My son becomes so uncomfortable early in the morning and often even in the afternoon. He takes Adderall 30mg in the morning and 20mg in the afternoon. Does great at school but gets in the moods at home where he will not listen, says terrible things to my wife and I, doesn't care about anything. Disciplinary actions from my wife and I only make him angrier. The physiatrists and therapy we have been in indicate ODD however I feel like there is just more to it. He has no emotional control and does his best to push us until we break. This mood and behavior is absolute hell. He can be such a great kid, and definitely is one at school but we just can't get past this awful behavior at home. To clarify he gets in these moods 3-4 days out of the week.
11 yr old son. ADHD, anger/emotional ... - CHADD's ADHD Pare...
11 yr old son. ADHD, anger/emotional rollercoaster
Hi There - Sorry to hear that you are going through this. It’s so so hard and sounds like you’re doing so much to support your son. It’s hard hard work and extremely exhausting.
I thought I would offer you some encouragement. My son was super challenging in the same ways at that age. He was fine at school but his emotional regulation and ability to cooperate at home were really challenging. We had some really horrible times where I felt helpless to support him. I thought he might have ODD but his psychologist was really resistant to that diagnosis. He’s 15 now and I almost forget those days because it’s so much better now. Like significantly. It’s taken time and hard work and lots of support but we’ve gotten to a good place.
A few things that worked for us. Guanfacine (Intuniv) for medication. Worked wonders for emotional dysregulation and his intensive resistance to being controlled. I also find the stimulant does lead to emotional dysregulation when it wears off. My son rarely takes stimulants because he doesn’t like that effect. The guanfacine helps so much that I’m thankful for that. The nice thing about guanfacine is that it’s 24 hour coverage and it’s taken in the evening so it’s in full effect in the morning when he wakes up.
Another thing is that I set necessary limits and approached the tantrums firmly but calmly but I also learned to back off a tonne. This was all very very hard but necessary to preserve our relationship. I had to pick my battles very carefully and sparingly and offer lots of encouragement and constantly look for opportunities for connection. His need not to be controlled was very high and I had to work around it. Still do. Discipline always made it worse. Most of this work I did with the support of a counsellor who specialized in adhd.
The other very important part was maturity and time. 11 is a pretty tough time and they’re dealing with holding it together all day, social challenges and hormone shifts. You and your wife are his safe space and he’ll take it out on you. My son spoke horribly to me. It made me feel like a terrible parent. Understanding that this is part of ADHD allowed me to be more patient and understand his struggles when he was in these states. (Not easy!).
You’re probably doing a lot of these things already. Sounds like you’re doing an excellent job. I just want to let you know that it really is so hard right now and probably will be for a good while but it really does get better. I remember hearing that from others when we were going through it. It just seemed impossible and hopeless but I held onto that hope that it would be better for dear life. Maturity and support and connection go a really really long way. Others may have more specific advice but I thought I could at least offer you some hope.
We have been discussing the use of Guanfacine. I really feel like the Adderall is driving the emotional dysregulation. We have changed meds several times as well as he has grown. It is also so hard to find the right Dr.'s that will listen.. Your comments really speak to us, we really appreciate it. It is so hard. My wife takes the brunt of it as I work out of town and am gone a lot.
As an adult with ADHD, my own experience with Adderall was that I became irritable when it wore off.So, I can relate to the emotional dysregulation in the evening, like your son is experiencing.
I convinced my doctor to switch me to a non-stimulant medication, which works 24/7, but unfortunately only after I developed another side effect from the Adderall.
My current medication is atomoxetine (Strattera), but I've heard good things about Intuniv (Guanfacine) for treating kids. (Strattera can be very helpful for some people but can cause unpleasant side effects for others. Intuniv seems to have much less chance of side effects.)
A newer non-stimulant medication which is gaining in use is Qelbree. It is a selective norepinephrine reuptake inhibitor, which is what Strattera also is, but I haven't heard of it causing bad side effects. Qelbree is supposed to take less time to start working in a patient (days, instead of weeks), and was quickly approved for use to treat children with ADHD.
My son is the same age. Before the age of 11 ( which is still bad) 9 was the worst experience of my life. He was psych hospitalized twice and DX officially ODD and bipolar with mood dysregulation in addition to ADHD.Mine is not compartmentalized at school or any other activities so that is a blessing!
What works for us is consistency and allowing the child to make schedules that we have to buy into.
The schedules never go digital to digital ( which makes my son worse) and it allows him some control while we can keep the peace.
The schedule is most important for weekends in the home where the days are long. Can also help during summer and school breaks.
Essentially try to give a little while getting and making it clear and structured. Ambivalence is not a friend!
Best of luck and stay strong. This is not an easy time or road.
Perhaps look into pathological demand avoidance and consider the suggested strategies for that and also consider alternative medications in case the side effects to his current medicine might be related to unmanageable mood swings, crashes or evaluate his sensory profile to see if occupational therapy might help with identifying and reducing triggers
Vyvanse might be a smoother release and cover a longer period for your child. They just released a generic so it is more affordable and might be worth a try if the Adderall might be associated with the emotional dysregulation or crashes. When we started, we gave a split dose so our child had a small amount (10 mg) to cover the whole day but could sleep at night (with lots of exercise, a good food and sensory diet, and magnesium and melatonin in the evening).
