Stimulant rebound irritability - anyone else?

[Anonymous]

Ds is on adderall xr with an afternoon booster and intuniv. Despite this - he gets vvv irritable in the evenings. I think it’s partly that he is tired (he often doesn’t sleep well) but partly rebound. When he’s like this he tries to pick fights and it’s exhausting. Anyone else experience similar? What did you do?

[Anonymous]

Yes! We try to just take it easy in the evenings. Like, all bets are off after dinner. Everyone just slithers toward bedtime in their own space, so no one is provoked.

[Anonymous]

I have a severely irritable ADHD kid. Does he take his meds, including afternoon boosters, on weekends? Have you noticed he is less irritable if he doesn't take his meds? Are you sure the irritability is from the meds and not from the ADHD?

My kid also slept poorly when taking an afternoon booster, so we discontinued that.

[Anonymous]

Anonymous wrote:I have a severely irritable ADHD kid. Does he take his meds, including afternoon boosters, on weekends? Have you noticed he is less irritable if he doesn't take his meds? Are you sure the irritability is from the meds and not from the ADHD?

My kid also slept poorly when taking an afternoon booster, so we discontinued that.

Yes mine takes it on weekends too - he is on meds mainly for impulsivity, hyperactivity, emotional regulation so he needs it every day. It has been a long time since I saw him off them consistently but when he is off then he is crankier overall. He needs a ton of activity and stimulation to be level

You may have a point about the booster but when we don’t give it he rebounds at school and then is just cranky there

[Anonymous]

How old is DC?

I highly suggest adding the another ADHD med - SLEEP. We were in a similar situation and the one thing we knew we needed to concentrate on was getting a solid 9 hours of sleep a night, the recommended amount for our kid's age. DC's sleep was all over the place. We have started to use melatonin and it has really gotten us to our sleep goal. DC takes 3mg on school nights.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I have a severely irritable ADHD kid. Does he take his meds, including afternoon boosters, on weekends? Have you noticed he is less irritable if he doesn't take his meds? Are you sure the irritability is from the meds and not from the ADHD?

My kid also slept poorly when taking an afternoon booster, so we discontinued that.

Yes mine takes it on weekends too - he is on meds mainly for impulsivity, hyperactivity, emotional regulation so he needs it every day. It has been a long time since I saw him off them consistently but when he is off then he is crankier overall. He needs a ton of activity and stimulation to be level

You may have a point about the booster but when we don’t give it he rebounds at school and then is just cranky there

It sounds like your kids might not be irritable from rebound, but instead just irritable when not under the effects of meds, since you said he is pretty bad when he doesn't take them. That's the way my.kid is, too. My kid is also highly irritable, and there are studies that show that severe irritability can be caused by severe Adhd. I do think intense activity helps. My kid needs it, too, but also resists it, and is very demand avoidant. Fun fun fun.

https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.18101134

[Anonymous]

I have recommended this on this forum before, and just keep adding it to threads because I feel like it was a disservice that it was not offered as a first line for DS….

But we are doing stimulant combined with non stimulant. Ds is on meds primarily for hyperactivity. He needed a pretty high stim to be able to get thru a school day without getting sent to the office, but that meant high side effects (dulling personality) and come down at night. By adding a non stim, we were able to lower the stim dose by more than half so virtually eliminated side effects, his days are much more steady (no super hyper in the am and pm - just well behaved all day), plus we have the benefit that the non stim is very sleep inducing. So our kid who used to happily stay up until midnight in K is consistently falling asleep by 9pm- which can’t hurt, right? We’ve tried reducing the stimulant but he still needs some to get thru school. But this has been a great answer for us. Downsides of non stim is typically sleepiness or lethargy, which well, was not a problem for our insanely high energy hyper kid. A little lethargy was good to add….

Maybe isn’t right for you, but I wish someone had suggested this way before we got to the point of “everything else has failed”. I think it should be a first line approach for young kids diagnosed with hyperactive primary type adhd.

[Anonymous]

Anonymous wrote:I have recommended this on this forum before, and just keep adding it to threads because I feel like it was a disservice that it was not offered as a first line for DS….

