ADHD or anxiety? I don't know which it is

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Hi Everyone,

This is my first post. My 7 year old son has been diagnosed with ADHD for one year and has been on Adderall XR. It worked very well for us until about 4 months ago, and increasing the dose has not seemed to resolve the issues.

Concurrently, he seems to have developed issues with anxiety. Extremely afraid of the dark, needs to know where I am at all times. He will just sit in his room and scream "Mommy!" until I come, but is too afraid to come out and find me, even during the day.

I have no idea any more if I am seeing symptoms of ADHD or if it is unrelated anxiety. I am starting to burn out and feel like we have taken 3 steps back in the last few months.

Are there similar experiences out there? It was no nice to see my son happy and calm for almost a year. It is breaking my heart (and taking everything out of me) to see us going backwards.

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Hi Nic,
All I know is that stimulant medications can have side effects that include anxiety. Did your son’s anxiety increase along with the dose? You described this clearly and your son’s doctor should be able to respond to this change and to your concern for your son.
I’m happy to hear that for a year adderall was helpful. When my son tried different medications he would let me know if he had a headache, stomachache, etc. and if necessary we would consider a med change under the supervision of a child psychologist and a mental health nurse. It’s unusual to have one medication work from elementary school through highschool so anticipate med trial periods. Often with a change in meds a doctor will ask that a form be filled out by each person directly working with your child for hours at a time: teacher, parent, etc. to note symptoms or absence of symptoms. This data can help you decide what is working well for your son and what isn’t.
Sticking to a familiar routine will be helpful for both of you during med or behavior transitions. The exception is that if you find you haven’t done something you both enjoy for awhile, or if time outdooors is a good experience for you and your son, do a little some of that. Don’t wear yourself out during a stressful time, though. Listening to and observing our kids takes more energy than anyone has been able to quantify! Wishing you some happy and gentle times on your way to success!

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Hello Nic,

We've been having similar problems with our son. I have severe ADHD (and other stuff...) and my 5 1/2 year old was diagnosed with SEVERE ADHD and ODD (Oppositional Defiance Disorder) right after he turned 4! Doc said, "in all my years in this profession, I have only seen a couple other kids that were so young and had it so severe!" That made me feel great (dripping with sarcasm), especially since he was old and had obviously seen A LOT of kids! ARGH!

But seriously, back on topic... :) We started him on Focalin. First 2.5mg 2xday, then other doses, and are currently on Focalin XR 10mg in AM, Focalin 5mg in early afternoon, then Clonidine 0.1mg at night. He has been having that anixiety too. Wakes up screaming in the middle of the night, and nearly every night ends up in our bed with us. Won't even go into the bathroom anymore by himself to brush his teeth, or to go potty, or anything alone - he always has to have one of us with him. It's gotten to the point were he's started going potty in his pants again if we don't get there in time, and this has even happened at school! He's in Kindergarten, and he won't even tell anyone, he'll just sit in his chair and pee! The teachers will only know when they see the puddle under his seat! It's not every day, but about 2-3 times a month. I know it sounds crazy, but it's all because he's scared! If he says something to the teacher about needing to go (it usually is a quiet wisper, not a speaking voice) and they don't hear it, or can't go with him, then he's too embarrassed to mention it again...and will just go in his seat and sit in it... It seems like that would be more embarrassing, but he doesn't see it that way...

He's gradually (very slowly) gotten better, but it's still there... I'm on Adderall XR and have found it's the only one I can take, that doesn't have any major side effects for me. I've wanted to switch my son to it too, but because he's so young...I wasn't sure.

Anyway, one thing that has helped with the anxiety is the Clonidine. I, now, will break it up and give 1/4 of a pill in the AM, 1/4 in the afternoon, and the remaining 1/2 at night. It's helped a lot for him. Just a warning though, if you decide to try it. The Night-Time dose will make him very tired, especially at first, so make sure you give it to him within 30-45 of bedtime and with food. Also, it'll effect the mornings too. If he gets up really early, you'll need to give it to him earlier because I'd say, from our experience, it needs approximately 11 hours before he needs to be functional. We had to adjust all our dinner/bath/bed times in the evenings because if we wait to give it to him too late (approx 7pm) then he is SO CRANKY (putting it nicely) in the mornings! We get him up about 6am, and if he gets his night dose before 7pm, he's ok; but God-help-you if you wake him up too early or give it to him too late! HA!

