Managing the Rebound Effect

Rebound can be explained as the experience of irritability, depression, or trouble concentrating that occurs for one to three hours as stimulant medication wears off.

Sometimes, the behavior is worse than before giving medication.

Discipline needs to be flexible during this time of day.

If your doctor has evaluated your child, and feels that medication would be of benefit, then you need to be aware of the rebound effect of methylphenidates or amphetamines. There are several ways you can help to reduce or manage it.

Your doctor can help to manage the rebound effect through spacing of doses, prescribing a long-acting stimulant, or by switching medications. Ideally, this is not the job of your pediatrician; he or she needs to add a member to your team who is more qualified to do this: the medicating psychiatrist.

The Medicating Psychiatrist

A medicating psychiatrist deals with medications all day long. They are your expert, and the person you need to see especially if your child has co-existing conditions . Medications often help in one area and aggravate another. A pediatrician is just not set up to handle a complex case, and a wise one will refer you to someone who can better see to the needs of your child.

What Rebound May Look Like

For our family, rebound is the biggest issue. It happens in the afternoon, and by 5:00, she's fine. I have learned to bring a substancial protien snack to school when I pick her up. Usually, it's a Peanut Butter Sandwich. That helps a lot.

A child could experience a loss of emotional control and restraint, become unable to cope, or have a short fuse. They may cry, become withdrawn, or zone out. It is important to note that these mood changes ARE ONLY TEMPORARY. They get a second wind at some point and move on with the rest of their day.

If your child experiences symptoms for extended periods of time you need to contact your doctor RIGHT AWAY, as your child may need an adjustment or change in medication.

Chart Behavior

If you’re not sure if your child is experiencing the rebound effect, use the observation log to chart their behavior. For this log, it is important to note the time of day the behaviors occur as well as the length of time your child experiences them. This will provide clarity for your and help your doctor establish a pattern of behavior.

Breathing Room

Understand that your child my need some extra breathing room in the afternoon. You may want to let them do a mindless activity (see TV warning) for a while in the afternoon. This may include playing with inside toys, coloring, or building.

In our house, we thrive by swinging! Swinging is calming, provides deep sensory input , and allows the brain to organize itself.

The Lure of the Television

It’s easy to let your child relax with the mindless activity of watching television. Be warned, for some kids, watching TV hooks them in to a state like a trance.

Your child becomes so focused on the television in the middle of the afternoon that they can’t break away to get back to the routines of the day. They become angry and combative about turning off the television.

The bottom line: television viewing in the middle of the day may work AGAINST you.

Do we watch TV? Of course! But I am aware of its trance-like effect on my children, and keep that knowledge tucked away.

For the most part, I save TV for the beginning and end of the day, and as a reward for finishing a task. The ability to pre-record favorite shows allows ME to determine the time, not the TV station.

Strike a Deal

Your child may not realize that their behavior is affecting the rest of the family. They only understand that they feel “yucky” in the afternoon.

Our medicating psychiatrist finally had a conversation with our daughter that sounded something like this:

“Look, I know there are times in the afternoon and evening when you feel yucky. It’s not fair for the rest of the family to be miserable. We need to strike a deal.”

He stated the behavior and it’s affect on the rest of the family, and finished by making her more accountable for it. He continues:

“I’m going to have your mother get you a little something that you like. If you can go for 5 days without a meltdown in the evening, you get your treat.”

The meltdown triggered by the rebound effect was the target behavior. We went to the store and picked out a couple of tubes of cheap lipstick (her choice).

The meltdowns ceased. She became aware of how her behavior was affecting others, and the lipstick provided her with sufficient motivation to practice some self-control.

Guess what? After the first five days, we moved on to six days in a row. By the time those were over, she had enough practice in self-control in this area that the cycle almost completely stopped. And, once in a while when it rears its ugly head, we only have to ask, “Are you really being fair to the rest of us right now?” And it stops.

There are many things you can do to help manage or minimize the behavioral effects of medication. Learn to work closely with your doctor to tackle this problem together.