Help needed from parents of ADD children

[freakygirl]

My daughter, as most of you know, was recently diagnosed with ADD.

She started on Adderall XR 10mg capsule on November 23, 2002 and responded to it wonderfully. Her grades improved.. her all around person improved. She no longer felt as tho her "brain was crooked" (these are her words).

Well at the first of the year.. her insurance changed. And for some reason they won't pay for Adderall XR.. so they switched her to Concerta 18 mg tablets. Before putting her on the Concerta I talked to her dr.. and I read all I could on the net. Seemed as though the side effects were pretty much the same for both meds.

I toyed with the idea of paying for the Adderall myself. It was $85 a month.. I felt that because she was doing so well.. I hated to change just because some freakin' HMO didn't want to pay (I found out later that both meds are comparable in price. The HMO didn't want to pay for such a "new" drug )

We ended up switching to the Concerta.

Now.. my whole point to this thread is... I've noticed that Kimber is back to her old ways. Forgetting her homework at school. They get a homework packet (3 or 4 papers) that are due on Friday. Before the medication.. it was a fight on Thursdays to get her to bring it home.. and then actually sit down and do it. After her meds.. She would bring it home on Monday.. do it.. and then turn it in on Tuesdays. Now we are back to fighting on Thursdays.
She has to have things explained several times and still doesn't get it.

Is it possible that the Concerta is doing nothing? Maybe the dosage isn't large enough? Maybe she hasn't been on it long enough?
The Adderall kicked in immediatly.. and she has been on the Concerta for a week now.

I tried calling the dr today.. he was out of the office. I will try calling tomorrow.. but I was just wondering if anyone else has any experience in this.

 

[superlittlegirl]

I would recommend filing an appeal. If you found something that works, they need to accomodate your needs. ADD is protected under the Americans with Disabilities Act, so there may be some clout behind that.

 

[freakygirl]

I would recommend filing an appeal. If you found something that works, they need to accomodate your needs. ADD is protected under the Americans with Disabilities Act, so there may be some clout behind that.

I thought about that..

but I have no idea where to start.. do I call the insurance?

 

[superlittlegirl]

I'd start with your MD. The insurance will want documentation from him or her anyway, and the doc may have ideas on which routes are available for you to take.

I thought about that..

but I have no idea where to start.. do I call the insurance?

 

[freakygirl]

Thanks for the info..

I'll talk to him tomorrow (if he is in the office)

 

[Guest]

They are both stimulants with an immediate affect. It doesn't take a week to get Concerta into ones system. It is immediate. Sometimes though the tablet itself does not digest properly in patients (it is a time release that is different than the Adderall XR in form) which could have an affect.

Typically though 36 mg am is a standard dose for Concerta. 54 mg is also not uncommon. Bump it up first.

Ritalin is another one you could choose. They are all fairly similar, and are occasionally used at the same time as Adderall XR.

There is another one that just came out, Stratera, that is in the Wellbutrim family - not a stimulant per se, but used for those purposes. It's very new, though, and we just started a few patients on it in the last week, so I am not familiar with the quality of the affect. But a possible option IF she suffers any depression as well.

 

[xanadu]

I'm not real insurance savvy, but I do know that some people do better on the original form of a drug than on its generic equivalent.

Some also do better on one form of medication for ADD, but not others. My son did well on Adderall, but not on Ritalin. The doctor did tell me, though, when I had his original Ritalin prescription filled, to get the generic first (since it was cheaper) and if it didn't work, then try buying the Ritalin and see if it made a difference.

I don't understand why an insurance company would refuse to pay for a specific drug, but if you can show that it is the only drug that is effective, you may can appeal. I would suggest written statements from yourself and her teacher would be your first line of appeal, along with a statement from the doctor about how she needs this specific drug and not substitutes.

 

[Rubyfruit]

This is exactly why doctor's need to do follow up.

I agree that she's probably on too low a dose. My son takes 36 mg of Concerta and he's in 1st grade.

