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I am going on my third year post-op and have been having similar issues in regards to ADD/ ADHD meds as well. I used to take the XR Adderall and switched to the instant release tabs not too long after surgery. They worked great with out any issues for about a year. I am not sure if I developed a tolerance for it and it just would not help me anymore or if there was a change in the way it was made.

I started a couple trials with my doctor to see if other medications would offer a better therapeutic relief from my symptoms. I tried a liquid form of Ritalin called quilivant if I remember correctly, and tried Concerta. Both failed to offer really anything of benefit. I ended up going back to the adderall instant release tabs as it gave me some albeit slight help. Getting 3-4 hours on your vyvanse may be due to the fact that it is considered a extended release form of medication.

With the approval of my doctor, I tried adderall XR 30mg twice a day for about three months. I had good success with that for a little while until for what ever reason just did not help anymore. You may need to speak with your doctor about a booster of some sort. I would speak to them about changing the dosage and or frequency.