Expert: Dr Billy Levin - 1/11/2011

Question
My step-son was taken away from his birth mother at the age of 2, because she was in tied him to a pier and went into a drug house, and he fell in and almost drown. She kept him drugged 90% of the time to keep him asleep. When my husband and I got custody of him, he would stay awake for days, got kicked out of every day care he was placed in for aggression. He is now 7. He has been seeing doctors since the age of 4. At the age of 4 they said he was ADHD. He was placed on Ritalin 5 mg in the morning and Risperdal (if I remember right like .5 in the morning) and .01 Clonidine at night to help him sleep. Really didnt feel like any of them helped at all, but he seemed to not scream 24/7. When he started K. He was nearly kicked out for his behavior. He was took off Ritalin and placed on Adderall in the morning, this child got worse, he was harming other children with a week. His doctor at the time yelled at me for pulling him off of it, telling me that his meds were working. When in fact I knew they weren't. I found another doctor. They tried Concerta, Focalin XR, we got the same results as Adderall. The school was ready to throw him out. She placed him on Vyvanse 30 in the morning, she added Abilify 1 mg at 5:30 in the afternoon, and Clonidine .01 at bedtime. He seem to do some what okay, grades were okay, but he still couldn't sit in his seat for more than 15 mins in class, kept talking out, bothering his teacher. So his doctor slowly upped his Vyvanse. We were at 70mg in the morning, the Abilify at 5:30 and Clonidine at bedtime. He still kept getting out of his seat at school, bothering the teacher to the point where she can't teach, he is lying, stealing, harming other children, bulling. His aggression seems to get worse the older he gets. We are at the point the school again is ready to throw him out because of the harming children and bulling. He tells children he will cut their heads off, and if they tell on him he will break every bone in their body. He screams at everyone if he is ask to do anything. He begs for food, then has a fit because he has to eat it. He harms his 3 year old brother, his room looks like a bomb went off. His grades are falling. He is now refusing to do his work at school. When he is at home its like hell. The teacher has began calling asking me to just come get him because she cant deal with him anymore. I am to the point where I think I need a nerve pill myself. His doctor first thought I wasn't giving his medication, stating that it was my fault. So she put him on the patch 10 mg, so the teacher could make sure he was getting his meds. For a month, this went on. The teacher has spoke with his doctor on the phone, and she upped the patch to 20, added Tenex 2mg in the morning, 2 mg in the afternoon. He is getting worse. Its like we are not giving him anything. He cant play with anyone without hurting them. He blames everyone for his bad behavior, screams at us, throws things, throws fits that will make you think your ear drums are gonna bust. Now today, he is asking his brother to suck his winkwink. He is 7, and I have locks on all the tvs, to be sure of what he watching, he dont get to play bad video games. We have tried everything. I am to the point where I am going to have to leave to protect my son. What do you think we can do?

Answer
you describe ADHD. All the medications you tried will work if used correctly. None you mentioned were monitered using Conners rating scales to obtain an optimal dose. Only an optimal dose will work. Find an expert who knows how to use the medication correctly. He will also be able to advise you and the school about correct management which is essential.