A Medication Vacation
Should you leave room in the suitcase for your child’s ADHD meds?
By Katie Morell
It wasn’t until her son Francisco turned 3 that Chicago resident Maggi Steib began noticing behavior issues. “He was impulsive,” she remembers. “If it was time to put blocks away, he would start throwing the blocks instead.”
Francisco’s behavior grew worse as he grew older. He struggled with transitional periods—going to school, getting up to leave the classroom. Just before he entered first grade, he was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and started taking Concerta, a stimulant medication. But when it didn’t curb his impulsivity, his doctor switched him to Vyvanse, another stimulant, which solved the issue, Steib says.
While the medication helped him during school, it was affecting his appetite to the point that he hardly had one—a common side effect of stimulants. After consulting with doctors, the Steibs decided to keep Francisco off the drug when he wasn’t in class. That meant nights, some weekends and school breaks.
Today, Francisco is 13 years old, and Steib says transitions are still difficult when his meds have worn off, but his focus at school has greatly improved and his appetite is normal.
Many parents debate whether to give their kids a break from ADHD drugs when out of class. While not taking meds can allow a child to regain his or her appetite, catch up on growth or avoid other side effects of stimulant drugs, those on a drug holiday might see a surge in behavioral issues, hyperactivity, impulsivity or inattention that the drugs keep in check.
Understanding stimulants vs. nonstimulants
Much of the decision relating to a medication vacation revolves around the temperament of the child and the type of medication he or she is taking.
There are two categories of medications used to treat an ADHD diagnosis: stimulants and nonstimulants. Stimulants are more commonly used and stay in the system for a short period of time. “There are short-acting stimulants like methylphenidate or Ritalin that could last one-and-a-half to three hours. Kids on those drugs will take them two to three times per day, maybe at breakfast, lunch and then at 3 p.m.,” says Louis Kraus, MD, chief of child and adolescent psychiatry at Rush University Medical Center in Chicago, adding that dosages for methylphenidates will range from 5 mg to 20 mg per dose with a maximum FDA recommendation of 60 mg per day.
These short-acting medications are especially helpful when a child has the side effect of appetite suppression, Kraus notes. The child may take a dose after breakfast, then wait until it wears off, eat lunch and take the next dose. That way, food consumption is not negatively affected.
There are long-acting stimulants as well. For example, Vyvanse, the drug that Francisco uses, can stay in a person’s system for up to 12 hours. These long-acting medications are taken once per day with a pill that starts as low as 20 mg and goes up to 70 mg (the FDA-approved daily limit).
Kraus says it is not uncommon for a child to be on two different ADHD medications in the same day. They may use a long-acting stimulant during the day and then a short-acting stimulant in the later afternoon.
Nonstimulant medications, such as Strattera (atomoxetine), are less commonly used, and breaks are often not advisable. However, they can be quite effective. While nonstimulants such as Intuniv or Kapvay can help curb hyperactivity and impulsivity, these drugs don’t help as much with increasing focus. Unlike stimulants, they stay in the body much longer, thereby requiring doctor-supervised adoption and tapering off.
When a meds break is the wrong choice
The uniqueness of a particular child’s personality and daily schedule is a major factor in planning a break from pills. If a child is participating in organized activities over the summer, for example, doctors often advise parents not to stop meds.
Dayna Hardin has experience with children on and off their ADHD medications. She is the owner and director of Lake of the Woods Camp for Girls and Greenwoods Camp for Boys in Michigan and says it usually doesn’t benefit the child to take a break from medication in summer.
“Even though you aren’t studying academics [at camp], ADHD medications can help children with social interactions as well as behaviors,” she says. It depends on the severity of a child’s ADHD as to whether it’s necessary for him or her to stay on meds.
Wendy Moyal, MD, is a child and adolescence psychiatrist at the Child Mind Institute, a New York City-based nonprofit organization focused on treating mental illness in children.
She says ADHD has a high social cost and that treatment with medication can help.
“ADHD has social consequences, not only academic,” says Moyal. “Peers pick up on the hyperactivity and impulsivity and may find it irritating, or the inattentive symptoms get in the way of social connectedness. Thus, kids with ADHD can face isolation and even bullying at higher rates than their unaffected peers; they can become demoralized, and their self-esteem suffers. ADHD is a medical illness, and leaving kids untreated, without the appropriate medication and support, could get in the way of them developing a more confident sense of self.”
Advice for parents
Parents thinking of a medication break are smart to first consult their doctor. Those who do it themselves can experience disastrous results.
“There is a reason you put them on the medications,” Kraus says.
“Impulsivity can be devastating. They could get into fights and fail to consider their safety.”
Kraus recommends scheduling an appointment or phone call with a doctor two to three weeks before school ends, checking in during the summer and then making another call a week before school starts to discuss the effects of the drug holiday.
Still, even with medical oversight, there’s no guarantee that a break from meds will be easy. In the case of the Steib family, breaks have helped 13-year-old Francisco grow physically at a healthy rate, but time at home can still be a challenge.
Four years ago, Maggi started looking for moral support and founded the Chicago City Satellite of CHADD (Children and Adults with ADHD) a nationwide organization that offers resources on ADHD. Today she leads monthly support group meetings for parents with children who have ADHD and adults who struggle with the disease. Parents often talk about issues such as drug holidays.
While some doctors advocate continuous treatment, others may be OK with the idea of a drug holiday, especially if a child has fewer behavioral problems. Ultimately, deciding on a medication vacation hinges on individual considerations for each child.
Originally published in the Spring 2016 print edition.
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