We definitely noticed an increase in irritability and tantrums at the end of the day when our daughter first started Concerta. It lessened over time. I really only notice it now when she’s very tired from a long day or is particularly hangry.
Many stimulants have a rebound effect and that is what you’re seeing. It washes out as they adjust to the medication, but it can seem shocking the first few weeks of a new med. Make sure his physical needs are met and that will help.
The most important question is how is he 1 hour after medication up to 9 hours after medication. If he is better behaved and able to focus and follow direction during this time, hallelujah. Now you can tweak the dosage, formulation, supplemental medications like guanfacine and clonodine or other supplements like magnesium, fish oil etc.
Find this out first.
Is the ped familiar with ADHD, treating it often and staying up to date on current research? Could your son have been misdiagnosed?
If you’re confident in your ped/diagnosis, then the behavior could be due to the meds wearing off. Is he on extended release? If so, sometimes IR meds are harder because there’s no taper and it’s immediately in your body and wears off all at once. My daughter was diagnosed with ADHD by a psychologist and we started with methylphenidate ER 5mg and she was irritable at first but the adverse side effects (other than appetite) improved quickly.
My experience is that behavior seemed worse at the end of day or when medication was wearing off. Both my youngest boys started Ritalin at 5, though 2.5mg in the morning and 2.5mg in the afternoon. Because the behavior issues continued for my 8 year old, he was eventually moved to an extended release version and is now on Vyvanse with success.
I think the Ritalin, especially the fast acting one, lets them regulate so when it wears off it makes it harder for them to do so. Definitely follow up with a psychiatrist- I’m honestly surprised your pediatrician diagnosed/prescribed because mine would not - but just letting you know it could be normal.
my sons the same age, on the same dose, he takes it twice a day. his is extended release, and only last about 4 hours. if we miss the second dose he behaves the same way you’re describing your son. do you mind if i ask why you’re not giving the second dose? have you shared the concerns with his doctor?
Thanks for responding! We just started medication last week. Wanted to see how he would respond to just one dose first. I guess my concern is that what we're seeing now isn't normal for him. He absolutely has behavioral issues and is impulsive/hyper, but not to the extent we're seeing in the evening with just the morning dose. He's also in a summer camp and not in a school setting yet. Just wanted to take it slow.
Hi! I’m ADHD diagnosed since 1992, my son was just diagnosed at 7, and I’m a certified tech at a pharmacy and regularly help parents like you.
The immediate release tends to drop off and cause a rebound effect when it wears off. It happens in adults, too. This is why many people prefer extended release pills or formulations. Problem is I don’t think they recommend them until age 6?
But there are SO MANY formulations of methylphenidate, and several options for if you want something long acting that won’t cause a crash. There are patches (Daytrana). Concerta starts at 18mg but I think there are lower doses of Ritalin LA available if your kiddo can take pills. If not Quillivant (liquid) and Quillichew (chewable) are some options for methylphenidate. **The liquid and chewable extended release are great because you can adjust the dose without ruining the extended release mechanism that prevents the crash.** So even if the dose is 10mg for 6 yrs and up, you can lower it and still get the benefit of extended release.
If your child is having lots of emotional outbursts and impulse issues, you can try adding guanfacine. Guanfacine can help immensely with emotional regulation on its own and with the crash from stimulants.
My son started on meds at age 4. He was diagnosed with ADHD at age 3 and eventually autism as well just this year. If I could've done anything differently, I would've pushed harder for the autism diagnosis at an earlier age so he could've had the proper services. He has now been kicked out of his non public school, and we have no idea where he will be attending middle school.
Can I ask what behaviors you noticed that they diagnosed with adhd at 3? I believe that's quite early. I have my own suspicion about my son but everyone tells me they won't look into it until 5ish at the earliest.
He was extremely hyperactive, impulsive, and fearless. He would not sit still from the time he was a baby. He was constantly running everywhere. At family gatherings, he would run through my sister's (or whatever other relatives) house over and over again while the other kids were playing amongst themselves or sitting down eating or whatever. I had to put a harness/leash on him to keep him from running off from me in big crowded places. As far as being fearless, he would jump off the top of the slide at the park and preschool and stuff (thankfully, he has cat-like reflexes and always landed on his feet, lol). He's 11 now, and he still has the boundless energy. It's funny because I was diagnosed as well shortly after he was.
No problem. Honestly, he is struggling a bit right now with his behaviors, but we are using the resources available to us to get him the help he needs.
We definitely noticed an increase in irritability and tantrums at the end of the day when our daughter first started Concerta. It lessened over time. I really only notice it now when she’s very tired from a long day or is particularly hangry.
