What questions should I ask the specialist on Tuesday?

[shimsheree]

My son is 4 and has adhd, but the medication isn't helping his aggression at all, and it's pretty bad.  His behavior is very violet, random, but sometimes we can tell he will do something, and all day long.  My 2 year old dd is getting hurt all the time by him, as well as us.  I wonder if there are sensory things going on because he flips out in public sometimes and seems to get over-stimulated.  Our pediatrician is having him see a developmental behavioral pediatrician to see if there is something else going on along with the adhd that could be causing the aggression.   

I'm going to make a list of our observations of him and take it with me, but I'm wondering if any of you have suggestions for things I could ask him that I might not think of on my own.  I'm a little nervous to go because dh can't come because of work, and we usually go to these kinds of things together.  I tend to forget details that are told to me, so I'm going to bring paper and take notes so that I can tell dh exactly what the doctor said.  

Anyway, thank you for any help you might have.  I really appreciate it.

~sheree

[Emmeline II]

What medication is it?

Medications affect everyone differently. Some reasons an ADHD med may not be helping are

• the dose is too high
• the dose is too low
• they don't respond to the short acting version
• they don't respond to the long acting version
• they just don't respond to this med
• they don't respond to non-stimulants
• they don't respond to stimulants
• there is a contributing factor (like a sleep disorder)

My son's first med at 6.5 was Concerta (stimulant); though it initially worked well, after a couple of months it wasn't working well on his impulsivity and aggression-- increasing the dose a third time worsened symptoms. He was switched to Vyvanse (stimulant) and is doing well on his second dosage. We did try Intuitiv (long acting version of guacifine, a non-stimulant) to help with his tics, but stopped as it made his ADHD symptoms worse and caused insomnia.

I think seeing a developmental-behavioral ped is a good idea, though if that is just for an eval I would also find a child psychiatrist for medication management. We had an eval at a hospital clinic that included a developmental-behavioral pediatrician, a speech language pathologist, and a psychologist. They did include ds' sensory issues in the evaluation. We gave them a previous OT report and a bullet list of ds' behaviors, and they had us fill out parent evaluation forms and ds' teacher also fill out an evaluation form. The appointment was 3hrs (dh wasn't there) and the results appointment was nearly that long (dh was there for that). They gave us a sheet with ds' test scores and diagnoses, which I typed out (it was hand written) with the explanations they gave us, that evening before I forgot what it all meant.

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ADHD Parent Medication Guide prepared by the American Academy of Child and Adolescent Psychiatry and American Psychiatric Association http://www.parentsmedguide.org/ParentGuide_English.pdf

The Hows and Whys of ADHD Medication

A Full List of ADHD Medications

ADHD Stimulant Medications

ADHD Non-Stimulant Medications

http://www.webmd.com/add-adhd/guide/adhd-causes

Sleep and ADHD - Lack of Sleep and ADHD

ADHD and Food Allergies - ADD ADHD Advances

ADHD and Food Allergies - Adhd in Child

Food Allergy Testing for ADHD and Autism