Adderall

[sas3]

I'm reaching out again to hear from the community. My 8 yr old grandson was prescribed Adderall XR 10mg for his ADHD, and although at home and his teacher at school saw a reduction in his impulsivity and improvements in recall, we felt that at home there was an increase in his irritability and aggression. He has been diagnosed with ODD also. Has anyone else ever experienced this? We have stopped the medication (he was only on it for a few days) until we can find a way to move forward in a more positive way. He also HATED taking the medication and it was an intense battle each morning to get him to take it sprinkled in pudding. We have alerted his pediatrician that we stopped the medication. Thanks for any input the community can offer.

[MommaofandwithADHD]

Yes, when the Adderall stops working in the afternoons after school, the "come down" is awful. My 6 yr old is on 20mg XR and at about 6 pm every night we have to leave her alone for about 30-45 minutes. I would talk to your grandson's Dr and see what can be done, I have heard that non stimulants can help with this. She also has ODD and had been referred to a child psychiatrist for more in-depth diagnosis to see if anything else is there. She has been a threat to me and her brother but now is a threat to herself also. Keep advocating for trying other medications to find his right fit.

[Hidden in reply to MommaofandwithADHD]

My child’s paediatric psychiatrist called this situation that you describe after school a ‘rebound effect’. My son was also suffering ‘rebound’ in the mornings before the stimulant medication kicks in and he had a range of other side effects yet we were battling for 8 months and in the middle of all that changing the psychiatrist. I felt that my son was suffering and that it was inhumane to carry on like this with him every day having ‘come downs’ and other side effects. My son’s psychiatrist eventually agreed to swap him to a non stimulant - Atomoxetine and this has been successful, my son is happy, he sleeps well, he has a good appetite and enjoys his food and he is managing to do after school clubs and sports until 6pm every day (this was impossible in times before diagnosis and medication, and this was impossible on stimulant ADHD medication - because by 5pm my son’s medication was out of the system and he was a mess) . Had Atomoxetine not been effective we’d try Guanfacine. There is also Clonidine available. In the US you also have Qelbree but it hasn’t been licensed yet in the UK. So as you can see there is a good range of non stimulants for managing ADHD in children. Non stimulants work around the clock- there are no come downs. They take about few weeks to build level in the body so at first you may think the medication ‘doesn’t work’, it creates subtle but stable positive changes over time (if it works for the child, because of course there will be children who have severe side effects and can’t tolerate it). Mind you, the trouble with Atomoxetine is that the capsule has to be taken whole. It can’t be sprinkled in apple sauce etc. So if you are thinking of trying a different medication you need to make doctor aware that the child refuses to take tablet/ capsule. There might be oral liquid solutions? (I don’t know because my son is fine taking pills). I know from other parents on this forum that in the US children often are prescribed a stimulant to take in the morning and then a non stimulant (let’s say Guanfacine) in the afternoon and parents say that it works well and that this way child doesn’t suffer from come downs and is able to eat well and sleep. In the UK the psychiatrist told me that ‘he wouldn’t like to do it’ as there is not enough clinical trials showing that it’s safe and effective , equally when I asked why in US it is a common, accepted practice he said ‘US is more advanced but in Europe we are more cautious’. He was very clear that the ‘best practice’ in managing ADHD in children is using one medication. So anyway, my child is fine on a non stimulant (not great focus or motivation but he’s definitely more ‘with it’, more coherent with conversations, able to do a full week of after school clubs, also his mood improved, he’s happier and he feels and looks healthy and well). I hope this helps. I hope you find a medication that works.

[Momtrying in reply to MommaofandwithADHD]

Maybe try a 5 mg booster dose in the afternoon. It helps a lot with them coming off the meds. But you don’t want them taking it too late in the day to mess with sleep

[ilovepumpkinspice]

Finding the right meds is a bit of trial and error. I wonder if your pediatrician could refer you to a psychiatric nurse practitioner to manage the meds? They know so much more about how different meds will work and might be able to lead you to a better fit more quickly. That’s what we have done. My 8 yo old has ODD and ADHD and we have found over the course of a couple of years that the combination of Zoloft, Ritalin and guanfacine (morning and evening doses for the guanfacine) is a very good combination for him. It takes time and I feel for other parents who have to journey through this. Also, try giving a high protein snack to help with the come down in the afternoon. That’s a tough time for all ADHD kids on meds. We started with the sprinkle and it’s absolutely awful. Try to get him to swallow a pill and it will be easier. Offer a small reward for successfully swallowing the pill to help alleviate the opposition (a couple of dye free jellybeans maybe?). My son learned to do this by first having a mouthful of water and then dropping in the pill and swallowing. Good luck!

[Momtrying]

we had the same situation when my son was 9. We started on 15 mg Adderall xr but I noticed he was in a bad mood a lot of the time so we went down to 10 mg and that was really good for him. But he did have a much harder time in the afternoons so after a while we added a 5 mg booster dose right after school. That helps so much for him to get through the rest of the evening. We have gone up 5 mg every year since then as he has grown so now he is on 30mg xr with a 5 mg short acting in afternoon. I’m not sure if they have a 5 mg extended release but that might be something you try for the mornings and a short acting for the afternoon. You just don’t want them taking anything too late in the evening so that they’re not able to fall asleep at night.

The trial and error is hard, but once you get it right it will be much better. Good luck!

[sas3 in reply to Momtrying]

Thank you for your input! We will continue to work towards finding what works for him.

[Natalie_c]

I used tic tacs as a fun way to help him to practice swallowing the pills.

[sas3 in reply to Natalie_c]

thanks! Great idea

[Jalapenochips]

My daughter had the same exact experience. We tried a few different medications and she was opposed until late middle school. Everyone is different and it has to be tailored to fit him. Don’t give up! Also, look into the genetic testing like genesight. I waited too long and that test is supposed to reveal what works for his body. P.S. with age they grow out of a lot of the struggles 🙏

[sas3 in reply to Jalapenochips]

wow! Thanks for the encouragement and the genetic testing info!!