Ask the Experts

When Meds Go Bad: After-School Rebound Strategies

“Every afternoon, when my son’s extended-release stimulant wears off, he gets excited and acts out. I know this is called the “rebound effect,” but does this mean he is taking the wrong dosage of stimulant — or is this normal?”

It is normal. Almost all of the side effects of stimulants occur when the blood levels of the medication rise or fall. As the medication wears off at the end of the dose, children have a variety of experiences — from becoming overexcited and impulsive to becoming irritable, weepy, and angry. This is often the only effect of the medication — not the positive aspects in helping to manage symptoms — that many parents see when their child gets home from school.

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Rebound can be lessened in a number of ways. The simplest strategy is to add a lower, short-acting dose of the same medication at the end of the extended-release morning dose. This will lower the blood level more gradually. If your child has a hard time settling down to fall asleep at night, or is old enough to have an amount of homework that keeps him up late, try a second dose of extended-release medication, so that the rebound occurs while he is asleep.

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  1. That’s just one strategy. What are the others?
    Will a short-acting dose of the same medication prevent or just delay the rebound effect?
    If I give a second extended release tablet so that the rebound happens during the night, will she be able to fall asleep?
    Does an anti-psychotic like Abilify manage the stimulant rebound?

    1. I think most physicians prescribe a short-acting dose for afternoons that’s lower than the “all-day” dosage. That way it kind of steps down out of their system more gradually. Giving a stimulant late will, almost always, prevent sleep.

      Doctors don’t generally prescribe Abilify or other mood stabilizers to address rebound, unless there are also reasons for that type of medication. One medication that is known to help with rebound for a lot of kids is Intuniv.
      https://www.additudemag.com/intuniv-adhd-nonstimulant-medication/

      Other ideas:
      – offer a high protein snack 30-45 minutes before rebound usually starts
      – have your child doing some sort of physical activity during rebound time
      – try a medication that has a more smooth time-release mechanism that may wear off more gently

      Penny
      ADDitude Community Moderator, Author & Mentor on Parenting ADHD, Mom to teen w/ ADHD, LDs, and autism

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