Pre-teen with ADD/OCD

[MsLeFever]

Hi all! My DS (12) has been dealing (struggling) with ADD for 4 or 5 years. Tried every dang drug - currently on one that may be working but I'm not entirely convinced of that.

About 5 months ago he starts dealing with his depression/anxiety by creating rituals when anyone outside of the family touches him or before he can eat or sit down anywhere - yup OCD - which his Psychiatrist tells me is not an uncommon dual diagnosis.

The poor kid is a mental wreck. He is angry and depressed and anxious. He lashes out and is generally not a person that anyone wants to have around. I'm aware that some of this is just puberty but we've gone way past that. I'm hoping that someone here may have a child with this issue or may have gone through it themselves and can give me some hope that DS can come through this with some sense of self-worth and happiness.

thanks so much Dis family!
Barbara

 

[bookwormde]

It is actually a little rare for an ADHD kid to develop co morbidities and anxieties at the levels you describe, unless they have innate social skills or sensory differentials. The OCD is a secondary co morbid diagnosis not a "dual diagnosis", since it is the result of the underlying primary diagnosis.

bookwormde

 

[clanmcculloch]

If you've tried every dang drug then I wonder if you have an accurate diagnosis. There are quite a few conditions/syndromes/problems/diagnoses that can cause hyperactivity and inability to focus. True ADHD should be able to be helped with some kind of medication. How extensive of an evaluation did he undergo? Too many doctors diagnose ADHD based only on a written questionaire from a teacher and a parent along with a 5 minute observation of the child. There's so much more that can and should be done to rule out other things. Psychiatrists sometimes drive me nuts in case you can't tell.

Medication can definitely heighten OCD tendencies. One of my DSDs went into full OCD mode on one medication for depression. His psychiatrist should be aware of this. OCD doesn't just suddenly start. If he hasn't shown tendencies before the last 5 months, I'd be looking closer at his medication. Puberty can definitely make it worse, but it doesn't generally just appear out of nowhere.

 

[MsLeFever]

I think I see what you mean.

I wonder frankly if he really has ADD - they seemed to rather easily make that diagnosis. I am wondering if it was always anxiety related and that worrying about germs was what was causing him to be distracted.

His psychiatrist seems to me to be a pill pusher. I'm not at all against medicine if it will help but I'm hoping his new Psychiatrist will have some other ideas about how to proceed.

 

[MsLeFever]

I wonder if you have an accurate diagnosis. ..... True ADHD should be able to be helped with some kind of medication. How extensive of an evaluation did he undergo?

Medication can definitely heighten OCD tendencies. One of my DSDs went into full OCD mode on one medication for depression. His psychiatrist should be aware of this. OCD doesn't just suddenly start. If he hasn't shown tendencies before the last 5 months, I'd be looking closer at his medication. Puberty can definitely make it worse, but it doesn't generally just appear out of nowhere.

I completely agree with your questioning of his diagnosis - I don't think his evaluation was anywhere close to extensive. It makes me really uncomfortable how MUCH of it was based on teachers' and parent's observations.

When he was on the various stimulant ADD drugs there didn't seem to be any result other than he wasn't hungry. Now he is on Strattera and again - I'm not persuaded that it is making a difference. The compulsiveness started about the same time that he was prescribed Prozac for depression and his doctor increased the dose as a result. Which is counter intuitive to me but I trusted him at the time. Now it is about 2 weeks later and I see no change.

It breaks my heart to see him struggle so much and I'm finding it hard to be an effective advocate which is why I'm here - to learn from other's experiences and to arm myself for an appointment with a new psychiatrist in January.

 

[clanmcculloch]

Maybe try a Developmental Pediatrician instead of a Psychiatrist, or if you want to stick with psychiatrists, make sure it's not one who specializes in ADHD. I know that comment about not specializing may sound strange but I've had experiences with doctors who have a specific specialty wanting to pigeon hole everybody into their specialty whether they should or shouldn't. Developmental pediatricians are more likely to look at non-psychiatric issues while psychiatrists will look at conditions that fall within the realm of psychiatry. I hate that ADHD is considered psychiatric but that's the kind of doctor who treats it.

The medication that sent my DSD into an OCD tailspin was definitely in the Prozac family. I can't recall if it was that drug in particular (she went through many) but it was definitely in that family.

