I've had lapses in time where everything is great and then the traditional symptoms hit, but this is usually at most a six month span. There are times when I have to ask my son if he took his pill, so I think there can be flare ups while on medication. I know I have days that are worse than others so it would make sense that a pill at the same dosage would not work any harder on a bad day. Those are great questions though. I'm going to look this up.