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Medication side effects, something else or ADHD symptoms


Hello, I’m new here,

My 6 year old son was diagnosed with severe inattentive and hyperactive adhd in October through the school psychologist. (Grade one for him)

He’s had been having huge problems with behaviour, impulsiveness, distractibility, peer relations and the list goes on since he started kindergarten. He was quite shut down before we tried the medication and was having trouble coping across all settings.

He has been on Adderall xr since November and have been consistently upping the dose and he is now on 20mg. We have come along way with so many things however he is still at a point at school where he is still needs an adult at all times to stay focused. His behaviour and impulsive anger outbursts had gone down but they recently came back with a vengeance last week. We are also noticing he has become so extremely sensitive to noises at school that maybe that’s contributing to the outbursts? He has never been sensitive to noises, in fact it was quite the opposite for years as he was the one making noisy outbursts and not able to control the volume of his body/voice.

We are planning to increase the dose as we’ve seen so many positive changes and he has a bit to go in terms of distractedness. He says he likes the medication that makes him feel “calm”he also says it goes away in the afternoon which it shouldn’t until about bedtime. If anyone has any ideas about whether these could be side effects to the Adderall or if they’ve experienced this in their children I’d love to hear! Thank you so much...

22 Replies

Could definitely be side effects. He would be a rapid metabolizer and need an afternoon dose. My son didn’t do well on Adderrall as it made him very aggressive and agitated. Our psychiatrist ultimately recommended broad spectrum micronutrients which have worked well for him. He has now been off all medications for eight months.

I’ve never heard of rapid metabolizers, this is definitely something I’ll look into, he has always had a very healthy appetite though. We tried true hope for a while before stimulants and didn’t see long term changes with him. That’s fantastic it’s working well for your son.

We completed GeneSight genetic testing which gave us a good amount of information.

I’ll have to check that out, I’ve never heard of that either..

We did it in the pediatrician's office. Just a cheek swab. Came back with a list of potential good medications, ones he may have problems with, and ones to steer away from. Also how quickly he metabolizes them. Also confirmed MTHFR gene mutation.

That’s amazing, I wonder if this is something available with Canadian healthcare

Like Cjkchamp said, he could be a rapid metabolizer, but also keep in mind that most medications do not last from morning until bedtime (even if they are extended release). He might need an afternoon booster. It is great that he is able to tell you how he feels on the medication and when it is and is not working. My son had/has a really hard time with that and it made it more difficult to figure out the right medications/doses. My ADHDer is also sensitive to loud noises depending on the setting. He wore headphones at school when it was too much for him. I feel like once his medications were working the best; the trouble with noise was lower. Good luck.

Thank you! Yeah I had never heard of rapid metabolizers and also didn’t realize you could boost on xr. It’s interesting though that I notice when he’s coming off the drug at around 7pm because his impulsivity etc comes back but he says it leaves his body in the afternoon...

If it wasn’t for the medication he would never have been able to express the way he’s feeling like he is right now so I’m so grateful for that. He too has been wearing headphones at school.. hoping it’s just a temporary problem for him.

I would say that it could be the side most of us know, when it comes to ADHD meds and side effects, it's like anything could be possible! Our 7 yr old son started out with 5mg Adderall XR and did great for several weeks then slowly started having more episodes of anger and aggression, till he was out of control. His focus and attention was better but the negative side effects outweighed the positive. His psychiatrist actually backed his dose off to 2.5 mg a day, which means opening a 5mg capsule and sprinkling half the granules into a spoon of applesauce. A smaller dose is working great with the anger and aggression, but at the same time his focus and attention are not as good as they were on the higher dose, but still better than nothing at all. That is great that he can tell you how he feels when on meds. That is a big help in figuring out what works and what doesn't.

This is very interesting that you had a similar experience with anger and aggression coming out after several weeks. I couldn’t find the connection because we hadn’t done a recent dose increase. But it’s good to know it could be a side effect and possibly just not the right drug for him. Thank you!

It could be side effects or just needs a medication adjustment. I'm not aware of any medications that would last morning until bedtime - most should wear off @ 8 hours-ish, though that can vary by child / metabolism. But needing an evening booster is not uncommon.

May I ask - do you give him medication every day, or take weekend breaks? Are the behaviors primarily in the afternoon? How is he sleeping?

Yes I feel like we are still figuring things out with the medication because we’ve just been fairly consistently going up with dose since he’s still very unregulated and distracted at school. I still wonder if the outbursts are maybe the ADHD symptoms and a bit of his frustrations with having trouble with school expectations etc. We just did a dose Increase to 25mg today and he apparently had the best morning yet at school so I’m hopeful maybe that will take away some of the anger.

We do give it to him every day with no breaks. Our doctor doesn’t advise breaks as she feels it’s Doing him a dis-service taking it away.. like taking away crutches. I think at school they are primarily in the afternoon. He has some trouble going to sleep but usually is asleep by 8:30-9 and wakes around 7:30.

