Strattera? Any experiences?

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Eldest (9 yrs) has been struggling more, at school and at home. And I'm starting to see more of the *why* of it.

After an incident of roughhousing with his brother left the little one wailing (an accidental head butt; no lasting damage), he was in a semi-panicked state, and suggested that he go to his room. I, preoccupied with trying to soothe a screaming five year old, snapped that it would be a good idea -- I'd told them to stop, and now see what had happened?

So he went upstairs, and he LOST it. Sobbing, wailing, pacing back and forth and talking hysterically to himself.

Youngest calmed down quickly, so I started upstairs...and then sat down and listened, which was not an easy thing. I needed to hear what he was saying, and right then he wasn't filtering at all.

And none of it was good. "Why can't I *think* first? I don't want to be weird, I want to be normal! I want to be like everyone else!"

I went in a minute or two later, calmed him down. He told me that he didn't want to be autistic, he didn't want to have asthma, and admitted that sometimes he "thinks about dying." We talked for a while, I reassured him that everyone is, in their own way, different...and he dealt with things as he usually does, by asking me to bring home books. Ten minutes later, you would never have known that he'd been anything other than his normal cheerful self all night.

And then this week, we had his scheduled doctor's appointment with his new psychiatrist. And we had an evaluation form that his teacher had filled out, which pointed out a lot of impulse and behavior control problems.

The end result is that we're trying him on Strattera. 10mg for 1 week, 18mg the next week, and 25mg thereafter. The possible side-effects are a little terrifying, but we're going to watch him closely. Assuming that our insurance ever approves this medication, which might take some time....

Anyone familiar with Strattera, and have anything to say about it? Or about alternatives? Stimulants apparently often have atypical effects on ASD kids, so it seems are options are a little limited.

Have you considered Psychotherapy, rather than psychotropic medication? If you aren't aware, there is a black box warning on this medication, meaning it is contraindicated to children under the age of 18. I am not a doctor, but if I were you, I would be looking for a non medical alternative.

Well, I'm one of our resident anti-med militants...

...but I think it's worth a shot. He didn't do anything that bad-- in fact, he didn't do anything that doesn't happen all the time when even typical kids play roughly. The head-butt and the crying child-- especially when it was clearly an accident, not a repeated act of violence/aggression-- would have been treated as a non-issue where and when and how I grew up. Personally, I think that's the way it should be-- but we have to live with the current trends in the society we live in, and we're not here to debate parenting styles.

If his lack of impulse control is bothering him that much, something needs to be tried. Strattera may help.

I checked the black-box warning about suicidality. I don't know that much about Strattera, but I DO know (or anyway think I know) about how the similar black-box warning works in SSRIs. Allegedly-- this according to a very smart psychiatrist who pulled me back from borderline catatonia, med-induced psychosis, and suicidality in no time flat-- how the SSRI's cause suicidality is by fixing the physical symptoms of depression (fatigue, lack of motivation, inability to focus) while the cognitive symptoms go right on. Thus, people who previously could not get it together to kill themselves now can-- and they're still thinking depressed.

I wonder if Strattera might not cause a similar effect-- It's an ADHD med, so I'm guessing it's purpose is to sharpen focus. Someone who was previously distractible becomes much more focused-- and what they focus on is how much they hate themselves, how much they suck, how much they need to die and how to accomplish it. They might end up with more impulse control, but they also end up with more hyperfocus and more perseveration, and it fastens onto exactly the wrong things.

NOW. I AM NOT A DOCTOR. I'm not a psychiatrist, I'm not a pediatrician, I'm not a therapist, I'm not in any way or shape or form an expert. I'm just an Aspie with a lot of kids who thinks about this stuff a lot, and I MAY BE UTTERLY AND COMPLETELY OFF-BASE. At most, it's something to bring up for discussion with someone who would know. THEN it might become something to give you some idea of what to watch for, and how.

Good luck. Keep your eyes open.

If you look over at addforums.com, there are a lot of posts on experiences with all the meds, including Strattera. It takes a lot longer (weeks) to build up in the system so it will be awhile before you are able to determine if it is helping. One of the advantages of stimulants is that they take effect and dissipate quickly, so if there is an adverse or atypical reaction you can change course quickly.

I am also a med-avoider regarding my son, but that is something for each family to decide based on their own circumstances.

I will chime in with that you should be very careful about choosing a doctor and to make sure that person respects your views and is not going to push you in directions you are not comfortable going. While meds work great for some, they don't always, and some doctors will be very resistant to giving up when drugs do not work. They may either up dosages beyond your comfort zone or switch to heavier duty meds with increasing side effects. Sometimes this works and sometimes it has some really bad consequences. based on anecdotal stories posted here and elsewhere. So you want to make sure that you and your doctor are on the same page and you can trust him/her to listen when you have issues with potential risks and when you weigh them against the potential benefits.

What ASDMommyASDKid said. If you don't feel like you and your kid's doctor have a good relationship, go looking for another one. It's important whether you're going to medicate or not-- it's essential if you are.

If people had been willing to listen to me when I said, "This drug isn't working," I'd have an "Eh, didn't work for me" story instead of a "That drug almost killed me" horror story.

If they won't listen-- If their attitude is "What would you know, you're just a mom," hit the road. Even if it means you're out-of-network, or out of coverage, and driving 50 miles to see the doctor-- that's cheaper, and less hassle, than cleaning up a big fat mess.

We have been moving slow, believe me. We first saw this doctor back in early August, and he wanted to see the report from his teacher before we took any kind of pharmaceutical action. The target right now is to help with his impulsiveness, which is both dangerous (he STILL doesn't look before crossing a busy city street) and an increasing source of frustration to him.

