Rebound Irritability from Stimulants for ADHD

If your child is on a stimulant for ADHD & executive function, and has rebound irritability in the afternoon after getting home from school (or a little later), we need to determine what the cause is. The most common culprits are any one, or combination, of the following:

1. “Hangry”— the stimulant may be suppressing their lunchtime appetite which comes back with a vengeance some hours later, as the medication wears off and their body is in a low energy state and their brain starts to take notice. Giving a favorite snack upon your child’s arrival home can often help with this. 
2. Stimulant wearing off: in some cases, there is a “rebound” effect from the medication wearing off that leads to irritability as it leaves their system. 
   *We try to get around this by using longer acting stimulants: 
   * For example for methylphenidate based compounds we often use are Focalin XR, Jornay, or Adhansia XR. 
   * For amphetamine based commands we often consider Adderall XR or Vyvanse (when insurance approves it).
3. When the long acting stimulants are already in use, we can sometimes consider giving a short acting version of the stimulant at 3pm to help get them through the evening (these often last 3-4 hours). But we need to make sure their appetite for dinner doesn’t sink too low or that there isn’t any insomnia at bedtime. 
4. Fatigue/exhaustion from the day: in many cases children with ADHD often are simply exhausted from holding it together from a long day at school. They undergo a lot more stress than a child without ADHD, so they sometimes need some time to decompress after school. This ideally means some period of time without intense demands to do homework or chores.