When we brought John home in August he already had imipromine in his blood stream. In fact most of the 40 children at John's former residential treatment center receive some kind of psycho-active medication. Although the drug suppressed some of his activity and aggression, It did not lengthen his attention span or reduce his impulsivity. Since I have always held a bias against long term drug regimens, we weaned him off this antidepressant and ran for several weeks without any meds, enduring more than a few stressful days and tearful nights. When we finally cried Uncle, his therapist and pediatrician agreed - bring on the ritalin. We started with 10mg in the morning and I couldn't believe the change. He was calm, happy, and responsive. But by early afternoon the ADHD demon had repossessed his soul, so we started giving him another 10mg at lunch, and sometimes another 5mg in the evening. I was elated with this miracle cure, but a bit uneasy. Our son wasn't really there. He would answer questions coherently, but he never initiated conversation. He just sat in front of the TV and stared; didn't actively engage anybody. Still, it was a vast improvement - we could fine-tune the dose later.
As the weeks rolled by I noted wild fluctuations in his response to the drug. One day the dose was inadequate, allowing subterranean hyperactivity to burst forth like upwelling magma. The next day the same dose was excessive, squashing him into the fetal position under a blanket. On two occasions the drug produced symptoms of autism. He twirled around on the floor, banging his head and moaning. He was incapable of saying any words or responding to questions. He was terrified as he tried to hide from something he could not comprehend or evade. When I questioned him later he remembered every detail - the episode was not a ritalin induced seizure (though these are not uncommon).
Each morning we tried to calibrate his ritalin based on his activity level. As described above, too high or too low would lead to disaster. Keep in mind, we were administering the drug by cutting 5mg tablets into pieces, an inexact science at best. We certainly couldn't roll the dice in the morning and send him off to school, hoping the dose was correct for that day. Although it bought our family some short term sanity, ritalin was clearly not a viable treatment for the long haul. We had to think of something else.
As if in confirmation, Monday was one of the worst days he has ever had in our home. His idea of a hug resembled a flying tackle, babbling all the while. He raced up to the dog, stopping inches from her face as she backed away in alarm. (Any other dog would have snapped - we are lucky to have such a gentle animal.) Without doubt he was a danger to himself and others. The ritalin tablets we administered were about as effective as pissing into a forest fire. Contrast this with his behavior on Wednesday, just two days into a more wholesome diet. We cut his ritalin dose in half, 5mg in the morning and afternoon, and the reduced medication still kept him on an even keel.