A few things come to mind that I’ve learned with my own son over the years:
1. Could be a bad reaction to this medication. He may need to change. There are two types of stimulants: amphetamine (Adderall, Vyvanse, Evekeo…) and methylphenidate (Ritalin, Concerta, Quillivant…). Almost everyone does well on one type or the other, but not both. Since you’ve tried both types and found Concerta to be better, this is less likely the culprit.
2. He could be experiencing toxic school stress. The one and only time my son was violent like this at school (which was 8 years ago) was when he had a horrendous teacher who praised the kids that performed well academically and essentially punished the kids who didn’t. Dr. Jerome Schultz has brilliant insights and advice in this area! Read his book, Nowhere to Hide and check out his articles on ADDitudeMag.com:
3. Dr. Ross Greene is a genius when it comes to behavior. He sees behavior as communication, a symptom of something else that needs to be addressed (not the behavior itself). His book, Lost at School, will provide a look at why this behavior is happening and how to address it (it’s almost guaranteed his teachers aren’t handling things in a beneficial way).
4. Has he been evaluated for Autism Spectrum Disorder? My son was diagnosed with ASD 6 years after his ADHD diagnosis (ADHD at age 6, ASD at age 12, suspected ASD around age 10). It explained the intense outbursts and meltdowns that didn’t quite fully fit with the ADHD diagnosis. It may be worth it to have him professionally evaluated for ASD. It could be too well hidden to see at his current age, but maybe not.
ADDitude Community Moderator, Parenting ADHD Coach & Author, Mom to teen w/ ADHD, LDs, and autism