ADHD Medicines During Summertime?

Question of the Week

Q. My 8 year old has ADHD, inattentive type and she is doing very well on Concerta. Does she need to continue taking her ADHD medicine all summer when she is out of school, or can I give her a break from it?

A. Whether or not to stop a medication that has prescribed is something best discussed with your Pediatrician or prescribing doctor.

Personally, when a parent asks me this question, we discuss several factors before making a final decision, but I usually leave it up to the parent as to what they want to do.

Unlike most other medications, stimulants usually do not need to be taken on a daily basis for them to work. They can often be used on an as needed basis, where you only give it to your child on days that she needs it, such as when she is in school, and giving a 'drug holiday' when she doesn't need it.

How do you decide whether or not to give your child a stimulant every day year round?

I think the number one factor that you should think about is how much the medication is helping your child and what symptoms or problems is it helping. If your child mainly has trouble paying attention at school, and does well at home and with friends, then you can likely stop her stimulant over the summer. Or your could only give it on summer days when she will need extra help paying attention, such as when attending a summer camp or an organized sporting activity.

For kids who are very hyperactive and have behavioral problems and/or trouble socializing with other kids, if their stimulant helps with all or most of these symptoms, then you would likely want to give the medicine year round.

It can also be a good idea to give kids a break from stimulants if they have side effects, such as trouble gaining weight. Some time off of the medication may give them a chance to catch up with their weight gain. However, according to the American Academy of Pediatrics Clinical Practice Guideline: Treatment of the School-Aged Child With Attention-Deficit/Hyperactivity Disorder 'no controlled trials exist to indicate whether holidays have gains or risks, especially related to weight gain.'

So basically, you should review your child's benefits from taking the medicine with any potential risks. If your child tolerates the stimulant well without side effects and it is helping her day to day functioning, then you would likely want to continue the medication year round. If she tolerates the medicine but you don't see much or any benefit from giving it to her during the summer, then a holiday might be a good idea.

It becomes more difficult deciding what to do about the child who definitely needs to take her medicine, but who has side effects that bother her. In this case, instead of totally stopping her medication, it would probably be best to try a different medicine, such as Adderall XR, Adderall, Ritalin, Focalin, or Metadate CD, or continue her current drug at a reduced dosage.

Switching to a non-stimulant, such as Strattera, might also be a good idea if a child was having so many problems with a stimulant that she 'needed' to take a drug holiday because of side effects. Keep in mind that Strattera typically is taken every day, so you don't want to take holidays from it. If you did stop if for the summer, you would want to restart it 3-4 weeks before school was to start up again to give it time to work.

An occasional drug holiday can also be a good idea to see if your child even needs to continue taking the medication. Some parents like to do this at the beginning of the school year, allowing their child to start a new year without any medicine. However, this is likely not a good idea, since your child will have a lot of extra things to worry about and adjust to when school starts. Instead, you would be better off waiting until your child is doing well after 1-2 months in her new grade and then try a trial off medicine if you and your doctor think that it is an appropriate thing to do. A summertime drug holiday is likely not a good idea if you just want to see if your child needs to continue taking her medicine, since her time and activities will likely not be as difficult or organized as when she is in school.

It can also be a good idea to ask your child what she wants to do. For an older child who is becoming more independent and who doesn't necessarily like taking medicine, offering her a choice about what she wants to do about her medication during the summer can help with her overall compliance.