Abstract
Case: A healthy 9-year-old girl who is taking dexmethylphenidate extended-release (ER) (Focalin XR) 10 mg daily presents with residual attention-deficit/hyperactivity disorder (ADHD) symptoms and 1-2 episodes per month of aggressive tantrums. To treat the residual ADHD symptoms, dexmethylphenidate ER is increased to 15 mg daily. The family instantly notices an improvement in the girl’s concentration, but also an increase in the severity, frequency, and duration of aggressive outbursts in the afternoon. These outbursts remit on weekends, when the medication is not administered. The possibility of stimulant rebound is considered, and a booster dose is added, resulting in worsening episodes of severe aggression throughout the evening. Guanfacine is added with little improvement. Dexmethylphenidate ER is tapered off successfully, and dextroamphetamine/amphetamine ER (Adderall XR) is started. Her ADHD symptoms improve, and her aggressive tantrums resolve.
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