What Is Guanfacine (Tenex/Intuniv)? | Dr. Aly

[@ronwerks]

Got a guanfacine after dealing with ADHD most of my life, feels amazing

[@dralywood]

Happy to hear!

[@Ray-pp5qb]

@@okbuthuh8971 set an alarm.

[@jatinsharma5024]

@@dralywood Hello madam Nice video but I have a doubt. I heard from some doctors that If any person having Tic tourette disorder and If he takes ADHD medicines then His tics situation can become worse. Because in many cases ADHD meds worsen Tics symptoms. So how come This med ( which is used for ADHD ) helps in the cases of Tics tourette syndrome ?

[@Burevestnik9M730]

How do you feel now and how many mg do you take?

[@ronwerks]

@@Burevestnik9M730 4mg now, helps me pretty well, but my body does seem to b getting used to it, so my med manager might have to add a stimulant into the mix soon

[@Seanpiterpater]

I just started Guanfacine about 2 weeks ago. I was prescribed it for hair pulling and ADHD. I have a problem with picking my beard when i get restless. I feel different, but its hard to pinpoint exactly what is different. I am able to focus a bit more, and get less anxious when i refuse to pull my beard hair. So far so good!

[@dralywood]

YESSS! I'm so happy to hear that you've noticed meaningful change with this medication. Fingers crossed you continue to see sustained improvement. Thanks for taking the time to check out this video and share your thoughts. If you found this video to be valuable, please don't forget to SUBSCRIBE as more videos are being released weekly. Also, if you have any topic suggestions for future videos, let me know! Dr. Aly

[@PassaFloraElle]

I just started this a few days ago and have noticed the same two things! Decreased anxiety overall and no more facial hair picking :) I’m enjoying this med so much more than Adderall so far, there hasn’t been any side effects besides being pretty tired the first two days for a few hours after taking the med.

[@Burevestnik9M730]

@@PassaFloraElle do not ever go to more than 1mg. the prevalence of psychosis across all addhd meds is 0.21%.

[@eliw.1197]

Any updates?

[@idali675]

@@PassaFloraElle any chance I can pick your brain about your experience ? my docs recommending it but I’m really hesitant…

[@goscriskikifamily8984]

Super helpful, thank you. It helps my 6 year with school work but I am scratching my head as to why it seems to reduce his interest in play and outdoor activities he enjoyed before. It inhibits him in the aspects of his life that used to bring so much joy. Every Adhd med we tried does that to him, only wants to stay home.

[@matthewatwood8641]

Are you crazy? Take him off it! That's what the meds they gave me when I was a kid did to me. The doctors always tell you it's safe. They lie. Do some research. This is no different than the opioid thing. There's better ways.

[@AcieWHA]

With Guanfacine, it’s very sedating. It took 2 months for my 9 yr old to stop being that way..She told me that the medicine makes her mind calm and she likes she can rest her mind therefore she isn’t wanting to run at full speed playing. After a few months she was able to play again… She was just enjoying not being so chaotic in her mind and body anymore

[@alexismmcd]

@@AcieWHAthis was very insightful. Thanks Angel.

[@kristingray5314]

​@@AcieWHAvery helpful information thank you for sharing!

[@malindasmith3496]

I’m 40 and I’ve battled ADHD my entire life. I take adderal but my dr just added this. I am hopeful!

[@mohammedkhan8236]

I take Intuniv along with Mydayis, a long acting form of adderall that lasts in my experience between 12-14 hours. I think it’s great that your doctor is trying out this combination of stimulant medication and guanfacine er. I noticed while the mydayis gives me the boost and motivation I need to start tasks and stick with them, the intuniv is helping me prioritize what to focus on and what’s really important. It really does help with emotional regulation and controlling impulsiveness, which in a lot of cases can be worsened by stimulants, in the sense that you can’t prioritize and may spend your time focusing on menial tasks. But guanfacine er with stimulant combo addresses this issue and from my personal experience takes the edge off of the stimulant side effects as well.

[@dralywood]

I’m hopeful for you as well!

[@felicityduijkersloot6043]

@@mohammedkhan8236 what dose do you take?

[@Burevestnik9M730]

@@mohammedkhan8236 "It really does help with emotional regulation and controlling impulsiveness". Does it mean it can help with borderline personality disorder impulsive subtype?