I agree with your doctor. From what I’ve seen, many people who have problems adapting are not uncommonly giving medbreaks.

If it’s primarily afternoon but still during the school day, it sounds like he could be a fast metabolizer. If you aren’t ready for evening boosters yet, giving him the medicine at the last possible moment before sending him off to school may get him through a bit more of the school day on it.

If it persists at this dose, especially while the medicine is active, then maybe try the methylphenidates (Ritalin.) They are also a stimulant, but more studies are starting to point to that they are less likely to exasterbate other disorders than Adderall. My son has Tourette’s and mild anxiety, and is on a methylphenidate called Metadate CD, and it hasn’t increased his tics or anxiety, despite our fears that it might.

If he also has anxiety, it can be aggravated by the Adderall XR. The worsening can be delayed by a few weeks to a few months (usually becomes apparent after a dose increase).

Interesting.. do you know if it’s just specific drugs that seem to have this issue with anxiety and moods/outbursts?

I think our best bet is to monitor the moods now that we are at a higher dose and maybe switch to a different medication if they persist. Any suggestions on a drug that can work with these issues?

Any stimulant (Ritalin or Adderall product) can.

How medications work are so different for each person. It is kind of trial and error. Even with the genesight test (we did this as well), we still had to play around with meds. My son metabolizes very quickly and can not process excess adrenaline so that makes it difficult to find the right med. We are on a couple of meds to help him out and we are still not in exactly the right place. Some times it is more simple and it is just an dose adjustment or one med change and sometimes it is more challenging as is my son's case.

I would say to keep observing and keep a notebook to track and bring it with next time you go in for a medication check.

Thank you for the tips, I might try the genesight and (definitely the notebook), maybe that will be a first step for helping. I’m thinking we will need to play around with some different meds.

That must be hard to keep going through the trial and error, we have only tried one drug and I already feel like this process is so emotionally taxing. I hope you find a good fit soon.

Just curious are you working with a child psychiatrist? They are the best fit and specialize it helping with medications.

When we were on a single dose medication we did not have the great success we are having now..

Our son takes 1 ( Ritalin) medication for helping to control his impulses and one that helps with focus ( Intivi).

Looking back on all the trials of different medications, they were more of a challenge for me who had to communicate with the doctor, go get the new one, wait.. etc..

When I asked my son about that time (4+ years ago) he has no memory of it.

He also know what it is like to be stable for a long time and he says he doesn't want it any other way.

In fact, he tells me how lucky he is becuase he feels so good.

We give his medication ( right before he walks out of the house) it is an extended release so it dispenses 3x during the day in hos body.

Then we give him the same medication in a smaller dose at 4-4:30pm. Then at bed time he takes his 24 hour focus medication and melatonin. This set up really works and we can always tell when the medication wears off and if he doesn't take his focus medication he always does very poorly on assignment and tests.

One last thing, there is a scale for dose per child weight. Our son needed.a higher dose, but we have not changed it in maybe 2 years and he has grown a lot. I assume all of the symptoms would come back if we needed a higher dose.

Hope this helps..

Let me know if you have any more questions.

This is fantastic. I’m so happy to hear you’ve found success. I hope we can get to a place where he just feels great and is happy and can learn. I’ve been wondering what type of therapist would be the most beneficial but it sounds like definitely a psychiatrist.

When you say the xr dispenses 3x per day, is that all extended releases that do? And I agree, all this trial and error is very challenging.

One question maybe a little unrelated, once you got to this good dose, did you find his personality was the same? I’m wondering because when my son is super calm, I feel as though some of the energy to play outside and that kid excitement goes with it. Maybe again that would be because of the wrong fit with the Adderall or the dose is actually to high? What are your thoughts on this?

Great question. Before starting the medication journey ( he doesn't really know life before) I imagined his personality to change.

But he is really the same kid, funny charming..etc , just those symptoms are gone. We just knew "one day" we would find the right type, dose and timing.

Now I will say the our psychiatrist told us medication will only control %60 of the symptoms and we have to work on the rest through a changed parent approach, accommodations and modifications in school and thearpy.

Now we have his 504 plan we address things that are challanging for him (like getting teachers notes, sitting close to teacher, etc).

My opinion is a psychiatrist knows best and when the medication was wrong she and I discussed the symptoms and we made changes. You will know when it is right.

Good luck!

I like the suggestion of trying methylphenidates before giving a booster as I have this feeling it might be more side effects. Even though he says the

Drug leaves his system he is still showing way less hyperactivity until about 7pm..

Do you or anyone know if micronutrients such as true hope can be given in combination with fairly high doses of stimulants? Maybe that would help, I sometimes wonder if the mood crashes could have to do with electrolytes or lack of certain minerals.. (I kind of doubt it though)

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