Parenting impulsive kids

January 23, 2005 5:44 PM

Do you have any experience in dealing with smart, energetic kids with impulse problems and oppositional attitudes, with or without ADHD diagnosis? We're looking for dietary, behavioral modification or even meds suggestions. [MI]

Our daughter is book-smart. She’s a voracious reader, and praised by her teacher except for her tendency to daydream, lose focus or fail to follow directions. At home, it’s a different story. She’s prone to explosive temper tantrums, nonstop arguing with parents over anything, general histrionics and noisy wails of misery and injustice when we ask her to, for instance, pick up her shoes. Cries of “Nobody loves me,” “You never make (one of her two smaller siblings) do that,” and “I get treated like a slave in this house” are too numerous to note.

She’s been a handful since she was born. (The peds nurse brought her, days old, into my wife’s room at the hospital and said cheerfully: “This one’s got a temper.” What a rotten thing to say, we thought. Well, she was right.)

She’s four-foot-two and 85 lbs. She was born without a thyroid and takes Synthroid. She was diagnosed with ADHD last month, and was started on Concerta 18 mg. This was a huge step for us, as we have been extremely reluctant to medicate her for behavior. But it had gotten to such a point that we were willing to consider it.

The first week on Concerta, it was like we had the 8-year-old of our dreams. She came home from school saying “It worked!” When she went to bed that night, after quietly doing her homework, coloring nicely with her sister, etc., she said “This was the best day ever.”

Then it started wearing off. After eight days, we’re back to square one, or close to it. We tried Concerta 27 mg, for one day. It seemed worse, with big emotional outbursts, which we were warned about.

So:

1. Any suggestions on dealing with the oppositional behavior, other than tinkering with meds? (Average exchange repeated 100x daily: Please pick up your socks. “No. I didn’t put them there. (Sister) put them there. You’re always so mean to me.”)

2. Any meds suggestions or insights into pros and cons of Concerta for this type of behavior?

3. Any diet or nutrition suggestions for ADHD, impulsive or oppositional behavior that you know of specifically helping someone?

Oh, just to get it out of the way: I know you are not a doctor. I will not take any medical advice from strangers over the interweb. But I will sure use it as a jumping-off point for research or questioning of relevant medical professionals I pay for the pleasure. And thank you one and all.

posted by sacre_bleu to human relations (26 comments total)

DMAE may be helpful as a nutritional supplement. I use it as a nootropic but it is also reported as helpful for reducing ADD/ADHD symptoms. I am not a doctor, so as you have mentioned, you should take my comments in that light.
posted by AlexReynolds at 6:08 PM on January 23, 2005

Essential fatty acid deficiency is, I believe, still being seriously considered as a factor: [google] [American Journal of Clinical Nutrition] [International Health News]
posted by dash_slot- at 6:10 PM on January 23, 2005

No science to cite but one of our good friends has switched her family to strict vegan for over six months now to help her oldest (14 y.o.) with similar difficulties and sees some promising changes.
posted by billsaysthis at 6:16 PM on January 23, 2005

You have my sympathy. I went through a similar nightmare with my son. I won't go into medications, since I had no input on that in his case. I did notice a marked deterioration in his behavior after eating high-sugar foods. I know that a lot of people say there's no basis to that, but I saw it.

Be strong, be clear, be patient. Don't stop loving your child.
posted by Kirth Gerson at 6:28 PM on January 23, 2005

Are you completely certain that she continued to take the Concerta when the good affects seemed to "wear off"? Sometimes kids in this circumstance feel that the medicine is working too well and that they feel more comfortable the way things were. Don't want to sound overly suspiciious, but if she is as smart as you say, it wouldn't be much of a challenge to make it appear that she is taking it when she is, in fact, not.

While it might take some experimentation to get the dosage correct, I can't see the good effects of week one wearing off that fast.