[@mohammedkhan8236]

@@Burevestnik9M730 No, guanfacine honestly isn't strong enough to deal with that, sicne it essentially promotes release of norep. in your frontal lobe, there by helping with you executive function disorder or ADHD ie. impulsiveness, no solid plans, tiredness at the mention of effort, etc. Adderall or ritalin would probably significantly affect your bipolar disorder and throw you into mania. You probably need a mood stabilizer like lamictal, or something more like a sedative like Clonidine if you have moderate-severe level of bipolar. You might even be better off without stimulants completely, so consider that strongly, as stimulants take a big toll if you take them and don't have good reactions. The side effects are debiliatingly severe.

[@Thehumansmilyface]

Just got prescribed this yesterday going to start taking it today. Severely ADHD (21 years old) and it’s been taking over my life to the point where I literally forget to go to work and set myself 1 million Alexa Reminders sticky notes all over the wall 1 million Reminders in my phone a whole bunch of notebook writing things on my hand etc. etc. and I still forget the most important things in life. Friends keep walking away because they think I don’t care about them because I forget about their existence literally for sometimes for a week straight and that week feels like two days. It’s just been ridiculously so hard. I’m supposed to be starting my KZbin channel haha so hopefully this stuff helps 👍

[@sihemb-bey3098]

We noticed improvements 2 months later. It works

[@yunuskart4517]

I've been diagnosed with ADHD at 34 last week. Started wellbutrin a few days ago and today I'm adding Guanfacine Hydrochloride to the mix (as it was prescribed to me). I feel like wellbutrin has been helping with my mood, hope Guanfacine will help with my attention.

[@dr.willisofficial8041]

How is this going? I’m taking Wellbutrin and looking to add something for anxiety.

[@yunuskart4517]

@@dr.willisofficial8041 I'm not sure man, I definitely feel less angsty than usual. Though I don't know whether that has to do with Wellbutrin or Guanfacine. My heart has been acting a little weird lately too, so I stopped upping the doses.

[@egretter]

@@yunuskart4517 Hey there, just checking in for an update: do you feel like Guanfacine is helping with focus nowadays? Has your regimen changed?

[@kaylee.studies]

I started guanfacine (intuniv) 4 months ago and it is so helpful, ive had 2 other meds before, methylphenidate and dexamfetamine, but i had too many side effects so my psychiatrist prescribed me this and i am finally able to focus, im less hyperactive and less impulsive, i dont know if i can go without (for now)

[@oldmanhendo7183]

Have you had any side effects? I’ve been on Strattera for 5 weeks now and it’s pretty great but also has some kinda nasty side effects. Considering switching to Guanfacine

[@kaylee.studies]

@@oldmanhendo7183 I’ve had too many side effects when using the methylphenidate, so I switched to Dexamfetamine and I had even worse side effects and now that I switched to guanfacine I’ve had literally zero side effects!

[@MrDcrules]

Hi Dr. Wood--these are fantastic and very helpful videos. Simply thanking you for offering them to the community. Bravo!

[@HannahVanderWilt]

Good info, thanks. We saw some signs of improvement within ~5-6 days, and the second week we moved up to 2 mg and saw quite a bit of improvement (also pretty tired and some stomach pain, but we're hoping that is temporary). The signs we're seeing is that he will still get upset about something but instead of completely losing it, he might cry or even scream, but be able to express what is bothering him and do something about it (like plug in an air filter if he's upset about a smell).

[@Burevestnik9M730]

Since it is in use from the 80s, what are the long term side effects, after decades have passed? Any aphasia or other adverse side effects affecting heart, kidneysmetabolic profile, etc? Any effects on libido? After tapering off for month, does BP ever return to normal?

[@dralywood]

This is a great question. Here's an article to check out that looked at the long-term effects of treatment with guanfacine in those with hypertension: www.ncbi.nlm.nih.gov/pmc/articles/PMC1430125/ Dr. Aly

[@blairebonez]

I am going back to my kids psychiatrist this Friday. They had given me the option to put him on medication before but I opted to try therapies first. He’s almost 4. We did 16 weeks of PCIT therapy. Hasn’t helped like I had hoped. I had to up our appointment because my son has been suspended from daycare. He hits himself and others including teachers and has explosive anger, impulsiveness and just unable to control himself. I am desperate because I am going to lose my job if I have to keep leaving or taking off to keep him. This is the third school we’ve had trouble with. The doctor said that we will get him on some meds and discuss guanfacine vs stimulants. After doing research I don’t think I have weeks/months to wait before we see improvement. I am not saying this out of selfishness more out of the fact that we’re gonna be homeless if I can’t get this under control. Any advice?

