Should kids come off ADHD meds for the summer?

Fourteen-year-old Peyton has attention deficit hyperactivity disorder (ADHD), and he has been taking Adderall during the school year since the age of eight to treat symptoms such as inattentiveness and impulsivity. During the summers, on his doctor’s suggestion, he stops his meds. Peyton’s mom, Cynthia Hollingsworth, says he might just take them occasionally if he’s doing something that takes extra focus, such as a fishing trip with his grandpa or a summer reading project. “I believe it is very important to give your body a break from these meds when you can,” she says. “When Peyton doesn’t take his meds, he is more hyperactive of course—but I don’t mind, it’s his summer break.”

Many parents like Cynthia, whose kids take stimulant drugs for ADHD, wonder if they should be giving them a “medication vacation”—or a structured treatment interruption, as doctors call it—during school holidays. There are pros and cons to weigh before making that call.

First of all, this type of break is not an option for kids on non-stimulant ADHD meds, such as Straterra, Wellbutrin or Intuniv, cautions Karen MacMillan, who is an educational psychologist, the parent of a teen with ADHD and the executive co-director of Foothills Academy, a Calgary school for children with learning challenges. While stimulant meds often start working in less than an hour, it can take weeks to feel the full therapeutic effect of non-stimulant meds, so you can’t just stop and start them.

And even for stimulant meds, some medical professionals are wary about the physical side effects of taking a break. Kids may re-experience initial side effects that had previously worn off, such as headaches, irritability or trouble falling asleep. “After speaking at length with my son’s paediatrician and his psychiatrist about it, we were told that it would be easier on his system to continue with the medication, rather than sending him into withdrawal,” says Caitlin McCormack, mother of five-year-old Declan, who takes Vyvanse. Macmillan says lowering the dose rather than quitting cold turkey strikes a happy medium for some families during vacations—but before making any changes, always consult your doctor.

MacMillan says parents sometimes want to give their kid a medication vacation, because they're worried about common side effects of stimulant meds, such as height and weight suppression. “Studies do show that height tends to correct itself over time, but weight gain may be more of an issue, if a child’s appetite is being impacted in the long term,” she says.

Some kids don’t want to take their meds when school’s out, because they notice personality changes when they’re medicated, and complain that they don’t feel like themselves. Wanda Carleton, whose son Lucas* began taking the ADHD medication Concerta at age eight, would keep him meds-free on holidays and weekends. “He reported feeling like he was too quiet and couldn’t talk normally with his friends,” she explains. The whole family was supportive of these breaks. “There were times, when he was not medicated, that his hyperactivity was disruptive to the family, but we dealt with it.”

Other kids actually feel better about themselves when they’re on their meds. “I won't take my nine-year-old, *Nikki, off her Biphentin [during], because it does seem to affect her mood when I do,” says her mom, Chantal Saville. “Nikki is frustrated more easily, which makes her snappish, and she can tell the difference when she's off them, which isn't necessarily a good feeling for her.”

In fact while it was once a popular approach, the medication vacation is increasingly being called into question by medical professionals and parents alike, because it can undermine a kid’s sense of stability. “Declan has almost no control over himself when he does not have his medication. It's horrible to watch his fear when he can't stop doing or saying something that he knows he shouldn't,” says Caitlin. “He yells and screams at everything, runs away (thinking he’s invincible), and spins and rolls around a lot,” she says. “It’s unbelievable, the shift, when he’s medicated.”

Caitlin also keeps Declan on meds year-round as a protective measure, because he would sometimes attack others physically when not medicated: “If he were to stop his medication it would put his own safety as well as the rest of the family’s safety at risk.”

Some kids are not only taking meds to focus academically, points out Macmillan. “Kids with combined types of ADHD (inattentive and hyperactive-impulsive) can interrupt people, forget things, or behave in ways that really get them into trouble at home and in the community.” And even if school’s out, kids may still need to follow direction and get along with peers in daycare or at camp. “We wouldn’t take a kid’s glasses away for summer,” says MacMillan, “so why feel we have to take away meds that help them to function?”

Older kids, in the middle school and high school years, are likely to have strong opinions on the question of medicating through summer. Parenting book author and mother of four (now grown-up) kids with ADHD, Ann Douglas, believes that as kids get older, it’s good to let them be part of the decision-making process.

“Our paediatrician didn’t raise the idea of taking a medication break until the kids were preteens,” says Douglas. “At that point, she offered it as an option to them—specifically, as an opportunity to take a trial run of being off their medication, so that they could see how well they were able to manage their ADHD without it.” Since Douglas’s kids had treatment plans that included medications and coping strategies, there was some merit in seeing how they’d fare un-medicated. Douglas’s kids only took their paediatrician up on this offer around the time they were getting ready to head off to high school. And Douglas says, “That break did ultimately lead to them going off their medication permanently.”

MacMillan points out that if a kid is starting to question whether their meds are helping, with their paediatrician’s green light it can be interesting do a week-long break, during the summer, as an experiment. That way, the child and other family members can identify what—if anything—is different. “It’s good to engage a child in this way, so they understand the value of their meds during the school year,” she says. That said, evaluate whether your ADHD child is prone to risk-taking—possible at any age, but particularly prevalent among tweens and teens. They may need extra monitoring, if they stop their meds, to ensure they’re weighing the consequences of actions and decisions. Or it may just not be worth taking any chances.

If your family is planning to travel during the vacations, this can be challenging for a kid with ADHD, so be careful not to throw too many changes into the mix at one time. “Kids who have ADHD really benefit from routines, and they find it difficult to adjust to change, including medication changes,” says Douglas. Can your kid handle going off meds while busting out of the home routine all at once? Libby (last name withheld), the mother of a 14-year-old with ADHD, says, “I don't dare have a kid who hasn't been on meds potentially act out going through airport security. And two weeks in a car with my child off meds—the child who I love more than my own life—is my idea of hell!”

Ultimately, you need to ask three questions before you consult your doctor about a medication vacation, says MacMillan: “1. What side effects is my child experiencing on their meds? 2. What happens when my child doesn’t take their meds? 3. What’s my child doing this summer and does it require significant focus and social interaction?” No two kids are the same, and even your own kid is constantly changing from year to year, so the decision around giving stimulant meds a break has to be made on a case-by-case basis.

*Names have been changed

Read more: Your kid’s ADHD diagnosis might be missing something important Could your kid's ADHD be linked to a sleep problem?