ADHD meds only intensified special interest- what now?

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My son has been having attention issues and spurts of hyperactivity when something makes him nervous. He has been making careless mistakes at school (very intelligent but failing almost everything), often changes topics of discussion at random, and is very fidgety. He cannot seem to focus on things he needs to learn or instructions being given. He is also stimming much more at school than at home. We tried him on Adderall this weekend. He built Lego men (his current special interest) for almost 6 hours, with no reaction to the doorbell ringing, kids screaming and playing outside, and dogs running around. I tried to get him away from the legos and the result was one of the worst temper tantrums he has had. I told him I would give him a new Ninjago lego set I had bought if he would complete his homework; he got extremely happy but then only completed 2 questions before going back to building legos. He was like a machine. Anyone else with this experience? I am assuming that his reaction will be the same to all ADHD meds?

We are working on getting him an aide at school (2nd grade) and I am replicating all his schoolwork to figure out what is going on. It seems to be a mix of not paying attention to directions (not reading them), getting "stuck" and perseverating on anything he does not know and unable to move on, handwriting issues, trouble thinking and writing at same time, too many steps makes him lose his train of thought, and thoughts of his special interest popping into his head in the middle of a problem. All of his issues seem to be worse at school. He also goes to OT, speech, and has an ABA therapist. Any suggestions, meds or otherwise? (He is also on a very low dose of anxiety medicine to help control outbursts, and depakote for seizures.)

Last edited by kcal on 17 Sep 2012, 11:24 am, edited 1 time in total.

I would look into nutrition. Sometimes meds can have no effect because it is not a brain chemistry issue. He might need a diet adjustment. The standard is to go off all gluten and sugar. If he is going to complain about missing sugar (and he most likely will because he is a kid, and hey, all kids like sugar!) then look into Stevia. Sugar substitute that doesn't do horrible things like the other ones do. A doctor would be able to tell you more

Many of the drugs currently in the market for ADHD/ADD have very similar effects as amphetamines (some are even related to amphetamines, which is why the laws regulate them to the extent they do). The extreme focus on Legos/ special interests and increased stimming is quite akin to the occurrence of punding found in amphetamine users. These drugs can affect certain regions of the brain in some children, producing a hazy feeling, which can negatively impact the ability to truly comprehend a set of commands or carry out a task without "shorting out" mid-way into the execution of the task. Directly connected to this adverse affect is the need for increased intensity or frequency of stimulatory behaviors (stimming and punding) to "jump-start" the brain or "feel present (again, relating to the foggy/stoned feeling these drugs can cause)." My nephew had to have his dosage lowered because of this exact issue and from my experience of being initially misdiagnosed, I can attest to this first-hand (I've never been more "alive" than the day I stopped taking the pills - I know this isn't realistic for all patients, nor would I recommend it without having a doctor's approval). On your next doctor's visit, bring up the behavoiral problems and any other changes (eating less, twitching, increased fidgeting, etc.) and investigate possible courses of action.

We only gave him Adderall one day on a weekend, and it made his special interests intensify. All the other school things going on are without the adderall/ any other adhd meds, which is why we thought we needed to try adhd meds.

Stimulant medication often has adverse reactions in people with Autism. You might want to look into a non-stimulant ADHD med.

He's more able to focus and in turn, that makes his special interests more intense. You should celebrate his special interests, instead of trying to get rid of them. They seem to make him happy.

My son has a combination of anxiety and ADHD. The psychiatrist started with the anxiety treating with an SSRI (Luvox, but there are many others). This reduced his anxiety, obsessiveness in thoughts, and allowed him to use coping skills to work through meltdowns. She started on a very low dose and increased slowly over 6 weeks. Unfortunately, at the full dose, he had the side effect of becoming more violent in his outbursts. We reduced back to a half dose and it worked. After being on it for an additional 2 months, then she added a non-stimulant ADHD medication (Kap-vay). The first week, we didn't even tell his teachers, and I got two emails, a note from a teacher, and he got a reward buck, because he was doing so well. We got lucky and didn't have to try a bunch of medications. My son's psychiatrist did not want to use a stimulant, because it increases anxiety and obsessive behaviors in many of the children she has worked with on the spectrum. Other parents have used stimulants and found them useful. I just wanted you to know there are other options. After my son's behavior being so bad last year that he was in in school suspension every week after the first week of school, crying most of the day every day, and finally placed in a self-contained classroom. Even in the self-contained classroom, he averaged only one "successful" day (a day where he met the minimum behavior goals on his IEP) about once a week. Then as the anxiety decreased, he was able to mainstream out to one class, then two classes. This year, every day has been "successful" and he is mainstreamed in three classes, adding a fourth tomorrow, and a fifth in 3 weeks. The teacher thinks he will easily be back in all mainstream classes before the end of the year. It wasn't all medication, as we also got therapy, social skills on a daily basis in his IEP, and his special education teacher helped him apply the new skills he was learning in the moment. But the medication made a big difference in my opinion. It was the right combination done right by a psychiatrist with a child on the spectrum who works with a lot of children on the spectrum.