But we are doing stimulant combined with non stimulant. Ds is on meds primarily for hyperactivity. He needed a pretty high stim to be able to get thru a school day without getting sent to the office, but that meant high side effects (dulling personality) and come down at night. By adding a non stim, we were able to lower the stim dose by more than half so virtually eliminated side effects, his days are much more steady (no super hyper in the am and pm - just well behaved all day), plus we have the benefit that the non stim is very sleep inducing. So our kid who used to happily stay up until midnight in K is consistently falling asleep by 9pm- which can’t hurt, right? We’ve tried reducing the stimulant but he still needs some to get thru school. But this has been a great answer for us. Downsides of non stim is typically sleepiness or lethargy, which well, was not a problem for our insanely high energy hyper kid. A little lethargy was good to add….

Maybe isn’t right for you, but I wish someone had suggested this way before we got to the point of “everything else has failed”. I think it should be a first line approach for young kids diagnosed with hyperactive primary type adhd.

Thanks for sharing. Would you mind saying which stim and nonnstim he is on, how old he is, and what, more specifically, his behavioral problems were? I'm wondering if this might be a good combo for our severely irritable and angry ADHD kid who hasn't responded well to SSRIs or mood stabilizers, probably because the irritability really stems from a severe form of ADHD.

[Anonymous]

My child gets pretty cranky end of day when the stims wear off. my strategy is to try to feed him and give him space to be alone or play games. He's definitely hungry from eating little during the day and the transition from meds affects his moods. Its not a good time for deep conversation or chores!

[Anonymous]

Anonymous wrote:

Anonymous wrote:I have recommended this on this forum before, and just keep adding it to threads because I feel like it was a disservice that it was not offered as a first line for DS….

But we are doing stimulant combined with non stimulant. Ds is on meds primarily for hyperactivity. He needed a pretty high stim to be able to get thru a school day without getting sent to the office, but that meant high side effects (dulling personality) and come down at night. By adding a non stim, we were able to lower the stim dose by more than half so virtually eliminated side effects, his days are much more steady (no super hyper in the am and pm - just well behaved all day), plus we have the benefit that the non stim is very sleep inducing. So our kid who used to happily stay up until midnight in K is consistently falling asleep by 9pm- which can’t hurt, right? We’ve tried reducing the stimulant but he still needs some to get thru school. But this has been a great answer for us. Downsides of non stim is typically sleepiness or lethargy, which well, was not a problem for our insanely high energy hyper kid. A little lethargy was good to add….

Maybe isn’t right for you, but I wish someone had suggested this way before we got to the point of “everything else has failed”. I think it should be a first line approach for young kids diagnosed with hyperactive primary type adhd.

Thanks for sharing. Would you mind saying which stim and nonnstim he is on, how old he is, and what, more specifically, his behavioral problems were? I'm wondering if this might be a good combo for our severely irritable and angry ADHD kid who hasn't responded well to SSRIs or mood stabilizers, probably because the irritability really stems from a severe form of ADHD.

Op - yup - per my post dc is on intuniv as well - which is a non stim

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I have a severely irritable ADHD kid. Does he take his meds, including afternoon boosters, on weekends? Have you noticed he is less irritable if he doesn't take his meds? Are you sure the irritability is from the meds and not from the ADHD?

My kid also slept poorly when taking an afternoon booster, so we discontinued that.

Yes mine takes it on weekends too - he is on meds mainly for impulsivity, hyperactivity, emotional regulation so he needs it every day. It has been a long time since I saw him off them consistently but when he is off then he is crankier overall. He needs a ton of activity and stimulation to be level

You may have a point about the booster but when we don’t give it he rebounds at school and then is just cranky there

It sounds like your kids might not be irritable from rebound, but instead just irritable when not under the effects of meds, since you said he is pretty bad when he doesn't take them. That's the way my.kid is, too. My kid is also highly irritable, and there are studies that show that severe irritability can be caused by severe Adhd. I do think intense activity helps. My kid needs it, too, but also resists it, and is very demand avoidant. Fun fun fun.

https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2019.18101134

Op - yes - our psych (who I love and who is top adhd dude in ny area) insists the irritability is part of the adhd. It’s sad bc I can see dc get so irritated and frustrated that he cries - but he doesn’t seem ‘depressed’ - he is excited about everything and I think he feels generally good about himself and his life and home and family. He just feels like I feel at the airport whenever meds wear off.
Is he like that all the time off meds? He is more like tbh yes. The meds help him be less irritable. I think the irritability has strong roots in his dopamine issues - that come with the adhd.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I have recommended this on this forum before, and just keep adding it to threads because I feel like it was a disservice that it was not offered as a first line for DS….