Well, I'm not sure if any of this is helpful... HA! I think I got off track a bit (Normal) HA! :)

At minimum, at least you know there's someone else out there that's been dealing/still dealing with similar issues! HA! At least your son isn't pottying in his seat at school and sitting in it! (I hope it never gets to that point!)

Praying for you, your son, and your family! :)

Jessica (JJJ ADHD MOM)

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My Dear Mom,

Please know I am not speaking as authority, just experience. Adderall is speed. Having gone through an abuse and addiction to speed myself when I was younger I can attest to the effects and angst that speed can cause. The paranoia and anxiety. It makes me wonder if there is not some other issue involved with your son. He is 7 years old and has not learned the coping mechanisms to deal with the effects of speed. Maybe another drug will help. Maybe this is an effect he and you needs to learn how to deal with. I don't know.

Maybe a change up in the dosage for different times of the day will help. By not giving him so much Adderrall before he goes to bed will help. He is awake during the day and able to develop his own coping mechanisms. At night he is so vulnerable.

Just know that there are people to love him and you are there for him. Maybe you need to consider other treatment options.

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Welcome Nic!

First of all, know that you are not alone and we are all pulling for you! My son is 11 and we had a magical year on Adderall XR when he was 7. His symptoms were managed to the point that he needed no intervention whatsoever in school. Then it suddenly stopped working... :( We have not found another med that works as well but have found something acceptable (Vyvanse & Intuniv). He has been diagnosed with generalized anxiety disorder as well, but we have been able to manage it with counseling and minor routine changes. That being said, he still ends up sleeping with his little brother most of the time...

I agree that you need to discuss the anxiety with your doctor. Different med effect each person differently and anxiety is a big side effect for many ADHD meds. I am always a proponent of giving new meds/doses a real trial before changing, but 4 months seems adequate.

Hang in there! I often feel that we are just hanging on till we get to the next day/week/month/school year! :D

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My son has adhd innatentive and anxiety. Stimulants always make him more anxious and weepy. He has been on non stimulant, Strattera for a year. Down side is it doesn't work as well for his focus, but the upside is that it really improved his anxiety. It was originally developed as an anti depressant, so it has an added benefit for anxiety. Now that being said, every child responds differently. But my son went off it for a few months and wow, his anxiety came back immediately and I never realized how much better he was when he was on it. We tried anti anxiety meds, we hated them. Too many side effects. So we went back to Strattera. We are still in the middle of trial and error with adding a stimulant to help during school hours, but it seems all we have tried either make him too weepy, nervous and lose weight. Often kids with adhd also have anxiety, it isn't always one or the other. However, any doctor I have ever talked to or read have said to always treat the anxiety first. Sometimes that helps with everything else and sometimes you need additional help with the other issues. Anxiety is real, behavioral therapy helps, but it is also neurological. Hope this helps.

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PS. Sleep is extremely important. I think it is pretty common problem for kids with adhd. If my son doesn't get the right amount of sleep, he can not function and makes all the symptoms worse. If they can't sleep because of anxiety or insomnia, treat that first! I learned that the hard way over the years. No electronics at least 1/2 hour before bed so their minds can slowly shut down. Read a book, listen to calm music, even sleep apps with white noise. For my son, 10 hours is the magic number of sleep. I swear any shorter and he has a hard time the next day. Before we dealt with his anxiety, he could never fall asleep, would wake up almost every night and had trouble the next day. I can't tell you what a difference it makes. Just something to think about.

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Hi Michael, I think the reason use of the term "speed" makes me uncomfortable is because I'm afraid of the dangers of drugs and their misuse, too. When medication is prescribed by a doctor to a specific person to treat a specific condition under close supervision by a parent, remember that we're often already nervous about making that choice and want our kids to be healthy and safe. I know where you're coming from, but most of the comments I read on this site are from members appropriately concerned about medications so using the name on the label is important.

