My 6-year old son started on methylphenidate about 5 months ago. The psychiatrist started him on a low dose (10 mgs) and we initially saw some improvement. He was much calmer, able to focus during conversations, had better impulse-control, listened and followed instructions better... Over time, though, we observed that his behavior was reverting back to his pre-medication time. In consultation with the psychiatrist, we increased the dose to 20mgs and then 27 mgs, and each time, he shows an initial improvement and then reverted back to his pre-medication ADHD behaviors. It seems like my son's body is getting used to the medication more and more over time. When we discussed this with the psychiatrist, he didn't seem to have observed this before.
Has anyone else had this happen to them? And if so, what were your next steps? Did trying a higher dose work best, or switching to a different type of medication?
My wife wonders if his behavior is due to factors other than medication. She thinks his behavior may suffer from not sleeping enough. Has anyone had this experience?
We want to regain the happier house and relationships we had when the medication was working at its best. Thanks for your help!
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dtrain5
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So I'm new here but not with dealing with psych meds in general 😉 We have had a similar experience: 6 yo son who just finished Kindergarten. 10, then 20 mg. Small improvement on 10, huge improvement on 20.
We just saw the MD & our son was pretty wild during the appt, so I was sure he was going to bump it to 30, which I didn't want bc eating is already such an issue. But he didn't & explained that summer is always hard (if you look a few posts back, I was asking for help re the summer!), that there is no way to replicate the structure of school, no matter how hard you try & that they try not to increase meds in summer bc it's better to do it when school starts, if they need to, bc it's easier to establish a baseline of what is needed, whereas there are so many outside influences in summer that they don't necessarily want to treat that with more medicine right away. That's what he said, anyway! Our counselor also always says that the meds really give you the space to work on longer term strategies, the "heavy lifting."
I feel you, though. Things have been ROUGH over here of late. My wife has ADD & says that the meds do kind of have less of an effect over time, but that you do also find an overall baseline dose that works unless life really throws curve balls at you & it needs to be momentarily adjusted. But she's not 6.5 yo 🤣 & can self reflect & has been dealing with this for a long time.
For us, the methylphenidate actually helped night sleep but I also get the "older" 2 kiddos up when our 2 yo gets up, so it's not like they can sleep in much!
Hope things improve. The responses I've gotten here this week have helped me feel a lot better about everything, anyway!
Stimulants are the first line of treatment hence my son also was at first on Methylphenidate. We managed 8 months on this medication (maintenance dose 30mg). We first noticed improvement because my son was able to focus at school better but he also developed unbearable side effects. My son suffered on Methylpenidate. He developed a ‘rebound’ side effect so basically in the mornings he was a mess (like a bipolar in a manic stage), then settling when the medication was kicking in and then again aggressive and emotionally unstable, manically hyperactive when the medication was leaving the system at about 3-4pm. He lost any joy of eating food, he started talking to himself at bedtime as his mind was racing and he couldn’t settle to sleep. He couldn’t do properly any late after school clubs - in his tennis club at 5pm he was done, he barely was following instructions. He also had a range of other side effects yet the psychiatrist was dismissing these. I don’t understand why stimulants are ‘first line of treatment’ for ADHD in young children (maybe pharmaceutical companies manage to lobby this strongly enough…).
It looks like your son suffers from the ‘rebound’ side effect and this mean methylphenidate is not the right medication for him.
Don’t get fooled when the psychiatrist will tell you- oh, we can give him Melatonin for sleep, oh and we can give him antidepressant or something for anxiety if he’s got low mood now (that’s what some of them want- to just keep adding medications).
I believe that the best practice in prescribing for ADHD is to have a mono therapy- when one medication was found by trial and error, that agrees with your child and alleviates the symptoms of ADHD with the fewest possible side effects.
You have 3 non stimulant medications in the US which are licensed to treat ADHD in children. You need to ask the doctor to try one of the non stimulants and keep trying until you find the best medication for your son.
What is good for one is not good for someone else. Just to give you example- when eventually psychiatrist did listen to us and changed my son’s medication to Atomoxetine, for him it was a life changer immediately. His appetite improved, his sleep improved, he told us ‘I am so much happier now’ which really broke my heart that we made him suffer for 8 months on Methylphenidate.
