Too thin 15 yr old boy - ADD meds the problem? I'm goin' crazy here!!

[Dancianna]

My ds started ADD meds this year so that he could stand the tedium of high school.  We half home-school and I really want him to go to school full-time next year for a number of reasons.  He's sort of o.k. with that - would rather do the relaxed way we do now - but I don't think I can handle it for another year (I work p.t., manage the household by myself because my dh has mental illness and my older son is getting ready for college.)

Ds 15 is growing quickly and he is so thin we can now see his ribs.  The ADD med that he takes definitely reduces his appetite, and he's never been a big eater anyway.  He had cereal for breakfast and supper yesterday because I worked until 9 p.m. (at 15 he can fix his own meal but doesn't choose to) and decided to go to bed hungry last night rather than take the time to make himself something.  I had leftovers in the fridge but he rarely will eat leftovers.  I'm going crazy here.

Any advice so appreciated.

-Dancy

[karne]

First, you can also post in the SN forum, where you may find support/ideas.

Secondly, I don't quite understand, so forgive my questions!  What do you mean started add meds for the "tedium" of school?  Meds are prescribed for particular dx in order to allow kids to function in an appropriate way in a variety of school/life settings when a medical dx of add/adhd has been determined.  Is this the case for your ds?

Hopefully your ds is receiving monitoring from his pediatrician/MD.  In this way his weight, as well as his height, can be tracked.  Usually, if there is not acceptable growth, or unacceptable weight loss, a different med can be tried, or perhaps a break from meds can be talked about?  Loss of appetite is very common, and it's worse with some meds than others.

There are several ideas, but again, I don't know your specific situation, you may have tried these already.    In general, if meds are necessary, you can try to maximize each meal, going for high calorie, nutritionally dense foods.  If you google you can come up with lists that might help you. Med breaks over the weekend, or vacation times are sometimes suggested.  Does he need them every day if he is partially homeschooling?  Could he use them only at times when he really needs them?

The weight piece is really tough.  I would look at switching meds, if he needs them, to one that has less of an appetite inhibiting effect, and see if that helps.  And, get a good read from the doctor as to how his weight/height look over time.

Good luck!

[Dancianna]

Originally Posted by karne 

First, you can also post in the SN forum, where you may find support/ideas.

Secondly, I don't quite understand, so forgive my questions!  What do you mean started add meds for the "tedium" of school?  Meds are prescribed for particular dx in order to allow kids to function in an appropriate way in a variety of school/life settings when a medical dx of add/adhd has been determined.  Is this the case for your ds?

Hopefully your ds is receiving monitoring from his pediatrician/MD.  In this way his weight, as well as his height, can be tracked.  Usually, if there is not acceptable growth, or unacceptable weight loss, a different med can be tried, or perhaps a break from meds can be talked about?  Loss of appetite is very common, and it's worse with some meds than others.

There are several ideas, but again, I don't know your specific situation, you may have tried these already.    In general, if meds are necessary, you can try to maximize each meal, going for high calorie, nutritionally dense foods.  If you google you can come up with lists that might help you. Med breaks over the weekend, or vacation times are sometimes suggested.  Does he need them every day if he is partially homeschooling?  Could he use them only at times when he really needs them?

The weight piece is really tough.  I would look at switching meds, if he needs them, to one that has less of an appetite inhibiting effect, and see if that helps.  And, get a good read from the doctor as to how his weight/height look over time.

Good luck!

Thanks, Karne.

I have ADD too, and he definitely has him and it affects him in many ways, but the worst is that high school is just too overwhelming for him without them.  The energy that it takes to maintain focus without them tires him out (me too) and the school atmosphere with so many people just adds to the difficulty of focusing so that he comes home just exhausted. 

He's on a ritalin-type med, and he had tried Stratera but it made him so sick that he was not willing to stick it out to see if the being sick to his stomach would go away after a few weeks, so I'm concerned that there may not be any more alternatives.

The idea of nutrient- and calorie-dense meals sounds good, it's just hard to find things he will eat and find time to prepare them...I'll talk with him about it today.

I do appreciate your taking the time to give me some ideas!

-Dancy

[erigeron]

There are other options for ADD than stimulants and Strattera. They're just used off-label. If he has a psychiatrist they should have different options. If not, you might want to see about finding one.
 

[Dancianna]

Originally Posted by erigeron 

There are other options for ADD than stimulants and Strattera. They're just used off-label. If he has a psychiatrist they should have different options. If not, you might want to see about finding one.
 

Any idea where I could get more information about this?  I want to know how safe the different drugs are.  So far we have just gone to a family practice doc.

Thanks for this idea - I really appreciate it!

