Should there be a summer-long break from the ADHD medications for your child? The break may work fine. If you will let your child not to take any ADHD medication during the summertime holiday, your child may get back his appetite and his grow will be not that slow, as with ADHD, because some of ADHD medications may slow the grow.
But you should think twice if it’s worth it: the old behaviors and habits may be unleashed as well. Those are low attention, impulsivity, and hyperactivity, which could have an impact on you and other people who live with the child. There’s no a single, comprehensive answer. It depends on the child, you, other caregivers and how your child reacts if he stops taking any ADHD medications. Also, some of the results could be used as a real evidence, that constant taking of medications will ease hyperactivity, impulsivity and other symptoms better than “start and stop” system.
Benedetto Vitiello, MD, psychiatrist who leads the Child and Adolescent Treatment and Preventive Intervention Research Branch at the National Institute of Mental Health in Bethesda, said this approach wasn’t harmful and it was the part of personalization of health care, so there wasn’t any single standard for all the patients and this flexibility met the needs of different children and their families.
ADHD drugs work
According to Centers for Disease Control (CDC), there are about 6% of United States children take ADHD drugs (age 4-17). There are two types of ADHD medications:
- Stimulants (Adderall, Vyvanse, Adzenys XR-ODT, Focalin, Concerta etc.)
- Non-stimulants (Kapvay, Strattera, Intuniv)
Stimulants are different from non-stimulants. Stimulants working quickly (and leave the body quicker than non-stimulants). That’s the main reason, why it’s easy to start and stop taking this kind of drugs. Also, there is no any withdrawal symptoms. But still, there are some other things to consider. Mark Wolraich, MD, a pediatrician in Oklahoma City who helped write ADHD treatment guidelines for the American Academy of Pediatrics, said parents and caregivers needed to realize, that treatments improve behavior and so if your child would stop taking ADHD medication, his behavior will be reverted. Stimulants don’t build up in the bloodstream, that’s why you could start and stop taking them anytime. But if your child takes non-stimulants, you could do a summer-long drug break, but not over the weekend, Wolraich added. Non-stimulant drugs leave the body slowly, so they may cause bad side effects if they are stopped suddenly.
If a child is taking stimulants, you have to take longer breaks. ”You could 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.
Expectations
Vitiello said, that children, who stop and start taking their medications are doing okay with a drug holiday (that’s about 30% of all the children on ADHD medications). But, unfortunately, there are no any good studies that can tell how many children use this “start and stop” approach.
Pam Feldman, a social worker, of Ferndale, Michigan, didn’t give her son his ADHD medication (stimulant type). Several hours later, she got phone calls from teachers of her 9-year-old son and from the camp director, who asked her to pick him up. Feldman had to set up the system, where it’s impossible for her son to miss a single pill of the medication. This case shows, how quickly you will see the difference in behavior after child stop taking the stimulants.
Still, Feldman doesn’t wish to keep her son on medications and halves the dose on weekends. She fears that her son will not be able to learn how to control himself and she doesn’t see him not on his medications when he’s at home. “It’s my fear medicating too much,” she said. Part of impulsivity in sensory overloaded, she added, at home he didn’t have that and can be just him from 3:30 for two hours.
ADHD drugs effect on weight and growth
Another thing you need to count is stimulants effect on children’ appetite and growth. Studies have shown, that the growth slows by about half an inch during the year and the appetite can be curbed by the ADHD medication.
The growth can be slowed only during the first two years of ADHD treatment, and children will catch up after those two years. But sometimes, the medication simply doesn’t have any effect on children’ growth. Walraich pointed out not all the children to have the issues with the grow, but if they have it, it lasts two years in average. In the long-term perspective, there are not such effects.
Vitiello added, that the reason of this event was unknown. “It could be because of an appetite loss or because of changes in the testosterone,” he said.
Thinking of Drug Holiday
Before taking a break, you should get the consultation with your child’s doctor about the drug holidays. You should also consider the type of ADHD and the environment organization, before taking a drug holiday for your child. Wolraich said, that parents of children with hyperactivity didn’t report about any problems at home, only at school, so they didn’t feel the necessity to give drugs to their child during their after school, weekends or holiday periods. Otherwise, the medication should be taken continuously, without any breaks at home. This is more about the children with hyperactivity as the part of their condition.
On the other hand, well-organized home life will help your child to stay on track without taking medications. Wolraich pointed out the compensating well for child’s deficit if his parents have an organized structure at home.
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.
Forever on medications?
Another wise decision is to stop taking the medications just to check if the drug or the same dosage of it is still needed.
“ADHD is a developmental condition,” Vitiello says, “so it often persists, but it’s not necessarily; hyperactivity symptoms are tended to decline with the time. Sometimes children need the medication during the specific period of time of development and don’t need it when they are more able to control themselves.”
You also should consider the changes in a child’s environment, because hyperactivity or other symptoms of ADHD may be managed differently in college and not cause as many issues as they caused at elementary school.
I usually suggest not to have breaks in ADHD treatment even on holidays. This can only worsen symptoms.