Vyvanse might not be an option considering the current dose of Adderall of 30mg + 20 later on. Vyvanse converts to less than half the amount of base amphetamine. And it is extended release in that it is a long steady release. So I would doubt Vyvanse would get to a high enough peak blood concentration to be therapeutic. i.e. the max recommended dose of vyvanse is 70mg. Which would convert to between 30 and 35mg dextroamphetamine in the body. But, that would be released over the whole day. Which I doubt would come close to the blood concentration of 30mg IR + 20mg later.
Jornay pm is effective upon awakening and has transformed our mornings from what you described to allow connection and success.
thank you for sharing! Did he have this anger before starting the meds? Some stimulant meds can raise irritability. My partner had this issue with one med, then we had him take the gene site test to find out which meds had adverse reactions to his genetics. This is how we found what he is currently on.it has been a game changer for us.
No, however he has been on meds for so long and we have switched and changed dosage as he has grown it is hard to say. I like the idea of the gene test. Thank you for your comments.
Does he have anxiety? Adderall can aggravate anxiety and lead to more irritability. 'edginess', and blow ups.
Maybe. We have also thought about the effects of the meds and the potential of anxiety.
I’d go back to your psychiatrist to get their thoughts. Anger could mean that the ADHD isn’t properly managed - emotional disregulation is an ADHD symptom. Anxiety and depression can also present as anger/irritability. Has your kid had a full neuropsych? “High functioning” autism can look like willful disobedience when really what’s going on is skill deficits. If your kid has a co-morbid condition like the ones I’ve mentioned or an LD like dyslexia, your kid could be holding it together at school and then falling apart at home. Traditional discipline doesn’t always work for neurotypical kids. If the underlying biochemistry or skill deficits aren’t addressed, it is that much harder for them to behave under duress - they just don’t learn from negative experience the way neurotypical kids do. Parent coaching from our kid’s therepist has really helped us. Learning new tactics other than what we grew up with has make a world of difference. I would say trust your gut as a parent, if you think something is going on that the doctors aren’t seeing, I bet you’re right.
This is what ran through my head, too. Could his behavior be him expressing frustration with the world not conforming to his expectations and needs for things to be a certain way? Eg autism thinking (rigidity). I don’t know, just wondered. Reminds me of our son who has ADHD + HF ASD.
Similar to ODD is DMDD (Disruptive Mood Dysregulation Disorder).
NIMH describes it as follows:
"Disruptive mood dysregulation disorder (DMDD) is a condition in which children or adolescents experience ongoing irritability, anger, and frequent, intense temper outbursts. The symptoms of DMDD go beyond a 'bad mood.' DMDD symptoms are severe."
The Mayo Clinic describes ODD as follows:
"...oppositional defiant disorder (ODD) includes a frequent and ongoing pattern of anger, irritability, arguing and defiance toward parents and other authority figures. ODD also includes being spiteful and seeking revenge, a behavior called vindictiveness."
They read as being almost identical, but I continued reading other sources, and gleaned the following key differences:
• DMDD is considered to be the more severe of the two conditions.
• ODD behavior is regarded to include intent behind the misbehaviors, whereas DMDD misbehaviors are more specifically due to emotional dysregulation.
Perhaps that will give you some more talking points with your son's doctor or psychiatrist.
Do you think that his misbehaviors are intentional? It can be really hard to say, sometimes.
Another factor with ADHD is Rejection Sensitive Dysphoria (RSD). This is a type of emotional dysregulation which is believed to be triggered by the perception of being rejected.
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My eldest daughter exhibited a lot of bad behaviors in her teens which seemed to be due to ODD (though she wasn't diagnosed with ADHD, ODD, or and other disorder at the time). Since she was so high-functioning (verbally, at least), I think that everyone involved (including me) at the time of her issues just assumed that she was a neurotypical kid who was being rebellious.
But the more that I've learned about ADHD, RSD, and ODD, the more that I realize that she should have been evaluated for those disorders at the time.
She grew up to be a responsible adult, working and taking great care of her kids (my grandkids). But, her anger issues have caused problems in her relationships and sometimes at work. (On the plus side, she has great relationships with me and all of her siblings...and a mostly-good but slightly strained relationship with her mom.)
Sounds like he may be overstimulated. What does a typical day look like for him?
At what time does your son take the Adderall in the morning? If they take it later like after breakfast or when they get to school, they could try taking it earlier.
I have ADHD and also issues with daytime sleepiness. I would take my Adderall when my alarm first goes off. Then it would kick in after about 20 minutes to a half hour which would be therapeutic and make my morning much easier and less frustrating. I'd also hit the snooze button till I was ready to get up.
