28th December 2003
Researching ADHD and it's treatments does get overwhelming, doesn't it? I feel your pain. It's so hard to know what is best for kids!
Rebound hyperactivity late in the day as stimulants are wearing off is a common phenomenon. Dr. Horacek explained it in a way that I could understand in his book, "Brainstorms". He says that stimulants increase the production of 3 neurotransmitters in the brain: dopamine, norepinephrine, and serotonin. I'm oversimplifying what he's already simplified, but basically he says norepinephrine is energizing (he likens it to the gas of a car). He says that dopamine and serotonin are the "brakes" and "steering wheels". As the medication starts wearing off, for a period of time, norepinephrine continues to be produced after dopamine and serotonin production has ceased. During this period of time, you're left with a energized child who can't put the brakes on.
Many people take an afternoon dose of medication (or a longer acting formulation) to get through the afternoon. Dr. Horacek is a fan of clonidine for muting the effects of the norepinephrine. Whether or not you are comfortable with more or different medication is a very personal decision and not one that I would presume to make for you.
The research that I've read actually negates the idea of rebound hyperactivity lasting as long as a weekend. Of course, the fact that something isn't common doesn't mean that it isn't happening for your son.
I wonder if it's possible that what you're seeing on the weekends and vacations is what he was like before he started ritalin. That it appears worse because of the improvement in his symptoms during the week? If your answer is a resounding "no, he's definitely worse" then I, too, would have to question whether the medication is doing him more harm than good.
I hope this helps. God Bless You!
Rebound hyperactivity late in the day as stimulants are wearing off is a common phenomenon. Dr. Horacek explained it in a way that I could understand in his book, "Brainstorms". He says that stimulants increase the production of 3 neurotransmitters in the brain: dopamine, norepinephrine, and serotonin. I'm oversimplifying what he's already simplified, but basically he says norepinephrine is energizing (he likens it to the gas of a car). He says that dopamine and serotonin are the "brakes" and "steering wheels". As the medication starts wearing off, for a period of time, norepinephrine continues to be produced after dopamine and serotonin production has ceased. During this period of time, you're left with a energized child who can't put the brakes on.
Many people take an afternoon dose of medication (or a longer acting formulation) to get through the afternoon. Dr. Horacek is a fan of clonidine for muting the effects of the norepinephrine. Whether or not you are comfortable with more or different medication is a very personal decision and not one that I would presume to make for you.
The research that I've read actually negates the idea of rebound hyperactivity lasting as long as a weekend. Of course, the fact that something isn't common doesn't mean that it isn't happening for your son.
I wonder if it's possible that what you're seeing on the weekends and vacations is what he was like before he started ritalin. That it appears worse because of the improvement in his symptoms during the week? If your answer is a resounding "no, he's definitely worse" then I, too, would have to question whether the medication is doing him more harm than good.
I hope this helps. God Bless You!