[erigeron]

Maybe your family practice doc can refer you to a pediatric psychiatrist who would be more knowledgeable in the area. You can find package inserts for drugs online, and also you might talk to a pharmacist about any particular concerns that you have--any pharmacist will have some knowledge in the area. It would be especially good if you could find a pharmacist that specializes in pediatrics and/or psychiatry, but you might have to ask around a little to find one. (I myself am a pharmacist but specialize in neither field. I know the basic treatment protocols, but not a lot about the off-label use of antidepressants and which antidepressants to use, which I believe is the next step. Clonidine, which is an alpha-agonist, is the off-label med I see a lot and am most familiar with, but that's mostly used at night because it is sedating. Kapvay and Intuniv are the new extended-release alpha-agonists but they're so new that I don't know a lot about them. Someone who works in this particular specialty would have a lot more first-hand knowledge of how people tend to do on these drugs.)

[jdsf]

DD11 is and has been underweight since she was weaned. DP had the same problem, she was underweight even during her second pregnancy and had to drink protein shakes to keep enough weight on for her pregnancy. I don't have any particular advice to offer you about losing weight, since she's always been that way, but we use various techniques to get her to stay healthy.

The peanut butter-protein powder smoothie is a good one. She drinks this for breakfast, and sometimes as an after-school snack. It's very easy to make a smoothie full of calories and protein that still tastes good. We also let her eat as much ice cream as possible. My boss' husband has cancer and she feeds him ice cream constantly to keep him from losing too much weight.

Check out the "body builder" section at the store, they have a lot of good protein bars and supplements. Even if he doesn't eat much, make sure what he does eat counts.
 

[Dancianna]

Originally Posted by erigeron 

Maybe your family practice doc can refer you to a pediatric psychiatrist who would be more knowledgeable in the area. You can find package inserts for drugs online, and also you might talk to a pharmacist about any particular concerns that you have--any pharmacist will have some knowledge in the area. It would be especially good if you could find a pharmacist that specializes in pediatrics and/or psychiatry, but you might have to ask around a little to find one. (I myself am a pharmacist but specialize in neither field. I know the basic treatment protocols, but not a lot about the off-label use of antidepressants and which antidepressants to use, which I believe is the next step. Clonidine, which is an alpha-agonist, is the off-label med I see a lot and am most familiar with, but that's mostly used at night because it is sedating. Kapvay and Intuniv are the new extended-release alpha-agonists but they're so new that I don't know a lot about them. Someone who works in this particular specialty would have a lot more first-hand knowledge of how people tend to do on these drugs.)

These are great ideas.  I will start with the pharmacist because I'm hesitant to make more dr. appt.s  ($35 a pop and too much time).  I will also look on-line about these meds you mention - I hadn't heard of them, so the information is valuable to me!

Thanks.

Originally Posted by jdsf 

DD11 is and has been underweight since she was weaned. DP had the same problem, she was underweight even during her second pregnancy and had to drink protein shakes to keep enough weight on for her pregnancy. I don't have any particular advice to offer you about losing weight, since she's always been that way, but we use various techniques to get her to stay healthy.

The peanut butter-protein powder smoothie is a good one. She drinks this for breakfast, and sometimes as an after-school snack. It's very easy to make a smoothie full of calories and protein that still tastes good. We also let her eat as much ice cream as possible. My boss' husband has cancer and she feeds him ice cream constantly to keep him from losing too much weight.

Check out the "body builder" section at the store, they have a lot of good protein bars and supplements. Even if he doesn't eat much, make sure what he does eat counts.
 

Thank you - these are great ideas.  Do you have time to write down what you put in a pb-protein powder smoothie?  I wonder where else to look for such nutrient- calorie-dense ideas?  Ds and I searched Google earlier today and found some stuff - I wonder if there might be a thread here on the Nutrition and Good Eating Forum - I'll try it.

Thanks again!

-Dancy

[karne]

I would absolutely start with your physician, and ask for a referral to a psychiatrist as you feel is needed.  I really don't see the pharmacist as a first step.  ADD/ADHD is a medical dx., any use of or change in meds should be prescribed and monitored by a physician.  Again, the SN forum might be helpful to you.

[Holland73]

Originally Posted by karne 

ADD/ADHD is a medical dx., any use of or change in meds should be prescribed and monitored by a physician.  Again, the SN forum might be helpful to you.

ADHD (type I & II) is not a medical diagnosis, it is a psychological (DSM) diagnosis.   Therefore, the diagnosis should be given by a psychiatrist and meds monitored by a psychiatrist.  A psychiatrist's spend years getting training in psychological disorders AND psychopharmocology, whereas pediatricians (& family docs) receive minimal training in both.   This is the MOST frustrating (and sometimes even dangerous) thing about family practice doctors and pediatricians, who make psychological diagnoses & hand out psychopharmaceuticals without collaborating with a psychiatrist.    

I will start with the pharmacist because I'm hesitant to make more dr. appt.s  ($35 a pop and too much time).

The pharmacist cannot change his script.  Additionally, you shouldn't need to make an appt (if there is already an active diagnosis and psychopharm prescription in effect) to get a psychiatrist referral.  Just call them to ask for one. 

[karne]

Originally Posted by Holland73 

ADHD (type I & II) is not a medical diagnosis, it is a psychological (DSM) diagnosis.   Therefore, the diagnosis should be given by a psychiatrist and meds monitored by a psychiatrist.  A psychiatrist's spend years getting training in psychological disorders AND psychopharmocology, whereas pediatricians (& family docs) receive minimal training in both.   This is the MOST frustrating (and sometimes even dangerous) thing about family practice doctors and pediatricians, who make psychological diagnoses & hand out psychopharmaceuticals without collaborating with a psychiatrist.    