By the way, many of the symptoms you mention remind me of my son and seem more obsessive/anxiety based than inattention. The SSRI is originally an antidepressant, but has been found useful for OCD and seems to help with the obsessiveness that prevents children on the spectrum from moving forward such as having to have things just right, being unable to skip a problem they don't understand, getting stuck on an activity.

By the way, my son enjoys his special interests much more now than he ever did, because he doesn't get so upset on the mistakes and difficulties, is able to walk away and come back after he has calmed down and thought about the problem, and stays with the tasks rather than jumping around or getting frustrated because he can't do it fast enough or its taking too long. Taking medication did not make him stop being interested in his special interests.

I don't think the OP is trying to kill his special interest, just keep it in due bounds.

I would look at strattera or inuva, both non-stimulant ADHD medications.

I suspect the root cause of his inattention is related to sensory and biological issues. IMHO, I think you should try other things before pharmaceuticals.

Things that worked for us to treat these symptoms were inositol powder, vision therapy with a developmental optometrist, dha and attentive child chewable wafers. Please note my son was already on an atypical anti-psychotic medication to stabalize his mood disorder, but that only stopped the violence, not any of the other symptoms.

Strattera is a non-stimulant ADHD medication. Maybe you should ask his doctor about trying that?

If he can't concentrate it's mostly a sensory itnegration problem from his Autism. You just got to give him a weighted blanket, and other deep pressure input like lifting weights and going for car rides (vibrations help.) Massaging chairs, moving chairs and yoga balls when he's doing homework and stuff like that. No medication in the world would help me as well as deep pressure input has. It helps boost my concentration and makes me less fidgety.

Let me know if you want to know a lot more information, because I am too tired to tell you everything more specifically right now. I can explain exactly how it makes me feel, and how it most likely makes your son feel.

Actually, medication can't really treat sensory integration problems at all. They don't do a damn thing.

Make sure you're working with a doctor with lots of experience treating autism and related disorders. With the feedback you gI've about his response to Aderall, the doc should be able to decide if another stimulant may give a different result, or if you should try a non stimulant, antidepressant, or something like risperdone.

Deep pressure and other OT techniques did nothing for my DS. After 9 months, even the therapist was suggesting that ADHD meds were worth a try. For him, Aderall makes an immediate and noticeable difference in his ability to focus, but he still had terrible meltdowns. Resperidone markedly decreased perseveration and meltdowns for him. He tolerates a lot of sensory stuff well, and his meltdowns seem to be caused mostly by frustration or life not matching his idea of how things should go.

Thanks everyone!! You all have given me some ideas and I have more questions.

He actually has an appointment with a developmental opthamologist next week. I am not sure that this is where his adhd issues are coming from, but he definitely has issues with handwriting and still reverses letters, but he is a good reader (although he does get tired of reading easily). Also, he likes to get about 6 inches from the screen to follow his character when he plays wii. The OT has improved his ability to copy from a book or something to the side of him, but he is still struggling with focus between paper and the board.

He loves deep pressure-- even when he was a baby he loved to be held tight. He loves the OT swing that is made of nylon that closes in on him like a cocoon. They are really expensive but perhaps it is worth the investment. He also likes to bang the bottom of his chin on me; he says it makes him calm. He is a head banger when he gets angry. How do you do deep pressure in a inconspicuous way in the classroom?

I would absolutely prefer to keep him off meds if possible!! But 2nd grade seems to be taking off without him and leaving him in the dust. The doctor's first choice was Strattera, but I have read so much about the bad side effects (and because we have been through most of these with seizure meds) that I wanted to try anything else first. I am not sure the other non-stimulant meds are a good combination with the Depakote but I will ask next month in our appointment.

His concentration seems to go in and out (like within the same 20 minutes), and I am beginning to wonder if it is more obsessive thoughts (OCD) rather than ADHD. He does not have any classic handwashing or checking or lining up type symptoms of OCD, but his thoughts do seem to be distracted by about 5 recurrent themes (special interests). Do you get the same repetitive thoughts popping in your head while you are trying to concentrate with ADHD too or is this OCD?

There are several garments on the market that are designed to provide pressure and/or weight on the torso. Some are more concealable than others and some may fit different body types differently. There are garments with weights around the shoulders, some with weights at the bottom and others with weights in various locations. Other, non-weighted garments simply fit tightly (easy to purchase) or inflate and deflate depending on the wearer's needs (these may not be readily available outside of writing to companies for a trial period of the product). With weighted garments, there is a specific protocol for removing and putting the garment back on to prevent habituation. These may or may not prove effective depending on the individual's weight/pressure preferences (these aren't terribly heavy and some may need even more weight and pressure and some may need it in different areas) and other factors.

There are also weighted lap pads that are not too conspicuous. I have also seen baseball caps with weights sewn into them. My DS also craves deep pressure and moving heavy items or doing other large motor activities seems to serve the same purpose. His teacher has started asking him to move stacks of books from one place to another or to wipe down the desks after snack time.

I've got no experience with Adderal, but with a very similar drug for the same condition, Ritalin. First and most important point: the effects lessen after you become acclimated to the drug.

Second, it's not intensifying his special intrest, it's increasing his focus. These medications don't magically make you pick the right thing to focus on, they only make you focus. Notice that I said "make you"-being disrupted while trying to focus can make you much more irritated.