ADHD: The Pros and Cons of a Drug Holiday
Should kids go off stimulant medication in the summer?
Clinical Expert: Alan Ravitz, MD, MS
What You'll Learn
- What is a “drug holiday”?
- Do ADHD meds do more than help with school performance?
- What are the arguments for and against a drug holiday?
A lot of parents wonder if it’s a good idea to give their kids a break from their ADHD medication. Doctors call this a “structured treatment interruption.” Sometimes families call it a “drug holiday.” Whatever you call it, the break from medication should be done under the supervision of your child’s doctor. It’s usually done in the summer when kids have a break from school. Parents who worry about medication side effects might love the idea. And some doctors use the break to see if the child has progressed and if they still need medication at all.
But a break from medication is not always a good idea. Some doctors make the argument that ADHD meds are not just helpful for school performance. They say that kids’ emotional and social behavior is part of normal growth and that if they stop meds in the summer, this growth will be interrupted. Kids can also feel happier and more confident in social and team situations when they stay on their meds.
Some parents want to take kids off medication because of side effects like delayed growth and poor appetite. Studies have found that the delayed growth tends to happen the first year a kid’s on the medication but goes away after that. But if your child is losing weight or not eating much, taking them off drugs for a while might be a good idea. It’s worth taking those concerns to your child’s doctor.
If your kid has the hyperactive form of ADHD, those symptoms are likely to come back if they’re taken off drugs. So the “holiday” can turn into a bad experience for both kids and parents. If your child has the inattentive form of ADHD, behavior problems are less likely to be an issue.
Parents of children who take stimulant medication for ADHD often wonder whether their kids should take a “drug holiday” during the summer months.
A drug holiday, or what clinicians call a structured treatment interruption, is a deliberate, temporary suspension of medication. Since children with ADHD don’t need to perform academically during the summer or on extended holidays, parents wary of side effects often seize the opportunity to take kids off their regular regimen of Ritalin or Adderall. Other parents dread the interruption, fearing that their children’s behavioral problems will rebound, making them too difficult to handle. Sometimes a doctor will prescribe a drug holiday in order to evaluate a child’s progress and determine if medication treatment is still indicated.
Meds help kids outside the classroom, too
Child and adolescent psychiatrist Alan Ravitz, MD, recommends against drug holidays unless there is a compelling reason for them as the data shows that children with ADHD who stick with their treatment program year-round reap better results than those who experience interruptions. That’s because it’s a misnomer to think that ADHD affects only their performance in school.
“Kids who are being treated for ADHD do better in more than just the classroom,” Dr. Ravitz says. “Medication has to do with managing behavior in a variety of different circumstances.” Children’s social behavior and emotions are still developing in the summer months; they still have to get along with family and friends and function effectively in group activities like sports and day camp. One mother tells the story of her son’s baseball coach pleading with her to put him back on meds because it made a critical difference in his performance. When she saw that playing the game well boosted her son’s happiness and self-esteem, she gave him back his Ritalin.
A break from side effects
Another concern is that there is evidence that taking stimulant medications can affect a child’s physical development—an effect parents hope to mitigate with a summer drug holiday. Several studies in the last 10 years show that children on medication for as little as three years lag as much as an inch in height and 6 pounds in weight behind their peers. Another study last year, though, showed that in children followed for 10 years, into adulthood, there were no differences in height or weight between those who had taken stimulant medications and those who hadn’t. Researches found that the “delay tends to be most prominent in the first year or so, and tends to attenuate over time.”
For some kids what’s most noticeable, and most concerning, is weight loss due to the fact that the medications suppress appetite. If kids are eating far too little and it becomes an issue, Dr. Ravitz suggests it may be appropriate to go off the medication.
Overall, a parent should consider how a drug holiday would affect their child’s well-being. Generally, hyperactive or combined types of ADHD present the strongest case for continued medication, because the behavioral problems that result from going off medication can turn a holiday into a negative and unproductive experience. Inattentive types of ADHD, on the other hand, present fewer behavioral problems. “Even though there’s scientific data suggesting those kids do better taking meds 365 days a year, if there are no behavioral problems, I don’t make a big case for taking meds all the time,” says Dr. Ravitz.
Because ADHD affects social development as well as academic performance, the conservative approach is to avoid disrupting the prescribed treatment plan. However, there are no hard and fast rules on this issue; ultimately, decisions should arise from a conversation between the family and health practitioner. “I would never take a position of fighting with parents, because I would rather maintain the treatment alliance,” Dr. Ravitz says. “As physicians, we just do our best, because we understand some families feel very strongly about this.”