The pharmacist cannot change his script.  Additionally, you shouldn't need to make an appt (if there is already an active diagnosis and psychopharm prescription in effect) to get a psychiatrist referral.  Just call them to ask for one. 

Yes, I understand this, and misspoke.  However, the reality is that pediatricians are often the front line, but I also suggested a psych-pediatric, in particular.  In this situation, I would turn to my child's primary care physician if I had concerns about weight, weight loss, etc., because that would be monitored over time, lack of stature addressed, possible co-morbid factors discussed, etc.  A psych may do this as well, or refer back to the pedi. My experience is that pedi offices will check height, weight and blood pressure during ANY visit.  My point is that this is best addressed by a qualified medical professional.  A pharmacist would be an inappropriate choice regarding med changes or dx issues.

[jdsf]

The smoothie recipe is pretty standard, you can add or subtract things as you like. We either do banana, peanut butter, milk, chocolate syrup which is similar to the "peanut butter mood" at jamba juice or we do banana, berry, milk, vanilla protein powder (about a heaping teaspoon, any more and it "ruins the flavor" for her, lol), and peanut butter. blueberries or strawberries are good, I like mixed berries but then it has a lot of seeds. The protein powder comes in the bulk bin at our health food store, but you could use whatever as long as it's sweet or it will taste weird.
 

[erigeron]

Right, a pharmacist can't change a script personally (they can consult with the doc though) but if she wants specific info on the meds, which she said she did, then a pharmacist is a good person to consult. Pharmacists are drug experts.

[jdsf]

Oh, and I also use almond butter/milk from time to time, marginally healthier.

[Dancianna]

Originally Posted by karne 

I would absolutely start with your physician, and ask for a referral to a psychiatrist as you feel is needed.  I really don't see the pharmacist as a first step.  ADD/ADHD is a medical dx., any use of or change in meds should be prescribed and monitored by a physician.  Again, the SN forum might be helpful to you.

I was thinking of asking a pharmacist just as a starting point for information.  Sometimes MDs don't take seriously my concerns about whether a med has a long-term track record, etc. as I expect ds will be taking something for many years, so if I have some info. before hand, I'm better off.

 

Originally Posted by jdsf 

The smoothie recipe is pretty standard, you can add or subtract things as you like. We either do banana, peanut butter, milk, chocolate syrup which is similar to the "peanut butter mood" at jamba juice or we do banana, berry, milk, vanilla protein powder (about a heaping teaspoon, any more and it "ruins the flavor" for her, lol), and peanut butter. blueberries or strawberries are good, I like mixed berries but then it has a lot of seeds. The protein powder comes in the bulk bin at our health food store, but you could use whatever as long as it's sweet or it will taste weird.
 

Sounds super!  Thank you for sharing this.  I will go look for some good protein powder.  I do remember making these awhile back and ds having the same reaction as your daughter to the taste - and texture - of the protein powder.  I'll try to find small amounts so we can experiment.  I like the almond butter idea, too, although I don't know if the taste will work for him.

Originally Posted by erigeron 

Right, a pharmacist can't change a script personally (they can consult with the doc though) but if she wants specific info on the meds, which she said she did, then a pharmacist is a good person to consult. Pharmacists are drug experts.

Yes, I knew this!  

 

I so appreciate all of this input.  It really helps me think things through.  I think I will work with him on some diet modifications - he loves sugar...and then when school is out we can do some research on meds together.

I know it sounds a little strange, but the idea of starting up with another psychiatrist (two family members have mental illness), and going every six weeks for our too-high co-pay...well, if we need to go there, we will, and thank G-d we have health insurance...

 

Thank you again.

-Dancy

[Peony]

 I totally get the "yet another appointment" thing. We just started with our new pedi psychiatrist, 2nd appointment was a month from the first, only 20 minutes long to check up on the meds. 3rd appointment is for slightly longer then 2 months out, and then we'll see where we go from there. Insurance doesn't cover our meds nor visits so $35. sounds a dream! DD1 loses weight on her meds as does my DH on his. We have to make an effort to get high calorie, dense foods into them. Smoothies are great. In the summer because they both love sweets, I make a lot of pies, cobblers that are always eaten that same day. 

[Dancianna]

Peony, I got a big smile when I read your post!  I love what you said about the treats you make (and not the easiest things to make) being always eaten the same day. 

It's also good to feel like you "get" some of what I'm thinking here.

I realized I forgot to ask earlier - what is SN forum??  I thought it might be food/nutrition but I don't see any with the initials SN in the food area...

[Holland73]

Originally Posted by Dancianna 

I realized I forgot to ask earlier - what is SN forum??  I thought it might be food/nutrition but I don't see any with the initials SN in the food area...

Special Needs Parenting

[Dancianna]

Originally Posted by Holland73 

Special Needs Parenting

Oh!  Thank you - I'll check it out!