Question on rebound | ADHD Information

My son almost 11 year old son was diagnosed 3 years ago with ADHD. After a while of tweaking meds, he has been on 54mg of Concerta, tenex and a small dose of prozac.
He would get a booster of Ritalin in the afternoon if we needed additional focus with homework or he had a function/event he was going to in the evening. Everything was
going as well as I thought it could be.

Then BAM, this fall he began having these meltdowns in the evening that could range from crying to anger to high frustration. These fits could last 30 to 90 minutes. My other
kids would stare in wide eyed amazement and sometimes expressed fear of him due to his anger. We tried punishment, rewards for getting control of himself, sending him to
his room. We started therapy for him to help him learn coping strategies of other ways to express himself vs. these outburts.

Never until this morning did I consider rebound. I thought that rebound only happened when you first began a new dosage or new med. Could he be having rebound due to
insuffient dosing???? Any other ideas?With my daughter,  when her dosage was too low,  we experience rebound like symptoms in the afternoon/evening.    She was crabby, irritable, angry, etc.   Raising her dosages slightly helped us tremendously.   When her symptoms are better controlled during the day,  she does much better in the afternoon/eventing.

Is he only being treated for ADHD?

Another non-med coping skill is time and space.

When he is calm enough to talk after a meltdown. Let a little time pass so that what triggered him isn't so fresh. When feelings are escalating is not the best time to threaten with consequinces rather use a self-timeout time or space to think about coping skills.  Very young children can forget what they were upset about altogeher after five minutes of time out. Time out doesn't have to be a physical place. It can be that everyone in the room stops talking for five minutes. Space can be used to also isolate the quiet time.

  I was surprised at how well just repeating what they were saying back to them calmed them down. I think it's because they realize the arguement is over when were not rebuttling after every word they are saying.  No new information stalls spinoff escalations. 

While talking calmly after a meltdown the adult should do alot of the listening like letting him speak twice as much. Explore the underlying feelings that triggered the melt down. Then practice an alternative action for next time those feeling begin. Actually walk through what to do differently.  Help them understand that thier underlying feelings built up to the outburst. So talking a child through emotional development helps keep their emoional age closer to their peers development.  Doing this over and over and over for years, all parents do this already,  but adhd kids need this external emotional help. I truly believe this method is a trade off. You can tire of repeating it, but it's better than years in constant frustration due to lagging behind thier peers emotionally.  

  Remember that as a brain grows some connections are pruned and new ones form. So keep a med journal so that over time you may start to see pattern behaviors  before the outburst behaviors start agian.

Knowing what his baseline behavior is like - is also key. What he's like when totally unmedicated. So that the meds aren't being tweaked according medline temperment. I saw one person on 16 meds after 5 years . After detoxification her meds really bought her back to good feelings. So don't be suprised if a doctor takes him off totally from time to time. Hopefully not during school sessions!

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In response to the below post:

Having a solid routine in an environment where the triggers have been minimized makes a big difference during med changes.

Parental planning of the below helps minimze anxiety if consistently practiced im a timely fashion.

   1. Environment

   2. Structure

   3. Routine

Prompting movement between these minimizes stress as well !

For instance :

On a day when feeling irratable  all I could do was look forward to 6;00 so I could play a game with my dad. When dad forgot about it I exploded !

What mattered was coping with irratable feelings all day by looking forward to  6:00 PM

ommas40122.7066898148He has anxiety in addition to his ADHD. It is just so hard to see him struggle so much with his emotions and it is so hard as a family to survive with this. He is on 54mg of Concerta and the next dose is 72mg - Isn't that a
huge jump???It sounds like it very well could be rebound.  I know that when my son's dose was too low he would get rebound.  Also, if the timing wasn't right he would get rebound.  My son isn't on Concerta but I've read lots of posts here about it and I don't think 72mg is that high for an 11 year old. Definitely get a medication check with the doctor. Good luck!

it sounds like rebound to me.

My son, now 12, has been on concerta and guanfacine since he was 7. He had rebound for the first year. What I did was give him a candybar. The sugar somehow helped him.

I know that their sugars fall due to not eating for such long periods and then when the meds wear off, they are starving.

this also helped ease his "rebound" as it was happening.

Now, and since a year after he started meds, he knows to eat like at lunch, anything even a cookie and milk at school.

I also want to let you know that there is no dosage for these stimulants that leave the body based on age or weight. It is based on where they are successful.

My son was on 72mgs at age 11. He was actually at that dose back when he was 8. He just started 104mgs after being at 90mgs for 1 1/2 years.

Up the dosage according to your childs success level. Work with his doctor as well.

Our doctor takes our opinions and tries them, then we discuss the results. He always says, we will never know unless we try. If it doesn't work, then we re-work it!!

Please let us know how you guys are doing!! (I have been through what you are describing with the outbursts, it is scarey for us to just sit there and watch. )

I also want to add that my son had so much anxiety he would chew his fingernails and cuticles until they bled. He stopped except the nail biting.  I swear the tenex helps with this also!!

I feel bad that if this is rebound he was in therapy for it? Did it help? They honestly can't control rebound.

BETHANN40123.1917592593Just spoke to the Dr. He increased his Concerta to 72mg. I am anxious to
see how this helps him during the day and with family time in the evening.

Question: He has a half day at school tomorrow and was invited to a
birthday party in the afternoon which includes a movie, dinner then
swimming. I am nervous starting it on a day he won't be with me much of
the day, but also nervous about him being undermedicated during a party.
Should I just wait until the weekend?

Me, I would start tomorrow, but I might give it to him later so it lasts longer with the bday party.

My son ran out of his meds, 90mgs at the time. We gave him 108mg to get him through the day at school, and he felt nothing different. he is 12 and can tell us when we ask. He ate the same, slept the same, but was in need of an increase at the time. He is now at 104mg every day.

I wouldn't wait, he will probably be better at the party!!

I guess you're the one with the best answer to that.  It sounds like if you don't give it to him there will be problems anyway, so the only option that may not give him problems is giving it to him.  That's what I would do...

Hope it works out no matter what you decide!