PS... get ready for comments for people who think A.D.D. doesn't exist and that it is a sin to give a child Concerta (et al).
posted by spock at 6:32 PM on January 23, 2005

AlexReynolds -- have you noticed any side effects of DMAE?
posted by tidecat at 6:41 PM on January 23, 2005

I had that when I was young. Maybe not as pronounced, but definately there. I would read all the time and people would say I was very smart but I would not do homework to save my life.

Even as an adult, I take Adderal. I'm sorry your daughter has these characteristics (they make her who she is, so don't take it the wrong way) but it took time for me to grow up. Consider taking some non intrusive steps to make sure she is taking her medication.
posted by Dean Keaton at 7:02 PM on January 23, 2005

My 13 year old son is now on Strattera - you may find this helpful - and I'm not crazy about it (his sleep is affected; I do not like this, it scares me), although his teachers are ecstatic. But then, we kind of had the opposite situation: he was impossible at school and fine, if high energy, at home. In your case, I'd be particularly concerned about the mixture of medications - it seems strange that it would work and then stop like that.

However, I just had a long talk with an old friend with Tourette's syndrome (Tourettes & ADD are closely linked from what I've read) and he told me to get him on lecithin immediately, to drop the meds and take lecithin for 6 weeks, then stop for 6 weeks, etc. So I may try that and I pass it on FWIW. My friend was on Ritalin & everything else under the sun as a child with Tourettes and he now only takes lecithin and says that it works better than anything else.

The other thing I did with my wild child was severely limit & sometimes eliminate TV & computers, which helped a lot, and made sure that he got as much outdoor exercise, every day, as was humanly possible. He's still bouncing off the walls but he's a pretty cool happy sweet bouncer.
posted by mygothlaundry at 7:06 PM on January 23, 2005

In many respects, she sounds normal to me. I remember my cousin acting this way all the time - so histrionic! She's settled down now.

I'm not in your shoes, so my recommendation is easier said than done. However, if it were me, I would try and keep her really, really busy. I would hire her a tutor, get her music lessons, put her on an athletic team, have her study karate, get her painting lessons, etc.

The more she is in social situations with others, the less (I think) she will be prone to act this way. The Meds are an attempt to change the child's energy - these other activities might be a way of channeling it.

Finally, ignore the behavior, which must be some way of drawing attention to herself. Try as much as you can to have a sense of humour about it.

Don't be suprised if this drives her crazy at first. Having a sense of humour will deflect what she's unconsciously trying to do. Keep it up until she gives up.

I have a very clear memory of coming home to my parents after wrecking the car. My Dad was at the kitchen table - lauphing. "What am I supposed to do", he said, "cry?"
posted by xammerboy at 7:24 PM on January 23, 2005

Yeah, let me tell you one thing our family learned from many years of trauma:

Don't let yourself be preyed upon by experts who are over-willing to diagnose your kid with labels like "oppositional defiance" and the seeds of fear.

And never trust the school district to know what's best or to give you what you need. Many of them love to railroad a kid who is different into an alternative school, a dead-end that they'll advertise as if it were gifted ed.
posted by inksyndicate at 7:25 PM on January 23, 2005

Thinking about this a little more & remembering - I found with my son that he needed a lot more time than most kids to process transitions, even little ones like "it's time to come downstairs and eat dinner now" or "let's leave the house and go to the park" and big ones, like between home and school, were a huge trigger. So I started a system where I gave him tons and tons of warning - if, for example, I wanted us to start cleaning up, I'd start telling him about a half hour before that it was going to happen, and I'd keep reminding him at decreasing intervals. This was done cheerfully, not naggingly - and it helped a lot, because, although I didn't know it at the time, his short term memory is bad, and he would literally forget that I said something like pick up your socks unless I said it over and over.

The other thing I have learned is to pick my battles, in a big way. I set priorities - like schoolwork, occasional bathing, table manners, being nice to each other - and let a lot of stuff go by the wayside. So the socks stay on the floor. No big deal; it may mean that you and a happy kid made it to the park, met a puppy, hugged a sibling - and that's really the important stuff.
posted by mygothlaundry at 7:27 PM on January 23, 2005

[H]ave you noticed any side effects of DMAE?

