Are you considering giving your child weekends off or even a summer-long break from ADHD medications?
It may work just fine. Your child may regain his appetite and catch up on his growth (some ADHD drugs may slow a child's height gains).
Then again, a so-called medication vacation may unleash the very behaviors that have been controlled so well by prescription drugs. That could put a strain on the child, you, and other caregivers. And there is some evidence that keeping a child on their ADHD medications will lessen symptoms better than stopping and starting.
Unfortunately, there is no one-size-fits-all answer. It comes down to what works best for you, your child, and your family. Doctors say it's easy to get on and off the stimulants that are typically prescribed for ADHD, which is characterized by hyperactivity, impulsivity, and/or inattention.
"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
Another half million or so take nonstimulant prescription drugs -- such as Intuniv, Kapvay, and Strattera -- which work on the brain differently. Those should not be stopped, because they take longer to go to work and far longer to leave the body, says Mark Wolraich, MD, a pediatrician in Oklahoma City who helped write the latest ADHD treatment guidelines for the American Academy of Pediatrics.
If a child is taking nonstimulants, Wolraich says, ''You could do it [take a drug break] over the summer time, but not over the weekend.''
Stimulants, on the other hand, are quick acting and leave the bloodstream quickly. In other words, there are no withdrawal symptoms; so, there isn't a weaning period.
"On those meds, it's important to realize the treatments improve behavior and reduce symptoms," Wolraich says. "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.''
Drug Holidays: What to Expect
There are no 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-type ADHD medication.
Pam Feldman, a social worker who lives in Ferndale, Mich., twice forgot to give her 9-year-old son his dose of Ritalin. 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 of Ritalin 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.
"We have to learn to love our children and deal with them," she says. "On the other hand, the rest of the world doesn't have to.''
ADHD Drugs, Weight Loss, and Growth
Fear of overmedicating a child is overshadowed by a fear of weight loss and growth lag, Vitiello and Wolraich say.
Stimulants tend to curb the appetite in many children, and studies have shown that while on medication, boys especially lose ground in their expected growth 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 into adolescence.
"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 in the first place is an unknown, Vitiello says. It isn't only because of a loss of appetite, but also may be due to changes in levels of testosterone. Vitiello cites a study involving monkeys in which the onset of puberty was temporarily delayed in those who were given Ritalin for 3 years.
"This may explain the slight delay in human growth," he 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.''
Deciding on a Drug Holiday
Again, flexibility is important when discussing drug time-outs with the doctor, Wolraich says.
That conversation should happen at the time the child is diagnosed with ADHD and placed on 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.''
A good guide for deciding whether a drug holiday is OK is the subtype of ADHD the child has, and how well his environment is organized.
"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.
That's far easier to do if the structure is in place at home, Wolraich says.
"If you have a parent who is good in terms of how they structure their home and their child's homework, there isn't as much of an issue of having medication all the time," he says. "If parents have a really good structure at home, it's compensating well for their child's deficit.''