How to Manage an ADHD Medication Rebound

Boy (4-6) posing in bedroom, portrait
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Your child is doing well on ADHD medication—until it starts to wear off. Then, they suddenly develop a whole range of severe mood and behavior symptoms. If this sounds familiar, you're not alone. Your child is likely experiencing what is often referred to as medication rebound. A small percentage of children with ADHD do experience these rebound effects at the tail-end of their medication dosing.

As the medicine's effect wears off, people sometimes experience negative side effects such as a marked change in their demeanor, excessive moodiness, irritability, anger, nervousness, sadness, crying, fatigue, and even an increase in the severity of ADHD symptoms. The effects can be very impairing and troubling, and it is important to address this issue with the doctor so that it may be corrected.

Rebound vs. Side Effects

Medication rebound is not the same thing as a side effect.

Side effects are negative reactions to the medication itself. A headache, stomach ache, or loss of appetite can all be side effects of ADHD medications, and in most cases, these become less of an issue over the course of the first weeks of medication.

Rebound, however, is a result of the speed at which your particular child metabolizes the medication. Yes, your child may be taking a "four-hour pill," but that's an average duration of effectiveness. Your particular child may metabolize the medication more rapidly or slowly. If your child happens to have a fairly high metabolism, they may experience a quick drop-off in medication effectiveness before it's "time" for the next dose.

Negative Impacts of Medication Rebound

Often, medication rebound occurs after school and before bedtime. It may result from the reality that there is no nurse available to remind your child that it's time for medication—and, in many cases, parents are still at work or are distracted by the demands of dinner and other household chores.

This is the period of time during which children tend to socialize and take part in after-school activities. Friendships and team memberships depend upon your child's ability to respond to a coach's instructions, collaborate with friends, or simply hang out and chat without taking over or giving offense.

If medication rebound occurs at school, it can interfere with your child's sense of well-being as well as their educational, social, and personal success.

How to Avoid Medication Rebound

Talk to your child's doctor about your concerns. Rebound tends to occur more frequently with the shorter-acting stimulants that can move out of your child's system quickly. Sometimes doctors will add a very small dose of immediate-release medicine about an hour before this rebound effect occurs so that the transition off the medicine is smoother.

For some people, the rebound effect is reduced in the longer-acting stimulants which move out of one's system more gradually. As always, good communication with the doctor is essential in correcting any negative side effects that are occurring with the medication, as well as monitoring overall treatment progress.

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  • Russell Barkley, Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. The Guilford Press.

By Keath Low
 Keath Low, MA, is a therapist and clinical scientist with the Carolina Institute for Developmental Disabilities at the University of North Carolina. She specializes in treatment of ADD/ADHD.