Rob, before you panic, slow down and think about the entire situation. Next, take on board everything you're being told here (and by the doctor), add in a healthy dose of your own intuition and observations, then work out a list of questions to ask the doctor.
Here is my contribution to what you're being told here.
1) Although we too were told, "He will grow out of it," we now believe this is rare, if it happens at all, and is not likely to happen for our kids. HOWEVER - what DOES happen (based on our observations) is that SOME maturity comes in, as well as their cumulative experience and practice at living with a brain that is wired differently and which pushes them in different directions.
2) We adapt, in other words. Your child will adapt. Whatever the diagnosis, your child is the sum total of his environment and his genetics. His genetics also connects to how his brain is wired. His environment is not only the upbringing you provide, but also schooling, friends and also the way his own brain responds to the world around him.
Example: A science experiment ini which students put on glasses which make everything appear upside down. Trying to navigate around is really difficult at first, as you just want to hold on to everything. But you adapt and learn that if you move your hand THIS way, you will see it THAT way. You know this intellectually. And after a number of days (a week?) of wearing these upside-down glasses and putting up with the frustration of it all, your brain adapts, new pathways have formed and the world appears right-side up.
Then you take the glasses off, and go through it all over again until your brain re-adapts.
Our kids adapt to their brains and the differences.
A kid NOT on medications will adapt to their condition, but for some it can be a huge struggle, sometimes too huge. For those on medications, the medications can help speed up t he adaptation, but remember you are adapted WHILE USING medications. Stopping the medications means you have a different adaptation (more to do?)
3) Your son is on Concerta. It is a long-acting form or ritalin (methyl phenidate) which is a stimulant. Stimulants can be really good at helping kids with ADHD focus more intently and be less distractible. It seems paradoxic for a stimulant to do this, butt the theory behind it is, in kids with ADHD the part of the brain which is supposed to turn OFF distractibility, isn't switching off properly. A carefully applied stimulant, in the brain of someone with tis particular problem, works by STIMULATING this 'off' switch and thereby enabling the kid to focus.
The trouble is, the stimulants are not a PERFECT application, they are only as close as medical science can get. They are less of a blunt instrument than, say, caffeine (which has been recommended to me as an alternative "natural" stimulant - I pointed out that another natural stimulant is cocaine and I'm not about to dose my kids with that, either).
Because stimulants aren't perfect, they sometimes affect more than just the 'off' switch. There can also be other problems, such as rebound.
4) Rebound - both my boys have had rebound problems on ritalin (on Concerta, in difficult child 3's case). But it's not a problem specific to ritalin; while our kids don't get rebound on dex, I've known kids who DO get rebound on dex but not on ritalin.
Rebound isn't always immediately obvious - you can simply consider the problem to be your child's normal hyperactivity, returning now medications are wearing off. Doctors sometimes respond to this by increasing the dosage or by lengthening the number of hours for which the child needs medications in their system. If the problem is rebound, this only helps a little, in the beginning.
For kids with ADHD on stimulants - these medications are short-acting as a rule (even the long-acting forms wear off at the end of the day) and once blood levels drop below a certain point, the old ADHD behaviours surface. Add in that this tends to happen at the end of the day when kids are tired, they've had cumulative stimuli and stimulation through the day and need to process this in an over-tired, overworked brain and you get the evening hassles so well-known to many of us.
Rebound is when this is much worse and seems almost as if the entire hyperactivity for the day has been stored up like energy in a tightly wound spring, and is now being released with destructive force. With difficult child 3, we would see rebound as non-stop talking; fiddling with things until they broke; inability to sit still or stay on task; excitability; moody, extremes of mood from elation to sadness. difficult child 3's best friend is on Concerta (still) and gets rebound, including getting teary at the end of the day as medications wear off. he has even said to his mother, "I don't know why I'm so upset, I can't think of anything that is wrong." He gets less rebound on a lower dose.
The usual option when rebound happens with one type of stimulant, is to try a different stimulant and see if that is better. The trouble is, there is no commercial form of long-acting dex. We have a compounding pharmacist make ours up for us.
If rebound is a problem, you will see it with short-acting tablets too. When difficult child 1 was on short-acting ritalin (before Concerta was available in Australia) we would see rebound every two hours, as he was falling due for his next tablet. Once we switched to dex (also short-acting) we realised the difference between rebound, and medications just wearing off. A HUGE difference.
To test the difference - back in those bad old days, the advice was to give your child a 'holiday' from stims every so often. With difficult child 1 this meant stopping his ritalin during school holidays or on weekends. We found that the rebound problems were still a bit of an issue on his first drug-free day, but tapered off rapidly after that. However, his inattention due to the ADHD was bad again. But we could see which was which and also realised how rebound itself would wear off beginning a few hours after it appeared.
To get around the problem of kids abusing their medications, it is tightly controlled here in Australia. Kids are not permitted to carry their own medications to school or to self-medicate. Most schools have a designated staff member who will medicate the kids, but parents have to jump through hoops first including handing over the medications in the bottle with the prescription label on it, plus a letter from the treating doctor, plus a signed and dated request form.
I now have two adult kids on this, plus a teenager. The two adult kids have not had their medication dosage changed in years, except to lower easy child 2/difficult child 2's because she felt she no longer needed her higher (not that high) dose. I've also seen my adult kids change their behaviour and improve, as they get older and learn to control themselves better. This isn't the same as "growing out of it" by any means. I think they are now as good as they're going to get. difficult child 1 especially is much better now at recognising his own warning signs (of a panic attack) and has his own strategies well in place. This is part of getting older and more mature. It takes them longer to mature in tis way, but my kids at least have demonstrated that they do get there eventually.
Marg