He does things without understanding why he does them, and then gets mad at himself afterwards. The over-reaction to the headbutt was surprising -- I was annoyed, as I'd been telling them to stop being so rough, but not really upset, or angry with him. I didn't even chide him; going to his room was his idea, and I just agreed with it in the heat of the moment.

But yeah, we are worried about side effects, and we're going to watch him VERY closely. There's a history of depression on both of our sides, so there is reason for concern. If we see any signs of things going wrong, even a little, we'll talk to the doctor and pull the medication. But he's not happy with himself right now, and it's really beginning to effect him. We discussed medication with him a while back -- we're NOT going to medicate him against his will -- and he was nervous about it making him a "different person."

And now, he keeps asking when we're going to get his "brain medicine".

I wish we had the money for social skills classes, or regular therapy. We don't. Not by a long shot. And we're really struggling with how to help him. What I want is for him to be HAPPY with himself. The school issues can be dealt with, one way or another. The principal knows him, loves him, and it very happy to work with us. His teachers have all been fantastic, and his current teacher is annoyed with his behavior problems, but not concerned as such. His grades are still fantastic, other than the incomplete assignments.

I'm just seeing him growing more and more angry and frustrated with his own behavior, and it worries me. His self-esteem is already suffering, and I don't want to see that get even worse.

My DD (who is now 11) was on Strattera from the ages of 8-9. She was primarily on it during the school year and off during the summer. I can only say this now, a few years after she has not been on any meds (except for the occasional melatonin at night), but the Strattera changed her personality a bit. She definitely exhibited the "blunted" personality that some people speak about. Things wouldn't bother her as much (a plus, obviously), but then she wouldn't react positively that much either. She lost some of her creativity (she loves art and the art she produced at the time was good, but very "typical" compared to what she thinks of now). At the time, my husband and I thought, Wow, she is getting a hold of her emotions, but now I wonder if it was that most of what was going on around her was "rolling off her back", so to speak. She was happy, but subdued.

Because she ended up not passing a state standard testing (and I knew she was bright), I pulled her out of public school, homeschooled her, and stop her meds. I realized, for us, that the meds were to help her cope with the classroom behavior expectations. Even though she was in a self-contained classroom for most of the day, she told me she couldn't focus and the Strattera helped her do that. She actually asked to get off it herself; she was reading an advertisement for Strattera in a magazine and read through *all* the tiny print with the medical warnings that they have on the reverse of the ad. She said, "Mom, I have all the things they state! 'Nausea, headaches, sometimes I'm dizzy and feel tired a lot...." It was news to us, but then we didn't ask her specifically if she was having any issues with her meds, just "How are you feeling?" That was our fault!

With my teaching her one on one, it was easier for us to modify her environment. If she was feeling antsy, we went for a walk in the woods. Dislike math for today? We did a full day of science curriculum and then did math all day the next. Honestly, I think the calmer environment, where she felt like she had some control, really helped. It also paved the way for Cognitive Behavior Therapy, which we started almost two years ago. It was necessary for her to see that there was an alternative to feeling like she "didn't belong" or "wasn't doing the right thing." Homeschool helped her see that. In school, she constantly felt like she was under the gun to sit still, perform, pay attention, etc. on someone else's terms.

Last year, while homeschooling, she asked to go back to a "regular" school. Because it was middle school (6th grade), I was terrified. She never asked to go back on meds, but we told her that she was familiar with them and could revisit medication if she wished. She was adamant that she didn't want to. It was the combination of the CBT and frankly, maturing, that led to her being able to control her outbursts in public (she still has some at home; when she's tired or when her younger brother pushes her buttons!). But surprisingly, the combination of getting up every 50 minutes and walking around the building (when she changes periods), having her classes taught by different teachers, having the responsibility of a locker - these have all been beneficial for her!

After starting the medication, in addition to self-harm ideations (because that is one of the symptoms), I would also pay attention to whether your son's emotions seem "dulled" in any way. Check in with him often with specific questions ("Do you have a headache at all?", "Are you feeling sleepy during the day?"). We took the Strattera at night, so any tiredness wasn't affecting her daytime regimen. Strattera is not a "magic pill", as much as any of us would like to believe. It certainly does help and will probably go a long way toward helping *him* feel in control, which is very important.

ETA: What BuyerBeware said about the perseveration is true. Strattera, in our case, did create a kind of "hyper focus" / "tunnel-vision" situation. Thankfully, our DD wasn't depressed, but I noticed that her ability to get "off-track", when necessary (like when she was upset about something not going her way), couldn't happen. There are good and bad scenarios with hyper focus and as long as you, as a parent, are aware, it should be okay. Of medication, while my daughter still sometimes struggles with being attentive in subjects she doesn't enjoy too much (math, writing to a specific prompt), she can change course much easier. It's almost as if her ability to be flexible has improved when off the Strattera. But again, take into account that there is some maturity there too; age and social pressure (or lack thereof) played a big part in her theory of mind growth.

I also wanted to offer a virtual ((Hug)) to you. This is a very hard age in school. I think the expectations in 3rd and 4th grade increase dramatically. In addition to the academic challenges (which your son seems to be fine with), there are a lot of executive function requirements too. A student is now expected to keep his desk tidy, have all his materials at the ready, keep track of assignments and homework. It's exhausting! Throw in those social nuances (because now kids are seeing the differences between each other. Why does one kid do *that*? It's the beginning of social conformity...), and it's like a train wreck waiting to happen! School is hard on many levels....it's even more challenging for our kiddos on the spectrum.

my son is on it now and so far no issues with it. he started in early Sept, and it has helped with his focus on schoolwork.