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Attention Deficit Hyperactivity Disorder

Treating ADHD with Adderall

09/19/1998

Question:

My 11-year old son has been tested for and diagnosed with ADHD. This was back in third grade and now he is in sixth. We put him on Ritalin which became a problem because he had to go to the nurse's office mid-day to get a dose. Last year we switched to Adderall because of its once-a-day dosing. He was taking 10mg, but after not taking it all summer, the 10mg dose really caused him some trouble with extreme irritability and emotionality. So I cut his dose back to 5 mg. Do you think I should put the dose back to 10 mg. after he adjusts to taking it again. I am trying to get him to be aware of how the drugs are affecting him and if he feels he is taking enough/not enough to maintain attention throughout the day. He is behind already at school and I am very concerned. Are you aware of any ADHD experts in the Cincinati area? We get the Adderall prescription from our pediatrician, but perhaps we need something more.

Answer:

A few different points to consider: 1. Adderall has a time span of effectiveness between 4 and 12 hours, usually around 6 hours. 2. As strange as it may sound, one can feel "hyper" on too little drug. This may be what you are referring to, although it does not sound a lot like your description. 3. There is a difference between getting "emotional" while a stimulant is active versus when the medication is wearing off (the "rebound" period). The latter indicates the schedule may need to change. The former can indicate many things including that the drug is wrong, the dose is wrong, the scheduling is wrong, or that (as often happens) the experience of starting school was difficult and one needs to wait for those feelings to calm down. Discuss whether or not his dose should be changed with his doctor or consider a workup at one of the listings below. In the Cincinnati area there are a few choices of expert areas. There is an ADD/ADHD Clinic at Children's Hospital and several psychiatrists at the College of Medicine work in this area, U.C.'s Cognitive Disorders Center does testing, and there is a private center, The Affinity Center, in Kenwood that is dedicated to working with children and adults with ADD/ADHD and related problems. These are the only speciality places I am familiar with. Best of luck to you!

For more information:

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Response by:

Susan Louisa Montauk, MD
Formerly Professor of Family Medicine
University of Cincinnati