What strategies do you use for patients on medications for ADHD who experience afternoon rebound/withdrawal?

There are several strategies to try. The first thing I do to address withdrawal dysphoria is usually a high-protein snack about 30 minutes before the symptoms are typically noted. In most of my pediatric patients, this is a game-changer. If that's not helpful, you can consider using a short-acting s...

For the few patients where this happens, I may try to use a different long-acting agent, or I may add in a short-acting small dose for rescue in the afternoon.

In addition to the good points made above, adding to the “hangry” point and protein-rich foods, avoiding highly processed foods helps. Highly processed foods decrease urinary pH, which significantly accelerates renal clearance and worsens withdrawal.

Vegetables, spinach, legumes, plant-based protein...

Use a longer-acting formulation, and may have to increase the dose of stimulant. May use alpha-2 agonists earlier if necessary.

I have occasionally overlapped long-acting medication, such as Adderall XR, because that really does not seem to last for my patients longer than 3 o’clock in the afternoon, even shorter in some patients. So, I sometimes have them take a second dose, a lower dose of the long-acting medication around...