 

[Guest]

And remember that with an appeal, nothing carries more weight than the human resource department of the policy holder's employer.

Get people on your side to fight. As appeals go, this one is minor. Trust me.

 

[freakygirl]

Storm.. thanks for the info. And as far as we can tell.. she isn't suffering from any depression.

Ruby-My daughter only weighs 39 lbs.. is real tiny. Less than 5% on the growth scale. The dr has her on the lowest dose because of her size.

xanadu-This isn't a generic form.. it's the name brand stuff.

I've talked to her teacher.. there is a difference in school. She is writing a letter for me to pick up tomorrow.

 

[freakygirl]

And remember that with an appeal, nothing carries more weight than the human resource department of the policy holder's employer.

Get people on your side to fight. As appeals go, this one is minor. Trust me.

My daughter gets state funded aid. Welfare if that is what you want to call it.

Her *cough* sperm donor *cough* doesn't seem to think he needs to provide any.... so I went to the state. Someone has to make him pay for it

 

[Guest]

. . . Is it possible that the Concerta is doing nothing? Maybe the dosage isn't large enough? Maybe she hasn't been on it long enough?
The Adderall kicked in immediatly.. and she has been on the Concerta for a week now.

I tried calling the dr today.. he was out of the office. I will try calling tomorrow.. but I was just wondering if anyone else has any experience in this.

Oh - things were working so well for you! What a mess! I'm so sorry!

We have been through a few medication changes at our house.

Concerta/Metadate/Ritalin are all versions of methylphenidate. They have differing dosages and different delivery systems. (some are sustained, some are extended, etc.)

Adderall, however, is a combination of several different amphetamines (it also has different delivery systems depending on the type) In comparison with methyphenidate, I would think Adderall would have to work better because it contains more medication. (And unfortunately, as you already know, it is very expensive.)

I take Adderall XR - it helps me stay focused. (I can write naughty stories without it, but I cannot competently edit them unless I am on meds) I tried Concerta and Metadate - both caused me to act like my mother (no patience, short fuse - sorry mom - lol)

My 8 year old daughter, on the other hand, cannot tolerate Adderall. It gives her the same short temper problems.

She was on Concerta for over a year. It worked well for her but then her body adjusted and she outgrew it. Now she is taking Metadate E. R. but lately I am noticing a return of forgetfulness and stressed out symptoms so I imagine a medication change will be in order soon.

I did read something lately about a new medication for ADD that should be approved by this summer. I am keeping my fingers crossed.

Best wishes - I hope the appeal process works!

 

[Guest]

With that weight, that dose is probably decent, but they may want to try Ritalin 5 TID if the Concerta doesn't do it. They'd never try Stratera on someone that small - it's way too new. But to get the appeal down right, they'll have to try Ritalin to see if it works.

Does she get worse as the day goes on, or is her behavior the same throughout the day? The school folks should be able to give a good answer to that.

Is the doctor a pyschiatrist, or her pediatrician?

 

[Guest]

. . .Typically though 36 mg am is a standard dose for Concerta. 54 mg is also not uncommon. Bump it up first. . .

Surely that's not standard dosage for a small child. Perhaps a middle school kid?

I would think that the little Concerta tic tac - 18mg - is better for the little ones.

 

[Guest]

Metadate is pretty new as well, and not used on kids that young. Digestive shit again. It's a tme release, too, and the most difficult to digest.

And yes, jumping to a different stimulant is not uncommon at all. It happens all the time. It's rare to stick to one for an extended period.

 

[miles]

The ADA covers disabled employees in the workplace. It has nothing to do with insurance or prescription coverage.

Insurance companies do one thing very well: they love to say no. If the insurance is through your employer and they are self-funded (most are), they decide which drugs and procedures are covered, not the insurance company. The insurance company is an agent that administers the claims.

First thing tomorrow call the Benefits Manager (or HR Manager) and explain the situation. It's very likely all you need is a letter of medical necessity from the doctor, and they can fax that to your employer for approval.