Many stimulants have a rebound effect and that is what you’re seeing. It washes out as they adjust to the medication, but it can seem shocking the first few weeks of a new med. Make sure his physical needs are met and that will help.
The most important question is how is he 1 hour after medication up to 9 hours after medication. If he is better behaved and able to focus and follow direction during this time, hallelujah. Now you can tweak the dosage, formulation, supplemental medications like guanfacine and clonodine or other supplements like magnesium, fish oil etc. Find this out first.
Is the ped familiar with ADHD, treating it often and staying up to date on current research? Could your son have been misdiagnosed? If you’re confident in your ped/diagnosis, then the behavior could be due to the meds wearing off. Is he on extended release? If so, sometimes IR meds are harder because there’s no taper and it’s immediately in your body and wears off all at once. My daughter was diagnosed with ADHD by a psychologist and we started with methylphenidate ER 5mg and she was irritable at first but the adverse side effects (other than appetite) improved quickly.
That's what the second dose is for! Once it wears off it's not going to work anymore.
My experience is that behavior seemed worse at the end of day or when medication was wearing off. Both my youngest boys started Ritalin at 5, though 2.5mg in the morning and 2.5mg in the afternoon. Because the behavior issues continued for my 8 year old, he was eventually moved to an extended release version and is now on Vyvanse with success. I think the Ritalin, especially the fast acting one, lets them regulate so when it wears off it makes it harder for them to do so. Definitely follow up with a psychiatrist- I’m honestly surprised your pediatrician diagnosed/prescribed because mine would not - but just letting you know it could be normal.
We're just using our pediatrician... and I'm just using my GP! I think it depends on the person/area.
my sons the same age, on the same dose, he takes it twice a day. his is extended release, and only last about 4 hours. if we miss the second dose he behaves the same way you’re describing your son. do you mind if i ask why you’re not giving the second dose? have you shared the concerns with his doctor?
Thanks for responding! We just started medication last week. Wanted to see how he would respond to just one dose first. I guess my concern is that what we're seeing now isn't normal for him. He absolutely has behavioral issues and is impulsive/hyper, but not to the extent we're seeing in the evening with just the morning dose. He's also in a summer camp and not in a school setting yet. Just wanted to take it slow.
Sounds like the rebound effect once it has worn off you can feel really irritable and anxious
Hi! I’m ADHD diagnosed since 1992, my son was just diagnosed at 7, and I’m a certified tech at a pharmacy and regularly help parents like you. The immediate release tends to drop off and cause a rebound effect when it wears off. It happens in adults, too. This is why many people prefer extended release pills or formulations. Problem is I don’t think they recommend them until age 6? But there are SO MANY formulations of methylphenidate, and several options for if you want something long acting that won’t cause a crash. There are patches (Daytrana). Concerta starts at 18mg but I think there are lower doses of Ritalin LA available if your kiddo can take pills. If not Quillivant (liquid) and Quillichew (chewable) are some options for methylphenidate. **The liquid and chewable extended release are great because you can adjust the dose without ruining the extended release mechanism that prevents the crash.** So even if the dose is 10mg for 6 yrs and up, you can lower it and still get the benefit of extended release. If your child is having lots of emotional outbursts and impulse issues, you can try adding guanfacine. Guanfacine can help immensely with emotional regulation on its own and with the crash from stimulants.
My son started on meds at age 4. He was diagnosed with ADHD at age 3 and eventually autism as well just this year. If I could've done anything differently, I would've pushed harder for the autism diagnosis at an earlier age so he could've had the proper services. He has now been kicked out of his non public school, and we have no idea where he will be attending middle school.
Can I ask what behaviors you noticed that they diagnosed with adhd at 3? I believe that's quite early. I have my own suspicion about my son but everyone tells me they won't look into it until 5ish at the earliest.
He was extremely hyperactive, impulsive, and fearless. He would not sit still from the time he was a baby. He was constantly running everywhere. At family gatherings, he would run through my sister's (or whatever other relatives) house over and over again while the other kids were playing amongst themselves or sitting down eating or whatever. I had to put a harness/leash on him to keep him from running off from me in big crowded places. As far as being fearless, he would jump off the top of the slide at the park and preschool and stuff (thankfully, he has cat-like reflexes and always landed on his feet, lol). He's 11 now, and he still has the boundless energy. It's funny because I was diagnosed as well shortly after he was.
Thank you for sharing! How is he doing now at 11?
No problem. Honestly, he is struggling a bit right now with his behaviors, but we are using the resources available to us to get him the help he needs.
We stopped it immediately. It’s like giving a child a Red Bull and then the crash after the caffeine. My doctors words