ADHD and getting older

[MasterQuay]

DS is in Year 5 and has just turned 10. He has been medicated (Medikinet) since he was 7 for ADHD (hyper, impulsive and inattentive - hat-trick!).

We are noticing that the medication still seems to be working when he's on it during the day. However, morning and evenings when the medication isn't in his system seem to be worse than they ever were. It feels like he is getting all his boisterousness/silliness out, but in this shorter time frame, which obviously is difficult (read annoying and tiring) for us and DS2.

Does anyone else experience this? I know we could do a 5ml ritalin in the late afternoon to give a bit more medicated time, but this would delay his sleep, and he is worse without sleep! However, mornings and post 5pm are getting really tough and hard to manage. We don't have a review of his meds for a while, but tbh I'm not sure that meds are the answer. We still do all the excercise, boundaries etc, but he is constantly, constantly pushing. Help!

No advice, but following to see what other people say.

We are in the exact same situation - 10yo DD on Medikinet. Yes, it seems like she 'saves' all the crap up and lets it out when meds have worn off. We also want to avoid the afternoon top up. After school/evening activities are impossible.

Our DS 11 is on equasym XL 30 mg for daytime and then a 5 mg medicine at 5 pm . First thing in the morning his behaviour is dreadful, worse than it ever was with no sign of things getting any better as he gets older. Any after school activities simply would not happen without his medicine to top up at 5 pm, it means we can sometimes go out for a meal and makes things a little more bearable for everybody but by 8 pm it has worn off and we go back to annoying, argumentative destructive and impulsive behaviour. He sleeps well however and it doesn't stop him from getting off to sleep. The way I see it, the meds just buys everyone time .

See when my DD was on the 3 doses of methylphenidate a date (8/12/4) she wouldn't eat her evening meal, and couldn't sleep before the early hours of the morning. Using a slow-release that wears off around 3-4pm improves both of these issues a lot.

Yes, DS's sleeping and eating are affected by the medication - hence my wariness of him having any more. That said, these non-medicated mornings and evenings are really wearing for us, and not fun for him as he is having to be 'told off' so much - but we have to try to control DS for the sake of our other DS and anyone else in the vicinity!

Any bright ideas anyone? Or sympathy lol!

I've always found it hard to determine exactly what causes specific problems for my son (asd and adhd). Could be the condition, could be side-effect of medication, could be hormones, could be stress. In practice it's probably a combination of all four. That said, whenever I am concerned about medication I always email his consultant for guidance and if necessary we have a review.

At 10 years, I would be considering a hormonal burst as a factor, tbh.

Could you consider atomoxetine (Strattera), which builds up in the system for 24 hour effectiveness? For a while my son took atomoxetine in the mornings with methylphenidate three times during the day, but the atomoxetine kept him stable for the difficult times that the methylphenidate wasn't enough. He's now been able to drop the methylphenidate and is on atomoxetine alone now, but at a higher dose. Worth discussing with your consultant?

Queen - I didn't know this about strattera. That it builds up over 24 hour period. Would you say you saw many side effects that you could put a finger on ? my DS is due a review in Nov and hasn't had his medication altered for over 2 years, but I am wondering if it's time to try something new. his school say he is hyper and lacks focus late afternoon in lessons and his behaviour for me in the mornings and when he gets in from school is worse than ever. Or like a pp has said how much of this could be hormones, it's hard to tell.

He hasn't had any side-effects from atomoxetine, but everyone is different so the only experience that matters is your son's, really. It takes about six weeks to get to full effectiveness and you can't stop it abruptly like you can methylphenidate, so you have to adjust to it more gradually. But once there there's much more stability and fewer highs and lows, iykwim. Your consultant might not have mentioned it because it may not be suitable in your son's case, but it is probably worth asking.