 

[Guest]

Surely that's not standard dosage for a small child. Perhaps a middle school kid?

I would think that the little Concerta tic tac - 18mg - is better for the little ones.

see my above post - yes.

 

[freakygirl]

Sorry for my slow responses.. I'm cooking dinner also.


sweetsubsarahh-Thank you for the information and the well wishes.

Storm-Pediatrition.. She was seeing the pyschiatrist until the insurance stopped paying for that in December (they only allowed 5 visits a year). Now that we have new insurance.. they don't find it necessary. So she doesn't go anymore.

And to the PMer. Yes.. state funded medical. It's called Basic Health here in Washington state. I pay $30 a month for the privilage to use it. *smile* so.. no I'm not a fat ass welfare bitch with a moron child. I'm just a fat mother with a child with ADD. Now fuck off!

 

[Guest]

Insurance companies do one thing very well: they love to say no. If the insurance is through your employer and they are self-funded (most are), they decide which drugs and procedures are covered, not the insurance company. The insurance company is an agent that administers the claims.

Actually, they farm that part out to gatekeepers that make the decision. For example, United Healthcare uses United Behavioral Health, Aetna uses Magellan, Cigna uses Innovative Resource Group, etc. Those are the people paid to say "no".

The rest of your post is right-on, though. HR department!!

 

[freakygirl]

The ADA covers disabled employees in the workplace. It has nothing to do with insurance or prescription coverage.

Insurance companies do one thing very well: they love to say no. If the insurance is through your employer and they are self-funded (most are), they decide which drugs and procedures are covered, not the insurance company. The insurance company is an agent that administers the claims.

First thing tomorrow call the Benefits Manager (or HR Manager) and explain the situation. It's very likely all you need is a letter of medical necessity from the doctor, and they can fax that to your employer for approval.

When I went down last week to get the script filled.. the pharmacist said the insurance wouldn't pay for it, without a letter of necessity. The dr faxed them one and they still denied it.

 

[Guest]

Pediatricians CAN manage stimulants well, but they WILL need guidance and input from others like the school.

If you are not happy or comfortable, your county DHSS has psychiatrists that can help, and insurance should not be a problem with them.

 

[Guest]

. . .sweetsubsarahh-Thank you for the information and the well wishes. . .

You are very welcome. PM me anytime if you need to vent. And what kind of an idiot thinks that ADD somehow affects intelligence? Some latest studies suggest that giftedness and ADD go hand in hand!

The insurance company/whomever is not giving you adequate medication for the treatment of your child's condition. Bottom line. Any competent MD or psych would have to back that up.

Kisses! Hang in there!

 

[Guest]

Is that insurance essentially Title 19?

 

[Guest]

Her *cough* sperm donor *cough* doesn't seem to think he needs to provide any.... so I went to the state. Someone has to make him pay for it

I don't think that's legal. Him, not you. Unless he's terminated all of his rights, that is.

 

[freakygirl]

Kimber just came to me.. and told me she needed to talk to me.

I'll be back in a little while.

Oh.. something else I wanted to ask. I have three Adderall XR pills left. Should I give her one tomorrow instead of the Concerta and see what happens?

Someone asked about how she was throughout the day.
On the Adderall- Early morning.. she was fine... she was up at 6:30 am.. took her pill.. ate and got dressed.. left for school by 8 am. Had a great day at school.. completed her homework.. was helping other children. Was in bed asleep by 8:30 pm. Reading went from 1st grade level to low 4th grade level.

On Concerta- fight to get up by 7 am. Won't eat.. can't remember to get dressed half the time. Sometimes she will remember her socks.. other times not. Leaves for school at about 8:15 (school starts at 8:20). Has been doing school work ok. But it's sloppy.. done poorly and doesn't get completed in alotted time. Is in bed at 8:30.. goes to sleep around midnight if we are lucky.