Michael Hughes said:

My Dear Mom,

Please know I am not speaking as authority, just experience. Adderall is speed. Having gone through an abuse and addiction to speed myself when I was younger I can attest to the effects and angst that speed can cause. The paranoia and anxiety. It makes me wonder if there is not some other issue involved with your son. He is 7 years old and has not learned the coping mechanisms to deal with the effects of speed. Maybe another drug will help. Maybe this is an effect he and you needs to learn how to deal with. I don't know.

Maybe a change up in the dosage for different times of the day will help. By not giving him so much Adderrall before he goes to bed will help. He is awake during the day and able to develop his own coping mechanisms. At night he is so vulnerable.

Just know that there are people to love him and you are there for him. Maybe you need to consider other treatment options.

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It is hard with kids because they do not know how to identify and verbalize things and having two adhd (one with ocd as well) myself I can sympathize. Anxiety issues and adhd many times accompany each other. It is a chicken or the egg debate because having adhd can cause anxiety or depression even without any adhd medication. Many things can cause severe anxiety from a physiological level and of course a psychological one. The typical (and yes I hate the word typical) age range for different fears are-

INFANTS/TODDLERS (ages 0-2 years) loud noises, strangers, separation from parents, large objects

PRESCHOOLERS (3-6 years) imaginary figures (e.g., ghosts, monsters, supernatural beings, the dark, noises, sleeping alone, thunder, floods)

SCHOOL AGED CHILDREN/ADOLESCENTS (7-16 years) more realistic fears (e.g., physical injury, health, school performance, death, thunderstorms, earthquakes, floods

This reoccurring situation may or may not have anything to do with an anxiety disorder or adhd or the meds. Many sudden night time fears may have to do even with night terrors (which can be caused by medical condition such as mvp (Mitral valve prolapse- which many people have that can be the actual cause for many anxiety issues) or sugar intake before bed. What I am saying is, you do not know until you have him checked out if this continues on a continual basis. It can be very normal part in his development as well. Half of the frustration is knowing, what is normal? IMHO, if it continues maybe see a nuerologist that can deal with the adhd, anxiety and other potential physiological disorders that can be easy treated if diagnosed.

The best salve for the heart in the meantime is hugs and comfort in the arms of safety. It is amazing how much healing and comfort is given by caring parents such as yourselves that exceed what doctors can do. It is all in unison, using everything we have from love to medical science to help along the way. Poor kid, I feel for him and for the other kids I've read about in this post. I've had night terrors, peed in my pants in kindergarten because I was afraid to ask to go, Normalizing those reactions to extreme fears to a child is extremely validating for him... well for anyone regardless of age. Right now it is his reaction and talking about it with acceptance and 'ok to have done' without judgment in reaction to whatever he is going through may even alleviate the stress reaction itself. Many times it does depending on the source of stress. Best to you and yours.

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Michael;

I would also like to address your comment about Adderall being "speed". I don't know the circumstances of your 'addiction to "speed" when you were younger', but I'm thinking you may be associating 2 different drugs... If you're talking about the "speed" I think you are, then you're refering to Methamphetamine. Adderall is Amphetamine Salt. The Meth/Speed is a street drug, usually mixed with a wide range of household/industrial chemicals that alter it and make it a very addictive and dangerous drug. It is also well known to cause anxiety, paranoia, and psychoses, along with sleep deprivation, severe weight loss, long-lasting organ damage, and many more things. Mainly though, those problems are becuase of the additional chemicals, like battery acid, and not the Amphetamin. Adderall, on the other hand, is prescribed in a moderate dosage by doctors to patients that need it to boost their dopamine, seratonin, and other brain chemicals. Taken by a person that clinically needs it, and monitored by a doctor to ensure there isn't any misuse, Adderall is a wonderful drug. I'm not an expert, but like you, have experienced the daily challenges of addiction and also have done a lot of research because I take Adderall, and actually have taken it through my pregnancies prescribed by the Specialist I saw during them. If it was anything like Meth/Speed, you can be sure I wouldn't have taken it! In fact, if I don't take it then I can't sleep, I forget to eat, am out-of-my-mind with racing and uncontrollable thoughts.Of course, if it's taken by someone that doesn't clinically need it, Adderall has an effect/feeling of "speed", but for those that need it...it's a wonder drug! I am truly sorry you're going through the challenges of addiction; please, know you're not alone! I will keep you in my prayers, Jessica

