Expert: Dr Billy Levin - 5/24/2006

Question
HELLO, MY SON WAS DIAGNOSED WHEN HE WAS 4 1/2.  NOW HE IS SIX.  WE HAVE RECENTLY MOVED TO MEXICO.  THERE ARE NO PEDIATRIC PHSYHE KNOWCOLOGISTS!  I KEEP GETTING REFERRED TO A NEUROLOGIST.  IS THIS AN O.K. CHOICE?  WHO DO I TURN TO FOR ADVICE?  HID DOSE NEEDS TO BE ADJUSTED.  ALSO, HE WAKES UP A NIGHTMARE!!!!!!!!!  I SO DESPERATELY WISH WE COULD HAVE A GREAT MORNING.  IT TAKES OVER 30 MIN.  FOR MEDS TO KICK IN.  IT S LIKE YOU CAN T KEEP HIS MOUTH SHUT.  HE IS SAYING EVERYTHING HE KNOWS HE S NOT SUPPOSED TO X 100.  HE IS LOOKING FOR TROUBLE.  IT S USUALLY A SCREAMING MATCH BETWEEN HIM MYSELF AND MY HUSBAND WHO ALSO HAS SEVERE ADHD SINCE A CHILD.  MY HUSBAND IRONICALY HAS NO PATIENCE FOR IT THOUGH.  I HATE THAT EVERYDAY WE START THE DAY THAT WAY.  HE IS CURRENTLY ON 36 CONCERTA, AND 5 MG. RITALIN IN THE MORNING, 5 MG RITALIN AT NOON, AND 15 MG AT 4.  ALSO BEFORE NOON IT GETS REAL UGLY, AND AGAIN BEFORE 4.  SICK OF THSES SHARP WEAROFFS!!!  I JUST WANT SOME CONSISTENCY.  THE RITALIN HAS NEVER BEEN VERY AFFECTIVE FOR MORE THAN 3 HOURS WITH HIM.  SHOULD I BE LOOKING INTO A MORE EFFECTIVE MEDICINE?  ADDERAL?  ANY INPUT WOULD HELP.  WHAT CAN I DO ABOUT THE MORNINGS?  PLEASE HELP.

Answer
Yuo certainly have major problems . Success needs two parents who know not only about the medical treatment but also how to cope with themselves first and then to manage the child. I am confused! Who is on medication, your husband or child? It sounds both need it.It make little sense to use a long acting Methylphenidate like Concerta and on top of this short acting Methylphenidate like Ritalin three times a day. Why not just increase the Concerta. There is medication taken at night to allow the child to wake up in a better mood. Ask your doctor about Haloperidol. As ADHD is a medical ,not a psychological condition,a Neurologist is the person to help, provided he understands ADHD..