Are you thinking about giving your child weekends off or even a summer-long break from his ADHD medications?
It may work just fine. Your child may regain his appetite and catch up on his growth. (Some ADHD drugs may slow this.)
Then again, a medication vacation may unleash the very behaviors that have been controlled by prescription drugs: hyperactivity, impulsivity, and inattention. That could put a strain on the child, you, and other caregivers. And there’s some evidence that keeping a child on his ADHD medications will ease symptoms better than stopping and starting.
There’s no one-size-fits-all answer. It comes down to what works best for you, your child, and your family. How you go about a medication break depends on what your child is taking.
"The bottom line: It isn't harmful and it's part of personalization of care -- not to have a standard that fits all, but to have a flexible approach that meets the needs of the individual child and family," says psychiatrist Benedetto Vitiello, MD, who leads the Child and Adolescent Treatment and Preventive Intervention Research Branch at the National Institute of Mental Health in Bethesda, MD.
Here's what you need to know about the pros and cons of drug holidays.
The Nature of ADHD Drugs
According to the CDC, about 6.1% of U.S. children ages 4-17 take medications to control symptoms of ADHD.
Most take stimulant medication. These include:
• Dexmethylphenidate (Focalin)
• Dextroamphetamine (Adderall, Dexedrine)
• Lisdexamfetamine (Vyvanse)
• Methylphenidate (Concerta, Daytrana, Metadate, Methylin, Ritalin, Quillivant)
Stimulants and nonstimulants work differently.
Stimulants start working quickly and leave the body quickly. Because of that, doctors say it's easy to get on and off these medications. There are no withdrawal symptoms, so your child doesn't have to wean off of them.
But there are other things to consider. "On those meds, it's important to realize the treatments improve behavior and reduce symptoms," says Mark Wolraich, MD, a pediatrician in Oklahoma City who helped write ADHD treatment guidelines for the American Academy of Pediatrics. "If you stop taking them, you revert to behaviors you saw before. ... Stimulant medications don't build up in the bloodstream. That's why you can stop and start them.''
If a child is taking nonstimulants, you have to take longer breaks. ''You could do it [take a drug break] over the summer time, but not over the weekend,” Wolraich says. Nonstimulants shouldn’t be stopped for short periods because they take longer to go to work and far longer to leave the body. They can also have bad side effects if they are stopped suddenly.
Drug Holidays: What to Expect
There aren't good studies that tell how many children stop and start their medications. But of those kids who do, up to one-third "do OK with a drug holiday," Vitiello says.
You may be part of the majority of parents who notice an immediate change in your child when he's taking a break from his stimulant ADHD medication.
Pam Feldman, a social worker who lives in Ferndale, MI, twice forgot to give her 9-year-old son his dose of stimulant medication. Mere hours after he left the house, she got calls from teachers and a camp director asking her to pick him up or otherwise get him under control.
The experience forced Feldman to set up a system where her son can't miss his pill in the morning -- it's there, in his orange juice cup.
"I learned my lesson, and now I'm afraid to not have him on it," she says.
Yet Feldman says she still halves his dose on the weekends. Why? Because she fears that she is seeing him only when he's on his medications and that he won't learn to control his behaviors without them.
"It's my fear of medicating him too much. Part of impulsivity is sensory overload; at home, when it's just us, he doesn't have that. From 3:30 to 5:30 on, it's just him," she says.
ADHD Drugs, Weight Loss, and Growth
Stimulants tend to curb the appetite in many children, and studies have shown that while on medication, boys' growth slows by about half an inch a year -- during the first 2 years of treatment. Their growth after that does not seem to be affected, and in some cases catches up, even if they continue taking the meds.
"It's not all kids who don't grow. But if you look at the average, it lasts about a year or 2. The effects haven't been seen on long-term growth," Wolraich says. "That's why we recommend monitoring height and weight. If there is a decrease in growth, it's something being followed closely.''
Why stimulants delay growth is unknown, Vitiello says. It isn't only because of a loss of appetite, but also may be due to changes in levels of the hormone testosterone.
Deciding on a Drug Holiday
You should talk with your child’s doctor about drug holidays when your child is put on ADHD medication.
"We have a discussion right from the beginning," Wolraich says. "I get a sense of the family's and patient's preference, and we come to a decision about when they need meds. We'll review when children are having problems and need coverage, and weigh the benefits of covering those other times of the day.''
The type of ADHD your child has, and how well his environment is organized, needs to be factored into your decision.
"With kids who don't have hyperactivity, parents will report it as mainly a problem in school and not at home, so they feel they don't have to cover periods after school or on weekends," Wolraich says.
If hyperactivity is part of your child's condition -- and it interferes with his relationships inside and outside the home -- the medication should probably be continued.
"It's not just symptoms, but to what extent they are causing dysfunction. You want to keep them successful in academic work or in their social and family life," Wolraich says.
A well-organized home life can help keep a child on track, even when he isn’t on medication. "If parents have a really good structure at home, it's compensating well for their child's deficit,'' Wolraich says.
Will Your Child Need to Take ADHD Drugs Forever?
Maybe not. Another virtue of taking a break from meds is to see if a drug -- or the same dosage -- is needed, Vitiello says.
"ADHD is a developmental condition that oftentimes persists, but not necessarily; symptoms of hyperactivity, especially, tend to decline with time," he says. "I don't know how often it happens clinically, but it happens that children may really need the medication through a certain period of development, and after that they're more able to control themselves and need less of medication or none at all.''
It’s also important to recognize that a child’s environment changes as he grows up. Symptoms that may cause problems in elementary or middle school may be managed differently in college or at a job.
Benedetto Vitiello, MD, branch chief, Child and Adolescent Treatment and Preventive Intervention Research Branch, National Institute of Mental Health, Bethesda, Md.
Mark Wolraich, MD, chief, developmental and behavioral pediatrics, College of Medicine, University of Oklahoma, Oklahoma City.
Pam Feldman, MSW.
Multimodal Treatment Study of Children with Attention Deficit/ Hyperactivity Disorder, National Institute of Mental Health, National Institutes of Health, 1999.
Biederman, J. Archives of Disease in Childhood, August 2005.
Spencer, T. Journal of the American Academy of Child & Adolescent Psychiatry, November 1996.
Mattison, D. Proceedings of the National Academies of Sciences, published online Sept. 27, 2011.
Reviewed on May 12, 2015
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