Stimulant rebound: how common is it and what does it mean?

Objective: To examine rates and implications of stimulant-induced rebound - the behavioral deterioration that may occur as stimulant medications wear off. Methods: This study compares nurse observations on evening shifts compared to day shifts in 149 psychiatrically hospitalized children treated with short-acting stimulants, usually methylphenidate, comparing nonmedication and stimulant-treated states. Results: Behavioral deterioration (rebound), was observed in 30% of children on at least one dose of stimulants but was serious enough to discontinue treatment in only 8.7%. Children experiencing rebound did not differ clinically from those who did not. Conclusions: Rebound exists, occurs significantly in less than 10% of psychiatrically hospitalized children with attention deficit hyperactivity disorder, and does not appear to have specific diagnostic significance.