Hi

I recognise a lot of the above in our SWCAH son - ultra-competitiveness, temper so worked up we send him off until he can regain control, the detrimental effect of tiredness etc

We have found that certain times (e.g. between 4 and 5 p.m.) and situations (e.g.coming down with a virus, stress of say, the build up to a birthday party etc.) can trigger or exacerbate things. The meds are a "best attempt" to mimic the body’s steroid production, but when the levels go off a little there is an almost visible effect on general demeanour.

Our guy is 6 now and we all are getting better at spotting the troughs, either before they happen or when we’re in them! It helps him when we point out that it is his CAH that may be causing this, and that he has a choice about how he reacts. He is getting better at pacing himself ("I’m just going to sit over here for a while"), and of course sometimes we nudge him in the right direction (a banana and a drink directly after swimming or football, for instance).

Good luck.