After reading the full 7 pages of the abstract I received courtesy of Carol (who rushed around like a lunatic to her local reference library and got this and then scanned said document and had real probs saving it as word ---thanks to Carol there---she is a neat person!)our dosing schedule is as follows: 2am---2.50mg (I changed this after reading the absract in more depth. Also, I felt that for the sake of morning bloods tests, bringing it further back would be better anyway as levels would be much less.) 8am---7.50mg ---this is the largest dose because when you study the circadian rythym graph, this is actually where the largest peak of cortisol occurs. I changed this to 8am because given at 7am I was concerned about the fact that more that 8 hours was going by to the next and last dose at 3.15pm. Since Ash had had some at 2am and still some floating around anyway at that time I felt that giving the dose at 8am killed two birds with one stone. A.) brought it closer to the afternoon one and making me feel sure that there would be less in the way of androgen breakthrough hopefully around 2pm. The last does given as soon as he walks in the door from school is about 3.15pm and that is 3.75mg. This is still in the system at 9.15pm, in very miniscule amounts and falling down to next to nil wihich is what the cortisol levels are naturally doing before midnight. Due to the study in GH kicking in 2 hours after sleep starts, I did not really like waking him up at 10pm and later as it may be disturbing that. Also if we do not give the high dose at night then GH has a chance to kick in as I found out that it is inhibited by large amounts of cortisol. Now consider that a large amount a 8am is not the same as last thing at night when the body does not need such. In fact the abstract goes on to say that it is excreted much more slowly at night because of the next to nil need for it. This menas high amounts that are opposing what GH is trying to do. I firmly believe that even for kids who are treated very well, the evening dose is the key factor to causing STILL all CAH children to be that much smaller than the average height when they complete their growth. I think there is no way of knowing until more tests are done into the effects on GH at night in realtion to children who have or are being given large HCT doses. perhaps that is Hindmarsh's next study---or if it isn't it SHOULD be! It is a big nough reason to change the dosing schedule of THESE kids in particular because they are and always should have been treated in a "replacement" style or method. Really when you logically think about it, there is little use for substituting their adrenals diferently to how the body would normally do this. It will cause bone loss MORE than the average healthy child. things are certainly less likely to be as "normal" for them as they should be for a kid in my humble opinion. A slow releasing or delayed releasing pill would be ideal to given them at night. They can journey to the moon and the bottom of the ocean---so I am sure they can develop such a pill! It would certainly save me getting up at 2am or 3am!