Any emergence of mood changes (irritability or dysphoria) or agitation is very relevant and should be reported to the doctor! There a many possible causes that could contribute to this change.

• Titration of the right dose

  The medication needs to be monitored and adapted to the personal needs. So the child might need a higher dose of the medication or might be very sensitive to psychostimulants. This should be evaluated!

• Rebound

  Normal methylphenidate pills work for about 3 to 4 hours. After that time a "rebound" of the old symptoms can occur. The patients feel very uncomfortable with this. Adaptation of the right dose and interval is necessary or you might try long-acting psychostimulants instead.

• Change stimulant preparation

  Some children do not respond to methylphenidate but do fine with amphetamines.

• Evaluate comorbid disorders like depression or anxiety disorders!!!

• Assess sleep.

  Many adhd children have severe problems at night. If they cannot sleep they might feel irritable and dysphoric.