Your top questions about “drug holidays” for kids with ADHD

If your child takes medication for attention deficit hyperactivity disorder (ADHD), you may have heard of “drug holidays.” In short, they’re breaks from the medications children rely on during the school year. Doctors call drug holidays “structured treatment interruptions.” If you have a child with ADHD, you may wonder whether they’re a good idea. To find the answers, we spoke to the experts.

Why would a parent consider putting a kid on a drug holiday?

Some doctors feel that since school is not in session during summer, it can be a good time for a child to stop taking medications such as Ritalin® (methylphenidate) or Adderall® (amphetamine/dextroamphetamine). The thought is that this pause may ease side effects such as sleep problems and poor appetite. Researchers from the U.K. have estimated that 25% to 70% of families who have a child with ADHD have taken a medication break at some point. (If you have trouble affording your child’s ADHD medication, download the Optum Perks Discount Card. It unlocks savings on medication at checkout. You can also click the drug names above for instant coupons.)

Which kids are the best candidates for a drug holiday?

There are 3 groups of children who may benefit:

• Children who have growth problems and are underweight. “For most children, growth issues are not a major issue,” says Russell A. Barkley, PhD, a clinical professor of psychiatry at Virginia Commonwealth University School of Medicine. He’s also the author of Taking Charge of ADHD: The Complete Authoritative Guide for Parents. “But children who are small and not growing well can benefit from a medication break.”
• Children who have the inattentive type of ADHD. Children with ADHD that manifests as a limited attention span and easy distractibility often have fewer behavioral problems than those with ADHD who have social problems with other kids. “Children who don’t need medication to handle social situations may be good candidates for taking a break,” says Ronald Brown, PhD, a psychologist at the University of Nevada, Las Vegas. He specializes in treating children and adolescents with ADHD.
• Children who aren’t showing symptoms. You may not be sure whether your child’s medication is still working. In this case, a break could be helpful. “Your child may have learned strong coping skills and no longer needs medication,” says Caroline Buzanko, PhD, a registered psychologist in Calgary, Alberta. “A break is a chance to see how well they do.” (If your child has panic attacks, check out our guide to treatment.)

Which kids may not be the best candidates for a drug holiday?

Kids with ADHD show impairments in functioning across contexts, and school is just one of them. Thus, they need medication for more than just school, says Buzanko. She compares taking ADHD medication to wearing eyeglasses: At school, the child may need eyeglasses to see the board; afterward, she may need them to drive home safely.

Medication can work the same way. It not only helps children focus in the classroom, it also can help them make good choices when they are with family and friends. “Especially with younger kids who go off medication, family life can be very stressful,” Buzanko says. You need to consider how your child’s symptoms will affect interactions with friends and family if the child is on a medication break, she says.

Why is it better for some kids to reduce their dose of ADHD medication instead of stopping it?

It turns out there’s a middle ground here. Rather than stopping medication, some parents choose to scale back over the summer. This gives you a chance to see how your child performs on a reduced dose. It also can show whether the ADHD symptoms are causing problems, Buzanko says.

Reducing medication can also prevent future problems. If your child later goes back to a higher dose, she or he won’t have to re-experience the initial side effects of medication, Buzanko says. In either case, you should always talk to your child’s doctor before stopping or reducing medication.

What are the potential risks of a drug holiday?

When your child is not on medication, some issues could arise, Barkley says. These can include impulsive behavior and problems with friends, he says. “In teenagers, being off the medication can result in risks such as when driving,” he adds. So if you do take a break, be sure to watch your child closely.

Are there natural ADHD remedies to try during the drug holiday?

The best treatment for ADHD combines medication and behavior therapy, says Buzanko. So if you discontinue your child’s medication or reduce the dose, you should continue with the therapy. The goal is to maintain predictability and consistency. “Certain things build an ADHD-friendly environment,” she says. “These include having a structure and clear expectations about behavior.”

Beyond that, exercise and mindfulness can help with ADHD symptoms, says Buzanko. Some parents try vitamins and other dietary supplements, she adds. But these products haven’t been shown to be effective. That said, a healthy diet may be beneficial. Avoiding junk food is good for everybody — not just those with ADHD.

Are there cases when kids don’t go back on medication after a drug holiday?

Children who don’t show symptoms anymore or whose symptoms are mild can try staying off medication, says Buzanko. “I do worry about the teen years, though, when there are changes in the teenage brain,” she says. “These changes can make teens impulsive and more vulnerable to peer pressure.”

If your child is doing well with the strategies she or he has learned, you could try starting a new school year without medication, Brown says. “Within 2 to 3 weeks of the beginning of the school year, you and the teacher should assess your child’s progress,” he adds.

If there are no changes in behavior during the drug holiday, it could mean that your child does not need medication. But it’s something you want to figure out with your child’s doctor, says Brown. Work with him or her to determine the next steps that are best for your child’s situation.

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