Dear Teen Parenting Coach

Q: How Can We Stop Our Teen’s After-School Explosions?

When ADHD meds wear off, teenagers can switch from calm and collected to angry, rude, and defiant. Here, our Teen Parenting Coach explains how parents can prepare for this post-medication crash, and manage the outbursts and other poor behavior that come along for the ride.

Q: “Our teenage son has difficulty functioning within the family unit when his medication is wearing down or he is unmedicated. He is rude and mean; he throws things around. He thinks he’s stupid and hates himself. Afterward, he does acknowledge that he has behaved inappropriately. To remedy this, he chooses to spend all of his time alone in his bedroom.” —VictoriaBCMom

Dear VictoriaBCMom:

You describe a common (and challenging) family phenomenon: the “witching hour” when kids with ADHD transition off their medication. Several factors combine to make this a challenging time of day for everyone.

Your son, like many kids with ADHD, works hard all day to hold it together in an academic and social environment he may or may not like. Perhaps he eats lunch, but maybe not. When he arrives home, it’s almost as if a switch flips and he lets it all go. Without the medication’s positive effect on his brain, he simply can’t handle his emotions or behaviors as effectively.

The good news is that your son feels remorse following his angry outbursts. How he handles this remorse — with self-deprecation and isolation — is clearly problematic. Yet his self-awareness indicates that he wants to behave differently in those moments, but can’t imagine any alternatives.

[Inside Your Teen’s ADHD Mind]

Nobody feels good after “losing it.” If they could react and behave differently when upset, they would. He’s probably isolating himself because he feels guilty and ashamed about the anger he’s displayed. I’m sure you both agree that being mean and throwing chairs are not acceptable family behaviors. His awareness offers you a golden opportunity to collaborate on figuring out a predictable plan that empowers everyone.

Collaboration, meaningful incentives, and making amends are the most effective ways to create lasting change with teens who have ADHD.

  • Collaboration increases their buy-in to any problem-solving process
  • Incentives provide the motivational push they often need
  • Making amends gives them a chance to do something nice for someone they’ve hurt

In this situation, collaboration means discussing neutrally what occurs before, during, and after his eruptions — and brainstorming alternatives together. Incentives for things he likes will assist him in sticking with the plan. Making amends happens after he’s cooled down from an incident. You teach him necessary coping skills and accountability while he obtains something he desires. Everyone wins.

Try these tips for dealing with the witching hour:

  1. Start by discussing the physiology of what’s happening in his body so he can stop putting himself down for a biological process. Explain that, when the medication wears off, his brain lacks the support it needs to control his behavior as effectively. It’s not his fault, but he has to make different choices when this occurs. As a family, you’re going to work together to find better solutions.

[Grow Up Already! Why It Takes So Long to Mature]

  1. Next, look at the hunger factor. Is he eating when he gets home from school? I’ve found that if a teen has a protein-rich snack when he gets home, the transition off medication goes more smoothly. Whether it’s a bagel with cream cheese or a peanut butter sandwich, getting him some healthy calories will really help.
  1. Figure out what signals his body sends when his medication is wearing off. Most kids sense when this happening, but they may not have identified the signs specifically. Ask him what behaviors are okay and what are unacceptable during this transition and then share your opinions. Write down these ideas.
  1. Reflect on a time when he handled this transition well and what made that experience successful. Offer some suggestions based on your observations. Discuss what might be helpful during those initial moments when he notices changes. Maybe create a codeword like ‘volcano’ or ‘T-Rex’ for him to use when it’s happening. Write down all of this.
  1. Make a list of activities that matter to him to use as incentives for following the plan. Make a list of things he can do for others when he’s not able to comply.

[Why Teens Stop Trying]

  1. Now, create your plan. When he comes home from school, what does he do and in what order? Perhaps he snacks immediately and then does homework, earning extra screen time when it’s finished. Perhaps he does his homework followed by an early dinner, a game or TV show with you. Maybe he goes to his room to decompress for a limited amount of time before homework and earns computer minutes if there’s no arguing. If he can’t follow through, then he makes amends. While there’s mutual input, you, as the parent, have the final say. The key is making sure he feels like he is part of the solution, not just the problem. Post your agreement in the kitchen where everyone can refer to it.

When kids with ADHD understand that their biology fundamentally affects their behavior and when they perceive that you want to work with them to make different choices, they will try alternative solutions. Notice their efforts and encourage them along the way.

Do you have a question for ADDitude’s Dear Teen Parenting Coach? Submit your question or challenge here.

The opinions and suggestions presented above are intended for your general knowledge only and are not a substitute for professional medical advice or treatment for specific medical conditions. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your own or your child’s condition.

1 Comments & Reviews

  1. I suggest you have your son try Vyvanse.

    Vyvanse is “slow-on, slow-off,” with about a 2-hour ramp-up/ramp-down time. That means that you don’t get nearly the medication rebound that happens with other stimulants. Having experienced the rebound of short-acting stimulants myself, I am amazed that doctors still prescribe them. (It may be due to expense/insurance, but that needs to change.) Talk about “do no harm.” It is a horrible experience; you feel like dirt. (See below for a detailed description of my experience.)

    Vyvanse is the only medication that has been effective for my two daughters w/o side effects. I started taking it 3 years ago, and now both of my daughters as well as my sister do. She thanked me profusely for telling her about it – she had been taking Ritalin but would feel depressed later in the day so she had given up. She did have to go through a big rigmarole with her insurance, but they did approve it.

    I would say that Vyvanse has changed our lives. (I have no affiliation with any pharmaceutical company or anything else remotely related.)

    Here’s an email I wrote to a parenting coach / child therapist who specializes in challenging children:

    “I now know how HORRIBLE my daughter felt during 1st grade, and thousands of other kids feel when they take short-, mid-acting stimulants and they wear off (right at homework time). It’s really rough and unlike any physical illness you might be familiar with. I felt sick, but not like a flu. Metaphorically, kind of like bad nausea if applied to the whole body and brain/mind. A state that a child’s brain really shouldn’t have to be in (but of course I recognize the need and advantage of stimulants) and that a child shouldn’t have to experience.

    “I wish I had a way to tell all the parents, so they could really sympathize with their children. I know that we found the horrible rebound behavior my daughter had to be stressful for US, but didn’t REALLY get how horrible she must have felt.

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