Stimulants: Catch 22

We seem to go through the routine every few months: N's ADHD symptoms are GREATLY reduced, amazingly so, by his stimulant med (Focalin, currently). For a while, it's a miracle drug. He can go from swinging from the chandeliers (just about literally), yelling nonsense, throwing things around, screaming "NO!" to every little request, unable to follow directions, tormeting his little sister and laughing hysterically about it, calling us the most awful names--to a calm, sane, orderly, normal-acting child within forty minutes of taking the pill. Remember the Gadarene Demoniac in the New Testament? The lunatic who was running around terrorizing the neighborhood until Jesus healed him, and the next time he shows up, he's clothed and sane, talking as if nothing ever happened? Well, the stimulant affects N like that. Yep, it's that dramatic. The down side is, well, the side effects. After a while, we notice that he gets REALLY paranoid about things, and the oppositionality gets worse and worse. One of the milder blow-ups the last time he was on the stim involved him screaming at Matt to "Go kiss a monkey!" Charming. Then there was the time recently when he was angry at Matt and told Matt he should really be grateful to him (N), because "I COULD have called you a jackass, but I didn't!" His new school has really helped his vocabulary development, obviously, but that's another story.

At any rate, we always end up taking him off the stim because the side effects become too horrendous. We'll never know for sure whether stimulant use or dropping his mood stabilizer (or some other cause) resulted in his deterioration at school this Fall, to the point that he was transferred to the special ed school, but it's possible. Supposedly, kids who are Bipolar (still not 100% convinced of that diagnosis, but he certainly has the symptoms) can't always take the stims, and neither can people with anxiety disorders.

But without the stim, he's nearly uneducable in any school setting--very difficult to get any work done, very "disruptive," etc., only pays attention for short periods of time if it's one of his pet interests. And the hyperactivity and general difficulty at home proves so difficult to manage, that we end up putting him back on the stim. He's now at a very low dose of Focalin, which means the rebound is back, when the meds wears off and he's high as a kite.

So the point of all this, I suppose, is that it still amazes and saddens me to see how he can change to "normal" the minute the stim kicks in, and often becomes very polite and considerate, not at all belligerent and obnoxious. It's crystal clear to me that this is how his brain is supposed to work. This is the arousal level his brain should naturally maintain, but it doesn't. It isn't a problem with behavior, or motivation, or character, or environment. The stimulant shows me, for a little while, what he could have been like, should have been. And he knows this, too. I remember the times, after we've taken him off the stim, when he's begged us to put him back on, so he can "be calm" and "not get in trouble." Sad, very sad.