our going to one (afraid of losing the business? I don't know.). The first one we went to would routinely be two to two-and-a-half hours late for appointments, which was unacceptable. We were ready to see a psychologist with prescription privileges until she left the practice. And no one - no one - seemed to be on our insurance.

So we went with a recommended doc not on our insurance. Sigh...

As expensive as it is, she's been wonderful. We've only seen her twice but she is very straight-forward and includes Dylan in on everything in a very age-appropriate way.

Her approach is "Let's try it and see." She would rather try something to find a better choice than stick it out with a less-than-ideal option. Nothing ventured, nothing gained, and you can always go back is the way she operates. I like it.

First, she had us try a higher dose of the Vyvanse. You would think dose A is good, bigger dose B is better, right? Not so much. He was less focused. The same thing, actually, had happened when we had upped the Metadate.

Two weeks ago, we were set to try Straterra. She said it doesn't work for at least half of kids, but for those whom it does work for, it works great. Worth trying except...we couldn't get Dylan to swallow pills. It's mental rather than physical, but you can't exactly make someone swallow something.

A week later, she put Dylan on Tenex compounded by a local pharmacy as a liquid. Dylan balked but we were able to get it in him. As expected, he was very sleepy the first few days. Just as he started feeling better, the dose went up to two times a day and it was back to feeling tired and out of it. The doc encouraged patience...but in the end Dylan couldn't take it. He said he felt "dumb" and that he did worse in class than when he was on no medication.

So, we're back to Vyvanse. Only by the time we pulled off of the Tenex it was a Friday and we only had TWO capsules left. I didn't realize it until Saturday when one of those was gone. So we went the whole weekend without meds (challenging but doable). Today, I gave him some short-acting Ritalin I had from an old bump-up afternoon prescription for him. It seemed like a good idea...until we got home when the scream fest began. NO homework got done tonight and we had lots of yelling, drama, and accusations.

Tomorrow, he'll have the remaining Vyvanse and tomorrow afternoon we see the psychiatrist again and can get a refill prescription. It seems like "halleluia" but the reality it's just back to what we have had. We want better, but it could be that all we can have for now is okay and good enough. It's not fair that a bright boy with so much potential can't focus, remember, or retain enough to have even a moderate amount of success; that he daily feels like the "dumbest kid in the class."

It's not fair, but I guess right now not fair but adequate has to be good enough.

(c) 2012 The Argonne Chronicles