STEM_Dad mentioned Intuniv. It is often prescribed to be taken at night since it may make some people sleepy. So it can help with stimulant induced insomnia. And upon waking, be therapeutic from the start. It may also allow your son to reduce their Adderall dosage. But I haven't tried it yet for myself. May not be strong enough to be a complete solution. But if it helps...He also mentioned Strattera which can be taken with stimulants. It works well with my bio-chemistry but like all ADHD meds, can be hit or miss. It also for me in particular has some opposite, but positive effects from what Adderall does to me. But Adderall is still much stronger. Qulebree, heard good things, like Strattera only a bit better. But no generic so may be expensive.
It could be that the Adderall dosage is not quite strong enough any more. If they are very cranky in the morning then they may have downregulation/damage done from Adderall making them well below their natural baseline. Then if it is wearing off before the evening, giving them Adderall crash, then it may be wearing off too soon and not be quite enough to be therapeutic the whole day. But I would not recommend increasing the dose. I'd actually recommend trying to get them onto something else.
Obviously there may be other comorbid issues and it not just being the time when Adderall is not therapeutic and your son is crashed out from it. But, if it is the case that the issue is Adderall, then Adderall has done too much downregulation and damage and will only get worse for them down the line. My personal opinion on amphetamine based meds is that if you are not stable on a relatively low dose, then get off it. It is also my opinion that psychiatrists pharmacology training for ADHD is inadequate and full of drug company talking points and most know little of how Adderall downregulates/damages the brain.
Speaking from my own experience, everything psychiatrists told me about Adderall and amphetamines was wrong. Which led me to believe I just needed to titrate up to my therapeutic dose and that I may need to adjust it from time to time. And that it doesn't cause dependence except when abused. Till I was dependent on it, it was ruining my life, and there was nothing strong enough to replace it. All at prescribed doses. And 15mg twice a day was enough for all that to start and only accelerated as I increased the dosage. It also damaged my endocrine system. And at 11, there is still a lot of brain development going on, really not a good time to be damaging the brain, not that any time is a good time.
I'd recommend trying memantine 10mg twice a day. It's a mediocre Alzheimer's drug, but therapists who know more about pharmacology prescribe it with Adderall to protect the NMDA/glutamatergic pathways from excitotoxicity caused by Adderall. I've seen people in threads claim that memantine helped keep them at a steady dose and others even say they were able to reduce their Adderall dosage over time because of it. I can say that taking Strattera with my Adderall had me go from 60mg a day down to 40mg over the course of a year 3 different times. Strattera being a weak NMDA receptor antagonist, it had similar protection as memantine. Memantine being a non competitive NMDA receptor antagonist. Memantine is actually made for the job. One of the ways Adderall works is by triggering the NMDA receptor and releasing glutamate which modulates the neuronal communication, making the signal work better. But overexcitement is damaging and one of the ways Adderall can cause tolerance to build.
I have come across a few people in threads who take a combination of Modafinil or Armodafinil with Adderall. Modafinil/Armodafinil are wakefulness promoting drugs and sometimes prescribed off label for ADHD. If taking them, the Adderall dosage would have to be decreased since they increase the effectiveness of each other. But Moda/armoda have some neuroprotective qualities. Also a weak NMDA receptor antagonist, upregulates VMAT2 which Adderall damages and I think a few other potential things I have written down somewhere. Also part of the approach I am using to get off Adderall along with Strattera and a bunch of supplements. Most therapists are very reluctant to prescribe more than 1 stimulant at a time. Personally I got denied by several therapists who wouldn't work with me to get off Adderall this way while trying to maintain some level of therapeutic effect to continue working. Worried about heart attacks etc. As I predicted, my blood pressure was lower taking modafinil, strattera, and adderall together than when I was taking higher dose of adderall alone. 15 points lower.
I am very pro-psychiatry. But as you may have guessed, very jaded when it comes to ADHD pharmacology by psychiatrists. Not against psychiatrists, but angry about their curriculum and therefore the people who choose what to teach about ADHD meds. And even worse, found some of them to be completely wrong and not understand new drugs as they came out. Which is why I have gone down the rabbit hole of neuroscience research, supplements, etc. which all needs to be taken with a grain of salt itself.
Also, I'd recommend always knowing which brand of generic Adderall the script is being filled with. Most generic brands are just crap and don't work well. If it is not Teva or Sandoz, go to another pharmacy to get it. Mallinckrodt is mediocre but doable. Pretty much everything else is useless. As comparison, The end of 2021 I got switched from corepharma (no longer around) to Aurobindo (white labeled as North Star). Ended up taking 120 to 140 mg a day trying not to lose my job and was still not as effective as 40 to 60mg of corepharma.
Hi There! I am going through a lot of the same issues with my almost 10 year old, but he is on Qelbree as he was experiencing lots of negative side effects on the stimulant(headaches, tummy aches and lack of appetite and sleep). We are however dealing with very big emotions and not being able to let little things go. 50 mg of Adderall seems like a huge dose for an 11 year old. I was diagnosed ADHD 25 years ago and have been on 15 mg Aderall XR for years now and Im 33. I would make sure they arent over medicating him, because it could be causing him to be over stimulated and as it wears off after school into the evening he is having a hard time coming down and taking it out on you.
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