You can also write a letter to his teacher requesting an evaluation for sensory, obsessive compulsive and social problems. Don't just verbally ask; write a letter. This legally obligates the school to at least put together a meeting to discuss the need for an evaluation. The evaluation done by the school will include observations in the classroom as well as one-on-one evaluations by an Occupational Therapist, Speech & Language Pathologist as well as a school psychologist.

Have you ever done any reading on Sensory Integration Disorder? Many kids who are mis-diagnosed with ADHD actually have SID. SID can be a diagnosis all on it's own or it can be one component of autism spectrum disorders (don't let the word autism scare you; your son is clearly very high functioning IF (big if) he is even on the spectrum at all which right now I have zero information to base any kind of ideas one way or the other but I'm bringing it up because it's mentioned in much of the literature plus kids with both SID and OCD tendencies often do end up with a diagnosis on the spectrum) as well as being a co-morbid condition along with ADHD (though I personally suspect that if the child was given the proper tools for coping with the SID that the ADHD would be more manageable but that's just my opinion).

This may seem like an odd question, but does he have any kinds of health issues at all, even something seems unrelated such as eczema or asthma or acid reflux?

{{{HUGS}}} You're doing great mom. You're reaching out for help and doing what you can. It's hard. VERY hard. Everybody on this board knows the heartbreak you're suffering right now and I'm sure I'm not the only one who wants to reach out and hug you. Take a deep breath. Repeat. You'll get through this one baby step at a time. He'll be fine thanks to you and your determination. Honest!!!

 

[bookwormde]

Yes a developmental pediatrician or better yet developmental neurolgist is where you should be, Psychiatrists are only trained in dealing with "symptoms" not the source and as said medications are often counterproductive.

If you are seeing high levels of variability in attending (can focus for exceptional amouts of time or with exceptional intensity on areas of special interest) particularly around image based information, then it would help to get a much more complete evaluation including social, sensory and EF characteristics.

It is a bit of a drive for you but Kennedy Kreiger (Johns Hopkins) in Baltimore is one of the top centers in the world


bookwormde

 

[MsLeFever]

Thanks so very much. I looked up a few pediatric neurologists tonight that take our insurance and will call them tomorrow morning!

 

[gules]

I was definitely a depressed and angry teenager, starting about as young as your son. According to my own estimation, I turned out pretty well! You seem like a very supportive and understanding parent, so that will just help all the more. I went undiagnosed and my depression went by as "typical teenage angst." The hardest part for me was thinking that no one cared. I think and your son are just at a rough time and it seems really hopeless, but when he starts the process of feeling better, he'll definitely remember and appreciate that you were always there for him. Don't lose hope! It's just really rough trying to even out internally.

Also, I am a medication advocate as far as believing that the correct medication given at the correct time and dose are more helpful than just 'toughing it out.' However, ADD/ADHD and depression are some of the most over-diagnosed things in the field. When did he get the ADD diagnosis? And what led to it?

Medication used to treat depression can also be effective for anxiety in many cases. Since OCD is in the anxiety 'family,' that may be why your doctor decided to up the dosage of the antidepressant. However, on the same note, not every medication is for every person. There are so many on the market because for whatever reason some people just do badly on some of them. This might be happening in your son's case. I will give this to your doctor, though, Prozac is the mildest of the antidepressants s/he could have used, and it is wise to start off as light as you can. Medications affecting mood (depression, anxiety) can take up to 6 weeks to have any significant effect, which is terribly frustrating for everyone involved, but sadly true.

I would get him re-evaluated if you can manage it. You have a right to know what exactly he gets diagnosed with and their reasons for it, as well as the clinical symptoms and a full spread of what you can expect to deal with. Requirements for a lot of disorders are different when you have a young child versus an adolescent versus an adult, so it may really be different due to age. Ask tons of questions, no matter how basic you think they might be. This is my biggest 'thing' about doctors: Not enough of them talk to you. A lot are willing to, but they're busy or they've gotten used to people not wanting to know. Ask away, and be prepared.

I would also opt in for therapy, if your health insurance will spring for it and if you can afford it. Even the best medication won't solve everything, and looking into therapy options will help maximize the impact of your son's treatment. Look into Cognitive or Cognitive-Behavioral therapies, which are some of the most popular and well-backed by research. If you can't afford it, I can try to dig up some of the better titles I have around so you can have a go at it on your own.

