Is your child with ADHD suddenly acting up in the evening? Let's talk about 'Medication Rebound' (ADHD Medication Rebound)

Does your child with ADHD seem calm and collected throughout the day, but suddenly becomes very naughty and disruptive when you get home from work in the evening? Perhaps they just sit around looking sad? This could be due to a condition that doctors call 'medication rebound.' Simply put, this is a reaction that occurs when the child's medication wears off. When the medication wears off too quickly, ADHD symptoms can suddenly and very severely reappear.

This usually happens towards the end of the day, around dinner time, or when you get home from work. The good news is that this reaction usually only lasts for a short time, about an hour. After that, your child's symptoms return to the level you normally see when the medication is not in use. Sometimes, you can talk to your doctor and make small changes to your medication to help reduce the symptoms of this 'rebound'.

What exactly are the symptoms of 'medication rebound'?

This is a 'rebound' situation, where the medication has worked well throughout the day, but these severe symptoms only appear at the end of the day, when you think the medication's effects should last a little longer.

Imagine, your child has been doing their schoolwork in such a neat and tidy manner since morning, and is very calm. But by 4-5 in the afternoon, their behavior suddenly changes completely. Here are some of the signs you may see.

When these symptoms start, your child may feel very frustrated. As the medication wears off, they may feel like they're losing control and their ability to organize things. This can be a very difficult experience for them.

Why does this 'rebound' occur?

The main reason for this is your child's metabolism . The rate at which the medicine is eliminated from the body varies from child to child.

Stimulant medications for ADHD work very quickly. They enter the child's bloodstream and begin working within 30 to 90 minutes of taking the medication. After that, the medication is excreted through the liver or kidneys.

When the drug is rapidly eliminated from the body, the level of the drug in the child's body suddenly drops. This sudden drop is what causes 'rebound'. Instead of gradually returning, symptoms suddenly appear at maximum intensity and then return to normal levels.

Could there be other reasons?

Yes, there could be several other reasons .

• Transition from school to home: The child tries hard to control his behavior at school all day. He spends a lot of mental energy trying to listen to what the teachers say and to be nice to his friends. When he comes home, he feels that home is a safe place where he can be free from that pressure and be 'in his own way'. This may cause him to suddenly let out the emotions he has been holding back all day.
• Underlying condition: Sometimes this 'rebound' can be a symptom of an underlying anxiety or mood condition in the child. As the ADHD medication wears off, the symptoms of the underlying condition become more apparent. If you have any concerns about this, be sure to talk to your doctor about it.

How to prevent and manage this 'rebound' situation?

ADHD ' medication rebound' usually lasts only an hour. Once the medication is completely out of the body, the child's symptoms return to normal, the same as they were when the medication was not in use.

However, if you see this for several days in a row, it could be a sign that the dose or type of medication your child is taking is not working properly . The best thing to do at this time is to meet with the doctor who is treating your child and explain the situation. The doctor may be able to adjust the dose or give a 'booster' dose.

• What is a 'booster dose'?

That is, a small dose of a fast-acting `stimulant` medicine is given to your child when the strength of the medicine they usually take is about to wear off. This extra dose prevents the medicine level from dropping suddenly, and allows it to decrease gradually, thus preventing that terrible `rebound` reaction .

How to help a child during a 'rebound'?

As your child goes through these difficult times, there are a few things you can do to help manage their symptoms.

• Break large tasks into smaller parts: Instead of giving your child a task (e.g., homework) to do all at once, break it down into smaller, more manageable parts.
• Give instructions slowly: When giving instructions, don't say too many things at once, but say them one at a time, slowly, and clearly.
• Help to relieve frustration: When your child is angry or frustrated, try to calm them down by staying with them and saying things like, "I understand that you're having a hard time, let's work through this together." Never blame or scold your child. This is not something they do intentionally.

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