Toddlers on SSRIs?
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| Thu, 03-09-2006 - 2:54pm |
Ok, this has not been a great week.
Our DS has had a somewhat sudden increase in OCD behavior as well as emotional meltdowns that are more intense than in the past. Today our neurologist suggested we consider SSRI's before trying additional behavioral methods. Our neuropsych suggests the opposite, try more ABA first then meds as a last resort.
Neurologist feels meds are quicker and cheaper if they work (our insurance will cover) and if they don't work you can always do ABA (insurance will not cover). He is suggesting SSRI's or possibly using Strattera if the SSRI's don't work.
Neuropsych feels the meds are not FDA approved for kids as young as our son (almost 4) and that we should try other alternatives first.
What are your experiences and how should we go about making this decision?
We respect both these doctors who are both experienced with ASD in children and both know our son. Also, these two doctors work in the same office and our neurologist is the one who suggested we see the neuropsych to get a second opinion, although it differed somewhat from his opinion. Maybe it is just a difference in their disciplines.
I just thought is unusual to suggest meds for kids under age 6, although the neurologist says he prescribes as young as 3 if he feels it is warranted.
I really need some advice about how to make this decision. Any thoughts or BTDT stories?
Katherine

OYE!
Well, you probably know (cause I am NOT quiet about it) that we didn't have good experience with medications. And even when we did it was temporary for the most part. There are always adjustments to be made ot the meds, etc.
Honest, unless you feel that the behavior is really really disrupting his life and yours, it is going on for a while, and there isn't another option, I would hold off. 4 is still really young and meds are a slippery slope. Once on them it is hard to wean them off and get out of that whole thing.
I am not anti-med but you said his OCD increased just this week? I would give it time before adding meds. If there is a sudden increase then it could be due to stress, a developmental phase, some change in life, etc.
OCD is related to anxiety. Meltdowns and behaviors may be as well. Perhaps try removing some of the stressors in his life. Adding more sensory activities and calming activities. Add epsom salt baths perhaps and lavendar spray to his linens at night. Light lavendar candles for anti-stress aroma therapy. Chamomile is also good for stress and it is very mild. There are even homeopathic chamomile that disolve in water or juice and you don't know it is there.
BTW, SSRI's are tough to wean. It can cause some pretty bad withdrawal symptoms so I would be cautious starting it. I know my nephew had been helped alot but my SIL would like to wean him off and can't. His behavior goes through the roof if she even tries. It took me a long time to get Cait off them. She was on for a few years (from 7 to 11). It took a couple months to wean them then another good 6 months of moodiness and behavior to get it out of her system and she is just doing better now over the last couple months. I am glad I waited out that bad period of time when she was getting it out of her system.
Renee
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Hi Renee,
I guess I didn't explain too well. It's been a bad week for me bc the of the dog situation (see below and thank you to you for your sensitive response!). But Eric's OCD stuff has been going on since about Nov/Dec, not just this week. I just didn't get an appt. until today (been waiting) so it's like everything has happened this week. KWIM?
My instincts are with you and with the neuropsych. You know me, Mrs. GFCF, Vitamins, sensory stuff, ST, OT, floortime, touchy feely girl. Meds are the last thing on my mind too, and my DH.
It's just that for 3 yrs. DS has been cruising along, responding pretty well to ST, OT, GFCF etc. and now, since last fall, he's kind of falling apart at home and school and it is with these ritualistic things that have never been part of him before. That is what is upsetting the neurologist. It isn't that Eric's behavior is so disruptive to us. It's that when he doesn't get to complete his rituals, or forgets, it is disruptive to him and then he hits this downward low self-esteem spiral that is odd for a 4 yr. old.
For example he wants eggs every morning for breakfast. But in addition to eating them, we have to set the timer for 30 minutes, no more no less, prior to him cracking the eggs then I cook them. Any interruption to this is a crisis. If I drive a different direction to therapy, a crisis. If he doesn't check certain doors and light before we leave the house, a crisis. Just a few of many examples, I could go on and on. He never did this before, now he does. Not that this stuff is so important or disruptive to me, but it kind of chains him down. I don't even know what half his "rules" are until I accidentally break one and he freaks. Also, he's always grinding his teeth and humming all day long.
I like the neuropsych's idea of checking out the biomed things first. Does he have a dental problem and that's why he's grinding his teeth? Does he have a strep infection that is undiagnosed and can cause OCD symptoms? Does he have GI troubles (we suspect he does) that can be giving him anxiety. I think so. The psych feels check these things first, which is what we are going to do. But there is a level of intensity to the meltdowns and this OCD stuff is new (not stimming, it's OCD, he still stims too, this is different).
But your slippery slope comment is what I am afraid about. I know I should go with my instincts, which are NOT the drugs. But it's just I trust this doc and he has been with us since day 1, did the diagnosis. I think he a lot invested in this too.
Anyway, more later. I just didn't want you to think this just started this week. It's been a few months, but new over long-term.
Gotta go, Eric's about the wreck something. Hopefully, I'll get back on later.
Thanks again! This week has frankly been bad.
Katherine
My understanding is that risperadol isn't as hard to wean from is it? That is one thing that really worried me with the SSRI's after the fact. That is the class that they warn about depression and suicide with teens who take them. Usually it happens worst when they are weaned is my understanding.
Cait and Mike were both on luvox. Mike did well at first with the OCD stuff and then got worse. I found out after the fact that increased irritability and aggression can be a side effect with some kids with ASD's. Not all mind you, but some. Well one thing that happened when we weaned the luvox was when he stopped being so aggressive.