[@karinavargas5788]

My story is the same. And Psychiatrist prescribed him this medication literally just right now. I am here Watching this video hoping I made the right decision. 😔🙏 this so difficult I understand where you coming from.

[@sleekmodernchic]

@@karinavargas5788Omg. My daughter started this yesterday, only side effect is minor sleepiness. We’re gonna wait a month to see if it helps. She’s failed on 3 other meds, I’m praying for all of us parents, this is so hard.

[@stevetk8174]

Disruptive mood dysregulation disorder or DMDD. My 8 year old child takes Guanfacine, Oxcarbazepine, Amantadine, Clonidine.

[@ReadQuranNow]

Great video and kind voice, thank you!!!

[@lindapruitt2656]

Hi Dr. Could you please do a video about using Guanfacine and Strattera together. I am not finding any information when it comes to combining 2 non stimulant adhd meds. This site is massively helpful. Very glad to have found you.👍

[@Just_my_opinion_23]

Thank you for the great video. Would you happen to have a video that deep dives into Tenex vs Intuniv?

[@mwarren42]

Guanfacine for adult ADHD it changed my life for the better

[@dralywood]

Hey Mark- Thanks so much for taking the time to check out this video! I apologize for how long it has taken me to get back to you. I had a baby at the end of August and I'm trying to get caught back up. I'm so happy to hear that you've had a good experience with guanfacine and thank you for sharing your experience with the medication. If you found this information to be valuable, please don't forget to SUBSCRIBE as more videos are being released weekly. Also, if you have any topic suggestions for future videos, let me know! Dr. Aly

[@Burevestnik9M730]

When did you first notice symptoms of ADHD and how did they progress over years?

[@mrcurtis73]

I have automatic dysreflexia and take Guanfacine to take the edge off high blood pressure and anxiety.

[@Sereno44]

The problem that I have is that Guanfamicine is not available in my country because the psychiatrists are so ignorant about adult and infant ADHD.

[@dralywood]

So frustrating!!!

[@jatinsharma5024]

Where do you live

[@Lazer5051]

Sometimes i get so depressed that i just want lay my head in your lap and weep

[@dralywood]

Depression can be so hard! Keep working with your doctor and therapist…let them know so they can help. Dr. Aly

[@viktorb8905]

Another great video doc. Could you please make a video on borderline personality disorder and recommended treatments

[@dralywood]

Absolutely! Great topic suggestion!!! Dialectical behavior therapy (DBT) is the GOLD STANDARD treatment for those with borderline personality disorder. I started doing some videos on the DBT basics and threw those into their own playlist. Def more to come on DBT topics, as DBT is my personal favorite therapy modality.

[@Paul-kd3ui]

​@@dralywooddbt is the word😅

[@kazi1]

Thanks for making this video 👍🏻

[@dralywood]

Thanks for the support!

[@blakehunter7956]

Very informative thanks!

[@dralywood]

Thanks for taking the time to watch!

[@desirechristensen1856]

Love it! So helpful for patient education

[@dralywood]

Thank you!!!

[@KirstinLillynn]

We were just given this medication for our 9 year old with ADHD, OCD, ODD, and they advised us 1/2 the tablet (1mg) at night and the other half in the morning. I don't like how he is during the day. Very sleepy and hungry. We are on 2nd week and today was first day for the morning dose. I hate splitting the pill because I never know if he is getting what he needs or if it's even. Should we ask about one dose per night only? What is the normal script for kids? 9 years 70 pounds.

[@lilyrucker5034]

My childs specialist recommended this med, he is pre-teen, has sleep issues, and attention deficit. He has not started on it yet and Im a bit nervous as he has bever been on any medication.

[@AcieWHA]

It’s extremely sedating at first but after it gets in ur system (2 weeks to a month) it really helped my daughter. Her teachers are always commenting on how well she is focusing now.

[@yunuskart4517]

Are Guanfacine and Guanfacine Hydrochloride the same thing?