None so far. Insomnia? But then I have a hard time falling asleep before 12 AM, anyway.
posted by AlexReynolds at 7:38 PM on January 23, 2005

Any suggestions on dealing with the oppositional behavior, other than tinkering with meds? (Average exchange repeated 100x daily: Please pick up your socks. “No. I didn’t put them there. (Sister) put them there. You’re always so mean to me.”)

The first time I tried a stunt like that, my dad walloped the shit out of me. I couldn't sit down for a week. I also never did it again. I don't necessarily recommend this approach, and in any case it may be too late, but it is something to consider.
posted by kindall at 9:08 PM on January 23, 2005

I should be clearer: By which I mean, punishments that may seem extreme to you -- although not necessarily corporal in nature. To a certain extent you may (stress may) have deemed her behavior acceptable simply by not punishing her and/or assigning blame sufficiently.
posted by kindall at 9:22 PM on January 23, 2005

Before [ahem] smacking her around, be sure to at least try reducing your daughter's refined sugar intake, and make sure she's not drinking caffeinated soda. It's simple and has far fewer side effects than any new meds.

There's room for skepticism, I know; at least one metastudy has failed to find a link between sugar and behavioral problems. But the small sample size of many of the studies cited bothers me, especially given the sheer weight of anecdotal evidence that sugar is indeed a factor. Obviously, we need more research. Serious studies have only recently begun into the relationship between sugar intake, diet and severe autism, for instance. Note the researcher's claim in the article that there may be *subsets* of children - perhaps those with immune problems - who see more of a benefit from dietary changes. If so, that might explain why global studies are failing to find the link.

Anyway, I wouldn't wait. A good friend who works with seriously autistic kids tells me the first thing they always try to do is get the parents to heavily reduce, if not eliminate, refined sugar from the child's diet. She says it makes a clear difference, if you can get through the first week or so. Apparently, many parents quickly give up when their kids throw fits and demand candy, but those that stick it out see great results.

Eliminating all caffeine, on the other hand, should be a no-brainer.
posted by mediareport at 10:42 PM on January 23, 2005

Your daughter's reaction to Concerta resembles my own experience. After 6 months of taking Ritalin with good results, my doctor switched me to Concerta so I only had to take one pill a day. In about a week, the Concerta had very little effect, and I noticed a reduced quality in sleep. If I stopped for a few days, the Concerta would work again, but only for a week at most. Went back on the Ritalin, and haven't had any problem with tolerance since.

My doctor's theory is that I metabolized the time release component in Concerta at a slower than average rate. As a result, it was active at all times, and not allowing me to "recharge" with productive sleep. Concerta is pretty much time-release Ritalin, so if the Concerta worked for a week, Ritalin may provide the same results but actually wear off quickly enough to facilitate productive sleep.
posted by yorick at 10:49 PM on January 23, 2005

ADHD is a mighty gift. The name is a misnomer, as it is not a "disorder" or a disease. Its just different. Learn what it is and how best to handle it to empower your child to use her talents to their max.

Our culture, schools and home experience leave us to expect certain things. These things aren't neccesarily whats going to work best for such a child.

If you have not, do please, without hesitation, research the work of Thom Hartmann. He is an expert on ADD and has written several books. He's a first-rate human being who did not like his child be called "defective".

His books are available from Amazon, and you can go to
http://www.thomhartmann.com/
posted by Goofyy at 11:53 PM on January 23, 2005

I just want to point out that the person who has the ADD doesn't need a book to tell him/her whether it's a blessing or a curse. I know that my concentration issues have been incredibly unpleasant and endlessly frustrating. On the other hand, I've seen people who seem to groove on their ADD or hyperactivity. They may regret that it causes them to miss appointments or fail to fulfill responsibilities, but they like the actual minute-to-minute experience of bouncing from task to task. So, you know, to each is own.