Mind you- my son hasn’t had any side effects with Atomoxetine and because this works 24h/7 days a week (on neurotransmitters in brain) it means that he can do late after school clubs and he can still focus all right.
As I said every child is different- my friend’s son when initiating Atomoxetine, he suffered from sleepiness and feeling drowsy for the first weeks when his body was getting used to this medication, however they persevered and the initial side effects stopped after a month or so (sometimes doctor will suggest to start this medication during holidays - to give body some time to adjust).
What we find about the Atomoxetine - it’s 2 in 1 as it not only helps with focus and impulse control but also helps with anxiety and mood.
On contrary on Methylphenidate my son’s anxiety got unbearably worse and his mood dipped.
Just be the advocate for your son- if you see that something is not right it’s probably not right.
We found the same thing with Adderall for our son. He was needing more and more to get the same effect. What we found helpful was we started doing weekend breaks at any time he didn’t have school we tried not to give it to him or at least give him less on those days. That really helped maintain its effectiveness for him. Now after he’s been off of it for the weekend it seems to work better the following week, particularly in the beginning of the week. We are trying not to have him on it much this summer, just guanfacine. Some days are rough but we just try to persevere through them.
Yes my 7yo son started adderall at age 5 and it works great.. then over a few months it works less and less. Started on 2.5mg, then5mg then 10mg the 10mgXR with added 5mg booster after lunch.. it's been so exhausting. We stop it sometimes during summer unless we need to go somewhere and I need him to function in a more manageable way, then I give it to him. He's also on 3mg golf guanfacine which we've also bumped up from 1mg, to 2mg to 3mg over the past year. It's like he builds a tolerance to things over time. I just haven't a clue on what to do but keep increasing his meds at this point.
Our son just turned 8. We’ve been doing ADHD meds for close to a year. He is currently on methylphenidate 36mg. We initially started with Adderall, three different doses. No benefit other than side effects (not sleeping, not eating).
We switched to Concerta (methylphenidate) and started at the 10mg. Tiny change in behavior. Changed dose two more times up to 27mg, seemed to be the magic dose. We keep a behavior calendar with his teacher so we can see how his day goes. We began to see a trend that afternoons were going back to not so great (focus, fidgeting, blurting out, self control). So we bumped up to 36mg and now we are barely seeing any issues at school. We believe in progression, not perfection. He’s 8 so we expect children to be children and still have those days where they are balls of energy and flat out kids.
His pediatrician said there were two options. Bump to 36mg and see if that helps. If not, try a medication that takes two doses in the day. He’d have to see the nurse during the afternoon to take it. But luckily, the 36mg worked. We don’t see a rebound.
I will say that with ADHD, food and sleep can drastically change their behavior. Our son doesn’t like to eat. So We started giving him the Boost protein shakes (chocolate) in the morning since the protein helps keep him full, it’s tasty and really helps him stay focused at school. The Boost drinks don’t contain artificial sweeteners like Ensure does. We do Chobani yogurt, also packed with protein. Anyway to sneak in the protein will help. There’s definitely a link to hunger and mood swings so where we can get protein, and he will eat it, we’re going for it!
Try cutting out anything with Red40 coloring/dye. It’s in ALOT of stuff. Studies have proven this causes hyperactivity. This can increase ADHD symptoms so I’ve found it best to avoid it and honestly, it’s helped. You’ll find yourself reading labels and getting frustrated but it’s worth it. I’m not a health but, but I do avoid the artificial sweeteners and dyes for myself and the kiddos.
Last suggestion, for sleep, try a weighted blanket. We were told about it and from the night we gave it to him, it’s been amazing. He sleeps better and it’s a comfort thing. There are benefits to weighted blankets and maybe it will be for your son too!
ADHD is not a one size fits all. I’m learning that. But you’re doing the right thing. Good luck in this journey!
Thanks, everyone - this is really helpful to know others have similar challenges. We're trying a new medication to see if that works better and will take it from there.
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