hi all. Our son was recently diagnosed ADHD, and he currently takes guanfacine 1mg at 6:30pm and metadate cd 10mg at 6:45ish am. We are intensely struggling with aggression, impulsivity and disruption at school and have for years.
Here is what we have tried so far:
Vyvanse 10mg
Vyvanse 20mg (seemed to make good headway for a week and then things went south fast)
Vyvanse 20mg + guanfacine ER 1mg
We jumped ship from the vyvanse for another stim to see if that could help with the irritability, flat personality, etc. It’s been a few days on the metadate, and he’s really irritable and still having the same school issues. The only thing the stimulant seems to help with is his working memory (used to simply say “I don’t know” when we’d ask him why certain things happened at school), hyperfocus (mainly preferred activities), and eloping in the classroom.
The guanfacine has helped him fall asleep at bedtime but we haven’t noticed much else (almost two weeks in) except that he also seems to be having intense bad dreams.
We and his LMHC are thinking anxiety could be a factor at play here, which could be exacerbated by the stimulant. Has anyone experienced something similar and what did you do? I am wondering if splitting the Intuniv dose between evening and morning could be effective and help counteract the irritability of the stim more? Drop the stim entirely?
Other things:
-We are working with our pediatrician currently but have a child psychiatrist appt in early March
-Our child also has sensory processing disorder (seeking, proprioceptive, some auditory)
Emotional regulation in ADHD/Anxiety 6 Year Old
Switching Stimulants 
Medicate vs non medicate and when to medicate 
Anger issues/ explosive outbursts 
14-year-old son increasingly irritable and hostile during Stay at home orders. 
First, make sure the diagnosis is accurate. Often someone gets diagnosed by teachers or a family doc, and no proper assessment is made. There are a million things that present like ADHD, so making sure that's what you're dealing with is essential. I honestly don't know much about sensory processing disorder, so it's important to consider intersectionality between ADHD, their other disorder, their mental health and, well, life.
Try to keep a log. What is the behaviour, how long does it last, any identifiable triggers, what you did, and how they responded. Make it shorthand so it's easy to maintain and easy to review at a glance. Maybe even chart the measurable bits.
This will help you spot potential patterns, and also allow you a bit of objectivity when measuring the effects of med changes.
Debrief with them when everyone is able to do so calmly. What their take on the situation was, what they think set it off, what would be helpful next time, what they feel the consequences might be. See if they have a full understanding of the natural consequences, and build that into the discussion. Some conflict sometimes develops when they only see the immediate transgression, and you are thinking about other situations where the same behavior might have dire consequences.
I have anxiety and ADHD. Yes, a stimulant can make the anxiety worse. On the other hand, most of my anxiety stems from social and performance issues caused by ADHD, so treating the ADHD is the highest priority, not just because it helps with the cause of my anxiety, but because it makes it easier to engage in the strategies to manage the anxiety as well.
I was diagnosed in my first year at university, and I had a lot of irritability, but it wasn't from the med. It was from:
Learning that there was treatment that could've helped all along
Discovering that the meds didn't "fix" things
Discovering that I had a long road of learning and self-discovery ahead of me
Resenting everyone who ever told me I just needed to try harder
Figuring out what the diagnosis meant to me, and how much of "me" was the ADHD
Dealing with all the idiots who know nothing about it except what they've heard on tv or psyc 101 and yet still consider themselves an expert and thinks that the mountain of clinical research is wrong
Figuring out my relationship with medication.
I could go on, but suffice to say that if the diagnosis is new, your loved one likely has a mountain of things to process, and may have their own biases to work through.
thank you so much! We are eager to meet with the psychiatrist to gauge if he feels other factors could be at play that need to be addressed first. Great advice here!