But if someone who has ADD wants to just embrace it and live their life accordingly, they're going to run into barriers erected by a world that wants them to think and act (for lack of a better term) normally. So they have to choose; either adapt to the world and give up this "gift" or continue running into those barriers. I can't imagine that either option is very enticing.
posted by Clay201 at 1:11 AM on January 24, 2005

Another person suggesting a look at the refined sugar intake. One of my Tourette's/ADHD students modified his own diet about a year ago, cutting out soft drinks and chocolates alone, and noticed a significant improvement. His best friend, although not diagnosed with anything, becomes -incredibly- hyperactive and difficult to negotiate with after caffeinated drinks. To the point where I've told him that I'd refuse him entry into my class if he came to school after another 1L of Coke for breakfast.

I'm guessing you're not splashing that on your daughter's cereal, though. Good luck! There's some good advice here.
posted by chronic sublime at 2:02 AM on January 24, 2005

Listen to this radio show on The Mozart Effect. I listened to it last night and supposedly there was a study done into children where they played certain Mozart pieces and it had a statistically significant effect on the children.
posted by wackybrit at 4:34 AM on January 24, 2005

Less of a recommendation, more a ray of hope: I was just like that. My mother was a saint. I grew up to have a pretty decent life and a wicked temper.

I might look into how bored she is at school, as well. Sometimes being bored looks like ADD.
posted by dame at 7:28 AM on January 24, 2005

I second, third, or fourth the recommendation to cut down on sugar (or cut it out entirely except for special occasions). As a kid, my little brother had legendary temper tantrums. He was diagnosed as having ADD way back when it wasn't quite so well-known. The doctors recommended medication, but my mom happened to see some 60 Minutes episode about reduction of sugar intake and tried that approach first. The tantrums stopped immediately, only to re-occur when he had lots of sugar and was tired. He even began to recognize the pattern of the tantrums and called his tantrums "sugar fits."
For me, it kind of sucked to eat Cheerios with no sugar, but in the long run, the reduction of sugar was beneficial in other ways--neither my brother or I have ever had a cavity and we're in our early thirties. My sister, who came along a little later and got to skip out on the no-sugar dictum, has had a few.
posted by jenh at 8:51 AM on January 24, 2005

I have to mention to all the people who have mentioned caffeine: most of the people I know with diagnosed ADD and ADHD do not become hyper from caffeine, it actually has a calming effect (much like Ritalin).
posted by dagnyscott at 11:41 AM on January 24, 2005

Fair point, dagnyscott, but the post also described behavioral issues that appear larger than ADD/ADHD. They sound like the kind of things that might be helped by eliminating caffeine. It's worth a try, at least.
posted by mediareport at 3:01 PM on January 24, 2005

Because of the blessing/curse nature of ADD - though your daughter DOESN'T SOUND LIKE SHE HAS IT from what you say (histrionics at home aren't exactly a symptom, and if she's fine at school it seems she really doesn't have the problems of ADD, so you may want a second opinion. PLEASE get a second opinion. If the drugs don't work, there may be a reason, like you're medicating her for the wrong pathology) - deal with it until she's old enough to decide whether she wants meds and whether she likes it or not.

But those histrionics are exactly normal for most teenage girls. IT IS A HORMONE THING. REPEAT: IT IS A HORMONE THING. Want to check something fun? Go in and get her estrogen and free serum testosterone levels checked. You may find something interesting out.

Odds are, she'll level out after age 16 or so. But take her to an endocrinologist. ASAP. Most psychologists aren't good at diagnosing hormonal problems.
posted by u.n. owen at 4:01 PM on January 24, 2005

A number of people have suggested eliminating sugar and caffeine or making other modifications to the diet. Years ago, when my health problems were one big mystery, I tried, on the recommendation of an allergist, a week long elimination diet. What did I eliminate, you ask? Well, everything. No, seriously... I ate only lamb and rice and drank only water for seven days.

The theory behind the diet was pretty simple: eliminate every food and beverage that could conceivably be causing the problem. I ate lamb and rice rarely, so it followed that they couldn't be causing problems which occurred every day.

If you really want to explore the food angle, maybe you could try something like this. With a doctor's supervision and support, of course.
posted by Clay201 at 5:04 AM on January 25, 2005