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It's Summertime! ADHD and "Drug Holidays"
Parents of children who take stimulant medication for ADHD often wonder whether their kids should take a “drug holiday†- a deliberate, temporary suspension of medication - during the summer months.
Since children with ADHD may not 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 stimulant regimen. Other parents may prefer not to have an interruption for fear that their children’s behavioral problems will rebound. Given that not all cases of ADHD persist, sometimes a drug holiday may be indicated in order to evaluate a child’s progress and determine if medication treatment is still indicated.
What are the arguments for and against taking a “drug holiday?â€
For: A break from side effects. Some studies show that long term treatment with stimulants can suppress growth (in part mediated by appetite suppression), and that effects seem to be dose dependent and most notable earlier in treatment, with attenuation of effects over time. The clinical significance of growth suppression is debated. Some studies indicate that drug holidays can attenuate the effect of stimulants on growth suppression, though this is not conclusive. A recent review indicated that short breaks from medication (i.e.; weekend “holidaysâ€) could decrease side effects such insomnia and appetite suppression, without increasing symptoms of ADHD.
Against: While in occasional cases symptoms of ADHD may primarily impact children in the classroom, in many cases, ADHD treatment can help with symptoms outside of the classroom. For some, medication can help children function socially and effectively in summer activities such as camp, and poor functioning in these settings can significantly impact a child’s self-esteem. In adolescents, consideration of other activities (i.e.; driving) in addition to school should be made. Generally, hyperactive or combined ADHD cases present the strongest case for continuing medication as behavioral problems resulting from going off medication can turn a holiday into a negative experience. Finally, taking a drug holiday may increase the likelihood that the patient discontinues taking the medication altogether, particularly in the case of adolescents.
The bottom line: Given the myriad of considerations mentioned above, holidays, both weekend and summer, should be decided on a case-by-case basis. The severity and impact of stimulant side effects should be weighed against the potential impact of non-treatment of symptoms and the particular constellation of symptoms that are prominent in an individual child. If a family feels strongly about taking a holiday, it may be worth the trial in order to maintain the treatment alliance.
-Dr. Rheanna Platt, BHIPP Consultant
References:
AACAP Practice Parameter for the Assessment and Treatment of Children and Adolescents with Attention Deficit/Hyperactivity Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 2007 46(7).
Ibrahim K, Donyai P. Drug Holidays from ADHD Medication: International Experience Over the Past Four Decades. Journal of Attention Disorders, 2015 19(7): 551-68.
Vitiello, B. Understanding the Risk of Using Medications for Attention Deficit Hyperactivity Disorder with Respect to Physical Growth and Cardiovascular Function. Child and Adolescent Psychiatric Clinics of North America, 2008 17(2): 459–474.
Resources for parents:
Child-Mind Institute: ADHD - The Pros and Cons of a Drug Holiday
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Dr. Rheanna Platt is a clinical consultant with the BHIPP team and has worked with the program since 2013. She earned a bachelor’s degree in biology from Brown University and worked at a health advocacy organization in Boston before attending medical school at Mayo Medical School. During medical school, she completed a Master of Public Health degree at Johns Hopkins. She completed pediatric residency at Johns Hopkins, and went on to train in adult psychiatry at Columbia University/New York State Psychiatric Institute and a child psychiatry fellowship at the NYU Child Study Center. She joined the faculty at Hopkins in 2013 and is based at the Bayview campus, where she works with the Latino Family Clinic and is also working to increase collaboration and communication between pediatrics and child psychiatry. Her interests include detection of family mental health problems, Latino mental health, and integration of mental health care into pediatrics. In her work with BHIPP, she loves being able to support callers in taking care of the "whole patient."
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Resources and Information
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Suicide is the second-leading cause of death among adolescents. The American Academy of Pediatrics (AAP) has published updated guidelines to assist pediatricians and other child and adolescent health care professionals in identifying and helping adolescents at risk of suicide. Read more about the updated clinical report on the AAP's website.
The AAP has also released an updated policy statement on Substance Use Screening, Brief Intervention, and Referral to Treatment (SBIRT). Read the accompanying clinical report, which presents practical clinical approaches to support implementation of SBIRT practices, here.
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BHIPP Bulletin Newsletter Archive
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June 2016: Understanding Vyvanse
May 2016: Children's Mental Health Awareness Week, May 1-7, 2016
April 2016: "Universal" approaches for child mental health problems
March 2016: Pharmacological interventions for sleep concerns
February 2016: Behavioral interventions for sleep concerns
January 2016: Assessment of sleep disorders
November 2015: 5S's: Key questions for consultation
October 2015: Case discussion regarding school refusal
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