Ah…summer vacation. It's so very nearly here. Our children and their teachers are counting down the days until the final bell rings. They're dreaming of holidays down the shore or in the Pokies, and other equally magical places.
Parents are planning for summer holidays, too, but for those of children with ADHD, that often means deciding whether to take a "drug holiday," where they discontinue their children's stimulant medication for part or all of the school break.
If kids experience side effects from the medication – and not all children do – parents must weigh the potential pros of giving their kids a drug holiday from these against the pros of continuing the medication through the summer.
Though summer means that most children are not engaged in academic tasks during the day or homework at night, summer time is definitely not a break from environments that require children with ADHD to attend to instruction, regulate their emotions and behavior, and interact prosocially with peers and other adults.
For instance, many children will be in camps and other structured environments – sports practices, lessons, and daycares – that require paying attention and acting appropriately. Children on a drug holiday who become significantly impaired by their ADHD run the risk of experiencing yet another environment where their impulsiveness might result in labelling by peers as the "kid who doesn't follow the rules." This means they might miss out on opportunities to gain new skills and new friends – and therefore the self-esteem that flows from these summertime achievements.
Even on actual family vacations, children with ADHD off medication are vulnerable to highly impulsive and disruptive behavior, which increases the chance for sibling conflicts and general stress. This can lead to a negative experience for the whole family, including the child with ADHD. It could ruin the very point of vacation: to relax, bond with each other, and have a good time.
As parents consider whether to discontinue their children's ADHD medications for the summer, an additional benefit of stimulants that is little known, but important to consider is that concerning anxiety. Although the popular belief is that stimulants increase jitteriness and nervousness, actual research suggests otherwise: Stimulant medication appear to help kids with ADHD be less anxious.
For instance, a 2015 meta-analysis that reviewed 23 randomized controlled trials of ADHD treatment via stimulant medication found significantly less anxiety among the children who were taking the stimulants than among those who were taking placebos. The authors concluded that successful treatment with stimulants lowers anxiety by reducing the negative instances of peer conflict and academic problems most kids with untreated ADHD experience.
Another well-designed study found that children with both ADHD and anxiety experienced greater reduction in anxiety symptoms when taking stimulant medication than when taking a medication that more directly targeted anxiety. And a study published just this year showed that teens with ADHD who were first-time recipients of stimulant treatment reported not only less anxiety when taking the medication, but also greater quality of life.
Research shows that about 25 percent of children with ADHD also have an anxiety disorder. Many more have ongoing worries and fears that aren't quite diagnosable as a disorder, but get in their way of living their best life. And sometimes the best of living comes during breaks from school, not breaks from stimulant medication.
No decision about a drug holiday should be made without consulting your child's prescriber to weigh the pros and cons, and that goes for any type of medication. The decision about whether to discontinue a medication – even for a short period of time – should involve as much consideration as the decision to start the medication in the first place.
Happy summer vacation everybody – may it be safe, and healthy, and fun.