Summer Break, Treatment Break?

 ADHD Weekly, June 20, 2019

Question: Now that summer is here, should I take my child off her stimulant medication? I’ve heard it’s a good idea to let her body rest from the medication but I’m not sure if that’s what is really happening.

Answer: There is no need to discontinue ADHD medication during the summers or during school holidays. Children still benefit from continuing their treatment plans while at summer camps, enrichment classes, and sports. Some families do take the opportunity, though, to discontinue medication for a few weeks or the majority of the summer.

“There are two schools of thought on this,” says CHADD’s resident expert, L. Eugene Arnold, MD, MEd. “There’s no point in taking medication if you don’t need it for what you’re doing. The other is you should take it consistently to avoid the ups and downs brought on by symptoms. I think it’s an individual case-by-case judgement call.”

Should your child take a break from medication?

Stimulant medications for ADHD have been used successfully to treat symptoms in children for a very long time. They help to increase attention and decrease impulsivity, helping children to stay on task, follow directions, and to make better decisions. Medications can also decrease appetite and there is some evidence they can slow a child’s growth. It’s sometimes recommended that medication not be given on weekends or during school breaks to allow the child to have a normal appetite and gain a few inches during a growth spurt.

A medication holiday also helps prescribers and parents judge how much the medication is needed by the child to control symptoms. Prescribers might adjust the dosage of the medication following a break to fine tune the prescription.

“It’s worth trying to taper off every year or two, because there are some children who no longer need it,” Dr. Arnold says, explaining that some children, as they grow up, will have their symptoms become mild enough not to need continued medication management. “About 40 percent have an abatement of symptoms, which reduce to a level that’s not a problem for the children.”

Some prescribers also think that a break in medication allows children to shed any tolerance their bodies might develop to the medications. This would then make the medication more effective when restarted.

“By stopping medication for a while the tolerance goes away and it regains the beneficial effects,” Dr. Arnold explains. “I don’t know of a lot of data for that. But there is some animal data and clinical observations that seem to support it.”

Dr. Arnold emphasizes that discontinuing medication means symptoms return. A child who needs medication to be successful at school will likely still need medication for a positive day or overnight camp experience and during other summer activities. While some families can cope with ADHD symptoms returning, others will experience the stress and turmoil the symptoms caused before treatment started.

“If parents are pretty confident the medication is helping and they don’t want to risk deterioration [return of symptoms and difficulties], then they might decide to continue taking it,” he says.

Research on medication holidays

Researchers have also noted some benefits in clinical studies on medication holidays. One review examined 22 published studies between 1972 and 2013 and found that the break from continuous medication allowed for relief from side effects, an increase in appetite, and reduced insomnia. Longer breaks allowed for growth spurts. The breaks also helped when working with teens who were interested in managing medication on their own, or who wanted to experiment with no longer taking it regularly.

“Drug holidays from ADHD medication could be a useful tool with multiple purposes: assessment, management, prevention, and negotiation,” they concluded.

Time for a break?

Before discontinuing your child’s medication, discuss it with his prescriber. Review your family’s summer plans and any activities your child will participate in during the summer. Remaining on medication could outweigh any possible benefits of a break if discontinuing it will affect your child’s summer plans negatively.

Look for a time that is lower stress for your family if you consider a medication holiday, Dr. Arnold suggests.

“Usually the medication holiday is planned for when it’s not a stressful time and parents know they can restart the medication if needed,” he says. “The child’s old problems may return, which would be a sign to restart to the medication. There may not be any difference [in behavior] and they’ll stay the same. In a few cases they may actually do better without the medications. Once you have the answer, you can restart medication. Or if the answer is it’s not making a difference, or it’s not needed, then your child can just stay off of it.”

Looking for more information before making a decision?

Join the discussion: Are you considering a medication holiday this summer?