I hope things start to look up for you soon. As someone coming from your son's perspective, I can tell you that although it may be grueling some (or even most) days, and sometimes it seems like nothing will work, it will get better in the future. Best of luck, and keep us updated!

 

[Schmeck]

Psychiatrists are only trained in dealing with "symptoms" not the source and as said medications are often counterproductive.


bookwormde

Whoa, bookwormde, I'm thinking you are getting psychologists and psychiatrists mixed up! Psychiatrists are medical doctors, have 4 years of med school and 4 years of residency in their education, so saying they are only 'trained in dealing with symptoms not the source' is incorrect, by a long shot.

 

[bookwormde]

Schmeck,

Not for much of what they do but in this area both in training and practice it is true.

bookwormde

 

[Schmeck]

Schmeck,

Not for much of what they do but in this area both in training and practice it is true.

bookwormde

Not according to my friend's daughter, who is in med school.

 

[bookwormde]

That would certainly be great news if they are begining to teach any level of depth of neurological evolutionary gentic variances in the broader programs, especially for psychiatrists.

I would love to know what texts they are using.

bookwormde

 

[GraceLuvsWDW]

Medication can definitely heighten OCD tendencies. One of my DSDs went into full OCD mode on one medication for depression. His psychiatrist should be aware of this. OCD doesn't just suddenly start. If he hasn't shown tendencies before the last 5 months, I'd be looking closer at his medication. Puberty can definitely make it worse, but it doesn't generally just appear out of nowhere.

I second this post. My dd developed very severe OCD behaviors when she was on Zoloft (which strangely is a med used to treat OCD ) Some kids behaviors-mania, depression, OCD rituals and obsessions-can become WORSE on certain meds. Even after we weaned her off the meds the behaviors are still present-though not as bad. She was pulling out her eyelashes and hair, tapping things, counting while doing things. Now she has some finger flicking which I don't know if it's a stim or OCD.

Also, has he had strep recently? You can also take a look at his diet.

The best thing for dealing with the OCD is finding a therapist who can help. They (the compulsions and obsessions) don't go away overnight, but they can be lessened through some CBT or exposure therapy. You want to find a therapist who specializes in kids with OCD-that is VERY important.

 

[JulieWent]

Wanted to chime in here. OCD CAN definitely "appear" suddenly. Strep, certain stomach viruses, etc. can trigger it and make it appear seemingly "out of the blue," especially in children who are already struggling with other issues. I, too, would wonder about the ADD diagnosis because so many other things that are co-morbid with OCD present as ADD to people who are untrained to look for them: NLD, Aspergers, SID, depression, the list goes on. I'm glad you're looking for a neuropsychologist. That was certainly our route.

DS has had OCD since 4th grade (when it presented almost "overnight" after a short build up). He is now a sophomore in high school and is doing very well! (Just finished the first semester with straight A's!) Anyway, what we have learned: a lot of ADHD meds REALLY exacerbate OCD. Strattera didn't seem to, but it didn't do anything else for him either. The normal ADHD meds (Concerta, etc.) gave him a lovely case of tics that stayed with him an entire YEAR after we discontinued the meds. (We soon learned that we were barking up the wrong tree looking at ADHD as an explanation for his attention issues. He has NLD, which makes it difficult for him to concentrate on information that is presented in many traditional ways -- notes, etc.)
Finding the right meds for a child who is actually dealing with OCD is like looking for the right witches' brew. There are a lot of things out there; some are successful for some kids; some aren't. We tried zoloft for awhile, and it was mildly effective. Then we changed to Luvox (fluvoximine here in the States). It has been extremely effective. Of course, we mix it with a very healthy dose of Cognitive Behavioral Therapy. He has worked with the same therapist now for years. She keeps him (and us) sane. I don't think either the meds or the therapy would be effective without the other component.
If your child DOES have OCD, you are in this for the long haul. Yes, it gets better as you and he / she learn how to use coping skills and find your sense of humor again. But it is not something that just goes away. DS's friends are well aware of his issues and work with him in ways that touch me and make me love them deeply. His intuition and sense of humor about his life make them love him.
Good luck. Let me know if I can answer any questions.
Julie