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Lostgirl;

THANK YOU SO MUCH FOR YOUR POST!!! It realy has helped me to put things in a better perspective and actually has alleviated some of my stress!

You're right about learning what is "normal" or "typical" too. Sometimes we get caught up so, we forget that it could be something "normal" or "typical".

You're a beautiful person for all you said... :)

Thank you again,

Jessica

p.s. I hate those words too! Frankly, who would want to be "normal" or "typical"???? Sounds pretty bland to me. LOL!!!

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Thanks Everyone,

It really helps so much to hear from people dealing with the same issues we are. We live in a smaller city and there are no local support groups.

My son is still stuggling and is also now having abdominal pain. I am pretty sure the Adderall XR is the cause and have a call in to our pediatrician now to talk about what to do.

There are so many interconnected factors with ADHD that sometimes I can drive myself crazy trying to figure out what's what. Throw on top of that issues with his biological father (addictions and mental illness) and there is no way to know where the problems stem from.

A few follow up questions.....

I am thinking about asking to switch to Concerta instead of the Adderall. When we first put my DS on meds, we went with Adderall because he could not swallow a whole pill. That isn't an issue anymore. Has anyone made the switch between the two meds? How did it go?

I am also looking in to play therapy for my son. Like I mentioned, his father has been dealing with some serious issues of his own, and I am not sure what effect this has had on my son. He typically spends every second weekend with his dad, but did not see him for over 2 months (November - January) while his dad was in treatment. My son has never mentioned anytihng to me about the time with his dad, and I have no idea what he had to deal with at that house before his father crashed and ended up in treatment.

Up until now our course of treatment has solely been with medication. How do you feel about therapy for the anxiety/ADHD?

Again, thanks so much for all of the responses. You have no idea how it helps to have people who understand.

Nicole

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NicMacJay, therapy was helpful for my sons and, being divorced, I was comforted by the psychologist’s experience with kids living on two households. Meds were monitored in therapy, too, and prescribed by a qualified psych. nurse in the same department. It was also really helpful to me as an education and a great support.

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Aww JJJ Adhd Mom (Jessica)... I really needed that today, thank you.

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Hi Nic MacJay, thinking of you today. In your initial post you mentioned burnout. Paying attention to that on top of everything else is important because our kids’ well-being is such a high priority. Parents need rest and exercise, ha ha, or a good laugh now and then! If you’re curious about how others feel signs of burnout and how they cope you could try a discussion on that topic.
I hope you and your son are doing better. Best wishes.

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ArtFish said:

NicMacJay, therapy was helpful for my sons and, being divorced, I was comforted by the psychologist's experience with kids living on two households. Meds were monitored in therapy, too, and prescribed by a qualified psych. nurse in the same department. It was also really helpful to me as an education and a great support.
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I agree.....having that bit of validation from the psychologist is a comfort. Some times you are so worried that you question if you are doing the best you can for your child. It really does help to have someone put that in perspective for you.

In canada, psychologists cannot prescribe/monitor meds. We have a pediatrician who handles that side of things. But the psychologist will help my son come up with more practical strategies to handle the ADHD and his anxiety. I believe medication is an extremely important component to treating ADHD (and other mental illnesses), but I feel too many people end up relying on medication to be a "fix all" for their problems. I really want my son to learn some coping skills to help him as well.

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I agree. One of my sons did not take meds and the other did - different kids :). In the US a psychologist can’t prescribe meds either, but worked in the same practice with someone who could. Initially our pediatrician prescribed - similar to Canada. Thanks for reminding me, cuz the systems are sometimes different.
Best wishes to you and your son with your team!