When To Take a Break From ADHD Medication
Many studies support the importance of keeping a child with attention deficit hyperactivity disorder (ADHD) on medication year round as the best way to manage their symptoms. However, there are many questions as to what kind of medicine is best (once a day vs. two to three times daily) and the benefits and drawbacks of each.
Why Medication Holidays?
There may be some instances when a medication or "med" holiday would be appropriate. However, a qualified physician, not the parent alone, should only decide these instances. "If the child experiences significant side effects from the medication then a holiday may be needed," says Brian S. Smithley, MEd, a licensed psychologist at Sewickley Valley Hospital's Staunton Clinic in Pittsburgh, Pa. "For instance, when appetite suppression or sleep difficulties occur, a medication holiday may be used to provide an opportunity for the child to recover from the side effects. In addition, medicine holidays may be used to re-determine the current need for medication. But because the medication is a prescribed substance, medication holidays need to occur under the direction of the prescribing physician."
When medication holidays are necessary, parents need to be extremely diligent in utilizing behavioral interventions that can provide a structure and daily routing to minimize the severity of ADHD symptoms. Therapy and counseling can help the child and their parent(s) to develop an effective structure and daily routine.
When to Take a Med Holiday
As far as determining when a child would or should take a vacation from daily ADHD medications, it depends upon the purpose of the holiday. "Med holidays are done for different reasons," says Smithley. "For the significant side effects – or ones that affect a day-to-day event or need, such as appetite, sleeping, etc. – a medication holiday generally occurs on weekends. Summertime medication vacations can be useful in determining if the child has a continued need for the medication. A return of the child's ADHD symptoms would suggest their continued need for the medication and signal the need to restart the medication promptly."
It's No Holiday
There are several reasons why many experts state that the idea of a medication holiday is more harmful than helpful. One of the most evident and common is the effect of the medication itself on the child's body. "Kids with ADHD have sensitive bodies," says Susan Barton, founder of Bright Solutions for Dyslexia, a training and consulting firm for people with dyslexia and ADD. "Each time they start taking medication, it takes a couple of days for their bodies to adjust. During those couple of days, they may experience headaches, stomachaches and irritableness. Usually these go away by the third day. But if a child is taking a medication holiday every weekend, then every Monday and Tuesday that child will re-experience these side effects and just as they are adapting, again the weekend – and their next med holiday – rolls around."
Second, many doctors, experts and parents are concerned with the message these kids get from taking medication holidays. "[Med holidays] send the wrong message," says Barton. "A child with ADHD who only takes his medication while attending school and not during the summer or on weekends often starts to believe that the school is requiring the medication. The child often doesn't notice how much more successful he/she is in every situation when taking meds. If a child believes meds are being forced on them, then they will often refuse to take their meds as they get into the teen years."
However, the most dominate and indicative factor against medication holidays remains the yo-yo effect children often experience in their level of functioning. "If a child's medication reduces their ADHD symptoms, they are better able to effectively function in their life without receiving constant reprimanding or consequences for negative behaviors," says Smithley. "Removing the medication for a holiday is likely to bring a return of the child's symptoms, thereby setting them up for an onslaught of reprimands and consequences. It is setting them up for failure, maybe even after they have been doing very well for a long period of time. Its peaks and valleys can take their toll on anyone ... especially a young person."
"Do you give your nearsighted children a vacation from their glasses?" says Betsy Lampe, president of Rainbow Books, Inc. in Bartow, Fla. "After having raised an ADHD daughter I still don't understand why anyone would want their child to have a medication holiday from something that helps them. Do you take your glasses away from your children to give them a 'rest' from the benefit they derive from wearing glasses? Glasses help nearsighted children focus; ADHD meds help ADHD children focus."
A Holiday From the Holiday
There are options to medication holidays. These options can be discussed with your child's physician at any time. The options may be counseling, family therapy, training classes, various groups or even a simple dosage adjustment. "Not surprising, a small change in meds can have big results," says Smithley. "If a medication holiday is indicated because of medication side effect issues, sometimes a decrease in the medication dose can alleviate the side effect without removing all the benefits provided by the medication. The parents' need for utilizing structure and routine is still needed; however, their success will likely come with greater ease."
One Time Only or Repeat Procedure?
There are essentially no differences in the medicines that are found in the once-a-day tablets and their comparable immediate release medications. The only difference is the number of times they are taken and how the body uses it. Extended-release medications like Concerta and Metadate CD are simply longer-acting versions of their shorter-acting counterparts.
"The medicines are the same. Only the way the body receives that medicine is different (immediately vs. slowly over time)," says Smithley. "Determining the best medication for a particular child depends upon various factors – the type of ADHD, age, metabolism, severity of symptoms, medication side effects, etc. However, once-a-day medications have the benefit of eliminating the need for children to receive an afternoon dose of medication from the school nurse. Unfortunately, there continues to be a social stigma related to issues of mental health treatment, and children who take medication are often ridiculed and taunted. Because of this stigma, many children do not want their peers to know that they take medicine. And if you don't take it, it can't work."
The benefits of therapy and counseling, without medication, are generally limited. Medication plays an important role in the treatment of ADHD and should be as consistent as possible – year round. "Medication reduces the symptoms of ADHD, thereby allowing the child to make better use of their therapy and to cope better throughout the day – every day," says Smithley. "Taking a medication holiday would likely bring about an increase of the ADHD symptoms, setting them up for making poor decisions and getting into trouble. Finding the best medication and medication schedule for an individual child may actually require a carefully monitored trial of various medications at various doses before the most effective one is found. But not at the expense of the child's well-being."