Cait did well on Luvox but she hit an age where she didn't want to take meds anymore. She began cheeking them or what ever not to take them and her moods started to swing horribly due to the inconsistent meds. So I spoke with her and decided to try her off meds. The withdrawal from the luvox in particular was very difficult.
When it worked it worked well.
Meds can be helpful for many kids. I apologize for my slanted views on it but I was just burned to long and too bad by medications. If at all possible I won't do it again. Though it has crossed my mind. There are many things Mike could use them for but they have never helped for him and often they had horrible side effects or made things worse. So we have just come ot accept that this is life and his neurology for now. So we allow the obsessions and change them behaviorally or wait them out.
I am glad for anyone who has progress and good luck with meds. I wish we did with Mike. We did with Cait and she was the one who made the decision that she didn't want them anymore. They worked well for a while but in the end they just didn't work anymore even when I fought with her to take them consistently. She is doing great right now without med support all on her own using behavioral and cognitive type approaches. I know it is alot more work for her but she is at an age where I need to respect her thoughts on these matters as well.
Renee
Ok, that makes more sense.
I understand the doctors recomendation a little more then. And I understand your concern too. In fact we have been having a time of it with Mike since about Nov/Dec too. I keep thinking he will turn it around soon and he doesn't. We have had some brief glimpses of doing well again only to have another down turn.
Did you let Erik cheat at all during the holidays or there after? We did with the kids. They got goodies at grandparents, school, etc. even though the diet was the same at home. I have been getting a wee bit lax with them though. Letting them have syrup on pancakes on the weekend when DH cooks it. I was thinking perhaps that is what really caused the problems. I have started digestive enzymes but I am still waiting for the good effects. Had some at the beginning of this week I thought but it is back down hill with a vengeance since Tuesday/Wednesday. He is better in some ways and worse in others. More connected when I can get him to talk to me (takes alot of effort) but once he does we have had some great conversations. However, his behavior is through the roof and sometimes he is just completely withdrawn/shutdown.
HUGS on the bad week. I don't know what to say. It is likely that Luvox or a similar SSRI will help with the OCD symptoms. Actually we started Mike in large part due to some OCD type anxieties and even phobia's (bugs) and it helped tons initially. So perhaps just a small dose to get him through this and start to teach some better coping skills may be worth while. Just keep in mind the withdrawal thing. If you go the SSRI route remember if/when you want to take him off you may need to remove it VERY slowly and may need to be prepared to go through some pretty bad times while waiting for it to totally wear off. Of course, Mike was in such a bad way when we took him off his we did it quickly and he actually got better pretty fast
Renee
I don't think anyone can really answer the question for you. We needed to put David on meds (mood stabilizer) because he was really suffering, and a danger to himself. He had the symptoms you describe, but also a bunch of other stuff. It would have been a much harder decision for us if we hadn't been convinced he needed it.
When a doctor puts a child on these types of medications, they should encourage and expect you to keep in close contact for the first few days and weeks, to tell them how the child is doing. You should feel comfortable paging them late at night if you have any sudden concerns about how the meds are affecting your child. They also should start at a very low dosage and gradually work up---as far as I know. The same with weaning him off.
So, it's not like it's a lifetime commitment once you make the decision to give meds, but you do have to have good communication with the doctor. And, they need to discuss risks with you.
I think in general, it's best to avoid the meds if you can, but if it becomes clear that a child is not *available* for learning from any other kind of therapy, then he won't benefit from it. Does that make sense?
Sometimes I think if I knew parenting would be this easy, I would have had quintuplets. NOT! LOL!
Evelyn
BTW, as far as I understand, the "not FDA approved for use by children" isn't that big of a deal. It has to do with the cumbersome process of getting FDA approval.
Ok, junior is in bed so I am back!
Thank you Renee, Tina, and Evelyn. Tina, it is nice to know that someone the same age is on meds and it does seem like a trial and error process to find the right drug and dose. Evelyn, I know, we have to decide for ourselves. BTW, wanted to tell you I checked out the book you mentionted on a another thread, "Parenting your asperger child" and although Eric's dx is PDD-NOS, I kept reading it saying, "this is him!" he especially falls into the "OCD/Fantasy Boy" category. Our neurologist gave me the "OASIS Guide to Asperger's" today bc he thought the chapter on meds would be helpful and it looks interesting too.
Renee, playing detective, genetics or not, which I know is a part too, there has been plenty of anxiety at our house since last fall. We had the hurricane in late October. School was out for 2 weeks. Although our house was mostly ok, it was disruptive, no power for a couple of weeks, etc. Then we went out of state for Thanksgiving to visit my folks. Stressful for Eric due to usual holiday things--noise, lots of people,travel. That's when the tooth grinding started, on that trip. Then Eric was really,really sick with a stomach virus over Christmas, nearly hospitalized due to dehydration. Missed school for a week due to that then the usual break, that's when the rituals started to increase, after his sickness, and have escalated.
The neuropsych sees this stress as all part of it and wants us to check out the biomed stuff first, which we will. I just have that mom-dar his GI is at play here somehow. I note he only has bm's 2 or 3 x a week (although they look normal) and his behavior is the worst when he is due to have one. Afterwards, he is a different, happy child. I did finally get some digestive enzyme samples and will try those too. You know I have been struggling with that for awhile.
Anyway, I know you all can't decide for me, but I appreciate the thoughts and I really thank you for listening. I have needed you all a lot this week!
Katherine