[@Burevestnik9M730]

Have you ever prescribed it together with Buspirone 15mg and melatonine 3mg?

[@dralywood]

Yes- I've had people who have taken these medications in combination for various reasons. Dr. Aly

[@Burevestnik9M730]

@@dralywood Did you notice any anti-depressant effect with that combination?

[@crazyedd707]

Can it improve focus?

[@dadassery8506]

Helpful. Thank you

[@pigeonforgegokarts]

i take tenex 2 mg at nighttime. helps with my adhd and anxiety:)

[@brunodebrunis]

Can I add guanfacine to methylphenidate?

[@namanrawal5849]

Does it help at all for promoting wakefulness?

[@haydengaines5445]

Hey there! What are your thoughts on 1mg ER guanfacine before bed - & 15 mg ER focalin during the daytime?

[@bluebus2381]

Why do I get insomnia from intuniv? Is that a temporary side effect that will go away after a few week? I just lie in bed and my brain just wont get to sleep even if my body is completely relaxed(I listen to guided meditation). I like how I feel on intuniv and really want it to work but I just can't sleep. Does melatonin Interact with intuniv ? Can the insomnia be cause of to low blood pressure? Regards

[@ashleyspencer4927]

I am experiencing this as well. About a week now

[@bluebus2381]

@@ashleyspencer4927 it's really frustrating... I love how I feel when I take it. I hade to stop after 4 days as I could not sleep without sleeping pills :/ but thinking about giving it another go and hope that it's just temporary. I really need it to work as my RSD(rejection sensitive dysphoria) is affecting every part of my life.. it's the hardest thing with adhd. What time of day do you take it ? Have you talked to your doctor about it ? If it's only temporarily? The doctors in the country i live in only prescribe medication without me being able to talk to them about side effect and such

[@Burevestnik9M730]

Beta blockers are known to cause insomnia and they are used for HBP

[@Derobenjacob]

The medication allows me to sleep without my sleep medicine now , I take it 30 minutes before bed and am able to relax until I doze off

[@Burevestnik9M730]

@@Derobenjacob Unfortunately, it affects sexual function, just like all BP meds

[@PyroNonStop]

Informative and calming Thanks Aly!

[@dralywood]

Thank you for your support! I appreciate your feedback.

[@sicksaddearth]

Now why that child got their feet in the dishwasher

[@Saizaliyah]

bro😂😂😂😂

[@dralywood]

LOL!!! 😂

[@DoctorSiriChand]

Great video. So helpful!

[@dralywood]

Thank you!!!

[@ubded9597]

Does Guanfacine increase or decrease noradrenaline?

[@Burevestnik9M730]

Norepinephrine is being investigated for SZ lately, on top of dopamine, serotonine, and glutamate. What are the practical experiences in prescribing it for SZ?

[@dralywood]

I, honestly, am not on top of the research when it comes to using guanfacine for seizures. That is something that a neurologist is much more well versed in. Dr. Aly

[@Burevestnik9M730]

@@dralywood I mean ScZ

[@Burevestnik9M730]

Have you ever prescribed it to an ASD patient who also has NLD and C-PTSD?

[@dralywood]

No, I have not. Dr. Aly

[@fulgore1]

I have cPTSD & ADHD it works better than the stimulant type.

[@Burevestnik9M730]

@@fulgore1 How many mg?

[@Burevestnik9M730]

Any report of psychosis caused by Guanfacine?

[@dralywood]

Psychosis is not a commonly reported side effect of guanfacine. The FDA label doesn't even mention it. However, I did find a case report of one child who developed psychosis after taking guanfacine: journals.lww.com/psychopharmacology/Citation/2015/04000/Psychosis_Associated_With_Guanfacine.28.aspx Dr. Aly

[@ZigHorse]

How would you manage constipation from Guanfacine?

[@richardbrashear7666]

Is it just me or when I started taking it it makes me angry and all I sleep is about three hours a night

[@SariyaShakeer]

I am from guyana n this medication works bt it's expensive here n hardly pharmacy have it wish if I can get it for a cheaper price

[@koolaidjammerz91]

Exactly, I just got my prescription today. 50 bucks...sheeesh.

[@Iamjuanzapata]

Is common for adults to take this medication along with strattera?

[@dralywood]

Hey Juan! Great question. There are adults who take this medication and get benefit from it. However, a lot of the literature supports the idea that it is most effective in kids.

