My grandson was diagnoses with ADHD when he was five. His mother started him on Ritalin at that time. By eight he was contemplating ways to get rid of himself, fearing no one loved him. I brought him out here worked with him seven days a week trying to get him to see how much we all love him, care about him and want him to show people that he is a smart and loveable child. I kept him on the Ritalin , up until it was too unbearable for him (school pressures from fellow students calling him dummy and a number of unpleasant names) to go in the afternoon to take his pill. I request the doctor change him to Concerta which only required 1 pill in the morning. I also had him talk with the school psychologist, but he lost trust in her. The contract was, whatever they discussed was not to be shared with anyone and she was to help him resolve issues without disclosing his name. This did not happen and he stopped talking to her and asked not to go, because of what she'd done. The Concerta worked up until Junior High , then his appetite was completely gone and he had trouble sleeping. I had to threaten him eat daily.

So, I stopped the Concerta and his appetite returned and he was able to sleep. I can only say he did fairly well in school. From the 8th grade until now, his behavior is starting to drastically change. This year his older sister was diagnosed with cancer, this hit the whole family pretty bad. He was the only natural sibling for transplant, but unfortunately was not a perfect match. From that point, he seemed to give up trying in school and he barely graduated Junior High. Now he's a freshman, telling lies, clowning in class, not focusing during lectures and the list goes on.

Should I start him back on Concerta or seek another medication along with some weekly counseling? Can I get teen counseling for him in Fremont? Is it very expensive? What about this ADDERALL XR?

Any information would be appreciated.

Thank you,

Donna Neal

Answer:

Hi Donna,

Shari suggested that I answer your question since I am the Medical person on the Ask a Specialist team and usually address issues with medication and psychiatric diagnoses.

The situation with your grandson sounds quite worrisome. Your first step should be to talk with his guidance counselor or the psychologist at high school. It is important to get the school’s input about his behavior in school and equally important that they know about the stressors going on in your family life. They probably will then view your grandson’s behavior more sympathetically.

I would not put him back on the Concerta or suggest another medication before getting him into counseling and getting a diagnosis. Depression can cause all of the behavioral symptoms you describe and it sounds like he has ample reason to be depressed. Certainly depressed teenagers can have trouble focusing on their studies and can become the class clown. This idea is further strengthened by his behavior deteriorating after his sister’s diagnosis of cancer.

There are often several options as to seeing and paying for a counselor. The school can probably help you get that information. They may even be willing to ask for a mental health evaluation for him since his behavior is keeping him from being available for learning.

Most mental health clinics provide counseling with pay being by a sliding scale, you pay what they feel that you can afford. Sometimes the school will help with this if an emotional disturbance is felt to be interfering with his learning.

The mental health consultation can advise you about his diagnosis, what is causing his behavior, and then suggest medication as appropriate. Attention Deficit Disorder can exist with depression. If so they can treat the ADD with medication and the depression with medication and/or counseling.

It sounds like you have your hands full. I hope that he is able to get successful mental health services.

Kay S. Browne MD
Behavioral Pediatrician