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My son is a ball of energy and gets so excited about some things they take all of his focus.  Don’t get between him and a goal if he is trying to run or jump.  But we were concerned about his academics as the constant observation from his teachers was that he could not focus in class.

 

I am highly data driven so an initial assessment was key to make sure we had an accurate diagnosis.  Remember, the diagnosis drives treatment so it has to be right!  We parents and his teachers completed a Vanderbilt and Connors rating, which were good indicators of ADHD, and the final diagnosis was made by his Child Psychiatrist.  I tend to lean towards natural or behavioral approaches with patients and my family when possible.  So I am inclined to try therapies and supplements long before I will succumb to use of a conventional prescription “medicine.”  But when learning basic functions of daily living was getting more compromised, we turned to further research of a suitable prescription, even if only to be used temporarily.

 

 

You probably know that 1 in 68 children is diagnosed with Autism and the prevalence of ADHD is roughly 5-10% of the population.  But what happens when your child is diagnosed with both?  Well, it makes the treatment a little complicated.  Here’s why.

ADHD is said to be due to dysregulation of Dopamine (one of the hormones associated with depression) and Norepinephrine (a fight or flight hormone) so medicines typically used to treat ADHD work to increase these hormones, especially Norepinephrine.  Norepinephrine is a part of the adrenergic system, and the most common medicines to treat ADHD target that system.  For example, stimulants like Amphetamine and Methylphenidate increase Norepinephine.  Antidepressants, like and Atomoxetine, a Selective Noradreneric Reuptake Inhibitor, also increases availability of Norepinephrine.  Even the blood pressure medicines, Clonidine and Guanfacine, can get in on the game because they are alpha-Adrenergic agonists (i.e. they increase adrenergic hormones).

 

 

 

Now, remember that Norepinephrine is a part of the fight or flight system so it’s designed to stimulate your body to action in time of need.  Ironically, for those with only ADHD, stimulants tend to have a calming effect.  Not so for many of those one the Autism spectrum.  Stimulants tend to stimulate our kids, who already have a tendency to stim.

So what do you do?  Your provider is probably going to tell you to avoid stimulants.  Which is what we did.  We initially started with Guanfacine for our little guy and it seemed to work.  He was calmer and a bit more focused – the data gave us some direction.  His Vanderbilt/Connors scores went down and teachers mentioned the noticeable difference in class.

 

 

 

 

But there were side effects, and shall we say, complications.  Many blood pressure medicines make you sleepy, so we gave Guanfacine at night.  But then some days he would be tired at school (my baby fell asleep in class which was the opposite of our goal for focused attention L).  And it’s a blood pressure medicine so we have to periodically check and make sure it wasn’t lowering his pressure, causing dizziness or lightheadedness (he drinks water like a fish so less likely to happen but periodic checks with the doctor or school nurse helps monitor this).  And this smart little guy started cheeking it!  Yes, he would hide the medicine in his cheek and roof of his mouth.

 

 

So, stimulants were out and the pressure medicine was causing some issues.  What’s next?  While we were considering the next step, a parent shared the success she was having with Vayarin.  Vyvanse, I knew, but what was Vayarin?  Well, the combination of our drama with Guanfacine and my desire for a better option the led us to find the answer to that question.  And so begins the Vayarin Chronicles.

 
 
Next Steps:

 

Here are some things to consider:

  • Do you or your child have a co-occurring condition such as ADHD? How do you handle the complexities of dealing with multiple conditions at once?
  • When behavioral techniques have less success than you hope, do you discontinue them all together, or use them to complement other treatments?
  • What are your thoughts about medicine? Remember, in its most basic sense, a “medicine” can be anything you put in your mouth or can be absorbed through the skin for healing purposes.

 

 

Want to Learn More?

Bergina Isbell, MD is the mother of two children with Special Needs.  She is a Psychiatrist and founder of the Autism Alignment Movement, which includes a live interview series of other successful parents and experts who care for those with Special Needs.

To join the Autism Alignment Movement, which includes access to the live interviews and monthly newsletter, visit  https://bit.ly/autismstrategist.

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