[@Iamjuanzapata]

@@dralywood thank you !

[@Burevestnik9M730]

@@dralywood There is a youtuber SZA older patient who takes it together with Welbutrin and Rexulti for his SZA. He was an addict so he could not get approved for benzos. He takes Rexulti 6mg Guanfacine 4mg Welbutrin (forgot the dosage, but high)

[@Michaelisalegend12]

Does dirty green INTUNIV 503 MG have a flavor? please reply asap

[@dralywood]

I do not believe Intuniv tablets have a particular flavor. However, I’d double check with your pharmacist as they’d be better equipped to answer that question. Dr. Aly

[@Michaelisalegend12]

@@dralywood Ah thank you! I was really scared since i haven’t taken it for a while so i appreciate it!..

[@dralywood]

You are so welcome! Best of luck and let me know if you have topic suggestions for future videos! Dr. Aly

[@Michaelisalegend12]

@@dralywood I do actually! Can you make a video about the different Elvanse medications for kids?

[@NissaLorraine]

I am 29 and I’ve been put on it. I can’t find much information on use an adults are there any positive reviews on adults?

[@dralywood]

This is a great question. I’m going to make this into a video! So stay tuned!!! Dr. Aly

[@BeHappy-hh1ty]

I am 36, will it help me?

[@MrMirna84]

My son takes Guanfacine is ok when he has fever can I give him fever medication like advil

[@dralywood]

Ibuprofen can have antagonistic effects on guanfacine, meaning that regular use might decrease the efficacy of the guanfacine. Generally, intermittent use shouldn’t have drastic effects for most people. Be sure to ask your son’s provider whether or not this combination would be appropriate for him. Dr. Aly

[@brmcnallen]

My 6 year old granddaughter was started on 2mg a day for ADHD. 1mg in the am and 1 mg in the pm. She was so sedated she could barely focus. She was slurring her words and her blood pressure dropped to 87/60. Is this supposed to happen?

[@Burevestnik9M730]

switch to 1mg max

[@rachel.xo15]

Can you do a video on topamax ? Thanks !!

[@dralywood]

Hey Rachel! Thanks for taking the time to check out this video and for the great suggestion! I'll make sure to add that suggestion to the list for sure! That's a popular medication that many providers are prescribing for a number of reason. Anything specific about the medication you'd like to learn more about? Dr. Aly

[@AmritPalSingh-ml7sn]

Hello ... my daughter don’t swallow the medicine intutiv rather chew n eat it but on prescription it written swallow it ... different way to give medicine to 6 year old

[@dralywood]

Unfortunately, Intuniv (brand version) should not be crushed, chewed, or broken. Intuniv is long-acting and time-released and doing so can change how the medication is released into the system. You could talk to your pharmacist about the potential of having it compounded and made into a liquid formulation .

[@AmritPalSingh-ml7sn]

@@dralywood thank you for reply

[@shadowgod7101]

So helpful

[@ritawilliams8473]

What do I do if guanfacine is causing my child to be constipated?

[@dralywood]

Hi Rita! Thanks for taking the time to check out this video. Unfortunately, constipation can be one of the more common side effects of this medication, occurring in up to 15% of those who take it. When parents tell me their children are experiencing this, I often encourage them to push fluids to ensure hydration and to try to incorporate more high fiber foods into the diet. Some families I work with will also consider adding a fiber supplement to their child's diet. If this fails, my next go-to is to suggest an over-the-counter remedy, such as polyethylene glycol (Miralax). If ineffective, I then have them touch base with their pediatrician regarding further recommendations. Some children will not tolerate the medication and we will have to taper them off and try something different. However, this has not happened too many times in my experience. I hope this helps and if you've found this information to be valuable, please consider SUBSCRIBING if you have not done so already- more videos to be released weekly! Dr. Aly

[@LoveLife-gv8jg]

My child (14) was given a mouth swab by the Dr to avoid having to try every stimulant with side effects. Turns out he is not compatible with any stimulant. The Dr suggested Strattera and intuniv. Thank you for this information

[@dralywood]

Thank you for taking the time to watch. Hopefully, this video answered some questions you might have had!

[@felicityduijkersloot6043]

Never heard someone took this combination.. What dose? Is it still working?