But we are doing stimulant combined with non stimulant. Ds is on meds primarily for hyperactivity. He needed a pretty high stim to be able to get thru a school day without getting sent to the office, but that meant high side effects (dulling personality) and come down at night. By adding a non stim, we were able to lower the stim dose by more than half so virtually eliminated side effects, his days are much more steady (no super hyper in the am and pm - just well behaved all day), plus we have the benefit that the non stim is very sleep inducing. So our kid who used to happily stay up until midnight in K is consistently falling asleep by 9pm- which can’t hurt, right? We’ve tried reducing the stimulant but he still needs some to get thru school. But this has been a great answer for us. Downsides of non stim is typically sleepiness or lethargy, which well, was not a problem for our insanely high energy hyper kid. A little lethargy was good to add….

Maybe isn’t right for you, but I wish someone had suggested this way before we got to the point of “everything else has failed”. I think it should be a first line approach for young kids diagnosed with hyperactive primary type adhd.

Thanks for sharing. Would you mind saying which stim and nonnstim he is on, how old he is, and what, more specifically, his behavioral problems were? I'm wondering if this might be a good combo for our severely irritable and angry ADHD kid who hasn't responded well to SSRIs or mood stabilizers, probably because the irritability really stems from a severe form of ADHD.

I'm the PP you're responding to. Yes, he was diagnosed at age 3 with severe adhd. We started him on a stim at age 4.5, because otherwise he would have been thrown out of multiple preschools. He's very hyper, and very physical. I think the chaos of school and other people disregulatates him, and he will random body check other kids, pull their arms, yank their head. It's nonsensical. He's not emotionally disregulated; just has this weird physical outlet on chaos. We tried a bunch of stims between ages 4 and 7. They were all pretty decent on keeping his behavior manageable during school, but we felt like he was a walking zombie of himself, and didn't love how wired he was in the evenings and in the am. We eventually settled on concerta as the best stim for him, he was on 45 mg for a year or so with full success at school. Anything less than that, and we were getting almost daily feedback from teachers that he was not well behaved. But mom and dad didn't like how empty it left him. That's when we tried adding kapvay, and ultimately ended up on 0.3 mg a day, .1mg in the am and .3 mg in the evening, and then we started pulling back on his stim where we ultimately ended up on 18mg of concerta. He had 2 years of successful school at that level. Now he's on 27 mg of concerta as he's gotten older, plus 0.3mg of kapvay. His days are so much smoother, and personality seems more like his true self.

[Anonymous]

Anonymous wrote:How old is DC?

I highly suggest adding the another ADHD med - SLEEP. We were in a similar situation and the one thing we knew we needed to concentrate on was getting a solid 9 hours of sleep a night, the recommended amount for our kid's age. DC's sleep was all over the place. We have started to use melatonin and it has really gotten us to our sleep goal. DC takes 3mg on school nights.

I totally agree with you that sleep is so important but 3mg is A LOT of melatonin especially for a kid. Was your doctor ok with that? When I give it to my child we do no more than 0.5 mg. My own doctor told me no more than 1 mg for an adult.

[Anonymous]

Anonymous wrote:

Anonymous wrote:How old is DC?

I highly suggest adding the another ADHD med - SLEEP. We were in a similar situation and the one thing we knew we needed to concentrate on was getting a solid 9 hours of sleep a night, the recommended amount for our kid's age. DC's sleep was all over the place. We have started to use melatonin and it has really gotten us to our sleep goal. DC takes 3mg on school nights.

I totally agree with you that sleep is so important but 3mg is A LOT of melatonin especially for a kid. Was your doctor ok with that? When I give it to my child we do no more than 0.5 mg. My own doctor told me no more than 1 mg for an adult.

How is your kid? 3mg isn’t a lot for an older kid.

[Anonymous]

NP. I’m an adult and if I take 5mg it gives me nightmares. Same with DH.