[@LoveLife-gv8jg]

@@felicityduijkersloot6043 I'm sorry i didn't mean both pills..either or. He ended up taking Guanfacine which is a nonstimulant. It helps with his mood and is supposed to help with concentration but honestly now that in person school has resumed he is getting complaints from teachers who say he is getting very little classwork done because he spends so much time in one area. He said he is having more difficulty concentrating. Its heartbreaking for us but we wont give up.

[@Burevestnik9M730]

@@LoveLife-gv8jg I'm wondering what would be the effect of taking guanfacine 1mg and buspirone 15mg indefinitely?

[@nvnomorales]

Is this better than adderall ? Because I kinda hate adderall

[@dralywood]

Thanks for reaching out with your question! Generally, stimulant medications (I.e. adderall) are first line for the treatment of ADHD. If Adderall isn’t working out, there are other amphetamine based products to consider that might be tolerated better (Vyvanse for example). Some people also have better luck with methylphenidate based products if they have difficulties tolerating amphetamines. Examples would include Focalin, Ritalin, Concerta, etc. Guanfacine is often used more second line in the treatment of ADHD. In certain cases, physicians will recommend using it first prior to stimulants. However, this is often on a case by case basis. Generally, guanfacine has been shown to be more effective in kids compared to adults.

[@Rizzmtism]

@@dralywood yikes. I’m 31 and just got prescribed this medication because I have a very hyperactive brain that effects my ability to stay asleep when I get really overwhelmed so my clinician recommended this before trying a stimulant. I have trouble with getting going and procrastinating so now I’m worried the sleepiness will be too much for me 😬. I haven’t had my Rx filled yet so I haven’t tried this medication but I’m just curious; is the success rate better if an adult were to pair this with a stimulant?

[@valeriataboada1605]

@@Rizzmtism how did it go

[@Rizzmtism]

@@valeriataboada1605 I was extremely tired the first 10 days but intuniv has been an absolute miracle for my anxiety, sleep issues, and emotional regulation. However, I’ve noticed that it isn’t quite hitting everything for me so I understand why a stimulant would be prescribed in tandem with this medication. My doctor and I are giving that a shot next week.

[@Rizzmtism]

@Matthew Sparks intuniv didn’t help me with that at all, it made me more foggy.

[@banquetoftheleviathan1404]

Is that whats in energy drinks?

[@dralywood]

Hey Michael- Thanks for checking out this video! Great questions. Guanfacine is not found in energy drinks. The main ingredient in energy drinks caffeine. Depending on the brand, you might find other various components as well (i.e. ginseng, vitamins, sugar, taurine, green tea/coffee extract, guarana, ginkgo biloba, carnitine). If you found this to be valuable, don't forget to SUBSCRIBE as there are more videos being released weekly. Also, if you have any topic suggestions, please let me know! Dr. Aly

[@banquetoftheleviathan1404]

@@dralywood oh i have allot of questions about this drug specifically but i'm sure there is a better place for that. i was just joking cuz it sounds like guarana + taurine

[@ambassadors4christ373]

Does Guanfacine help with cognition and increasing intelligence?

[@ShimrraJamaane]

There are no drugs that increase intelligence. Your intelligence is innate. There is no drug like the movie/series Limitless. IQ doesn't change when taking stimulants or similar medications.

[@tinalifestyle888]

yes, by increasing blood flow in the prefrontal cortex

[@violetavaldez2969]

My son is 8 yrs old boy. He’s up all night 😑😰

[@dralywood]

So hard! Hang in there mama!

[@Burevestnik9M730]

Why children? Isn't this for everybody?

[@dralywood]

Hey Jovan- Thanks so much for taking the time to check out this video and for asking such a great question! I apologize for how long it has taken me to get back to you. I had a baby at the end of August and I'm trying to get caught back up! I originally made this video with the idea of targeting parents because more children are on this medication than adults. In addition, many of the clinical studies have focused on treating children rather than adults. With that being said, I do have adult patients who do great with this medication, so it by no means is exclusive to just children. If you found this information to be valuable, please don't forget to SUBSCRIBE as more videos are being released weekly. Also, if you have any topic suggestions for future videos, let me know! Dr. Aly

[@Burevestnik9M730]

@@dralywood Thanks. Have you ever prescribed it to an adolescent who has both mild ASD and NLD, and SAD?