ADHD Drug Holidays: Should Your Kid Get One?
Experts debate the pros and cons of giving kids a break from ADHD drugs.
Drug Holidays: What to Expect continued...
Pam Feldman, a social worker who lives in Ferndale, Mich., twice forgot to give her 9-year-old son his dose of Ritalin. Mere hours after he left the house, she got calls from teachers and a camp director asking her to pick him up or otherwise get him under control.
The experience forced Feldman to set up a system where her son can't miss his pill in the morning -- it's there, in his orange juice cup.
"I learned my lesson, and now I'm afraid to not have him on it," she says.
Yet, Feldman says she still halves his dose of Ritalin on the weekends. Why? Because she fears that she is seeing him only when he's on his medications and that he won't learn to control his behaviors without them.
"It's my fear of medicating him too much. Part of impulsivity is sensory overload; at home, when it's just us, he doesn't have that. From 3:30 to 5:30 on, it's just him," she says.
"We have to learn to love our children and deal with them," she says. "On the other hand, the rest of the world doesn't have to.''
ADHD Drugs, Weight Loss, and Growth
Fear of overmedicating a child is overshadowed by a fear of weight loss and growth lag, Vitiello and Wolraich say.
Stimulants tend to curb the appetite in many children, and studies have shown that while on medication, boys especially lose ground in their expected growth by about half an inch a year -- during the first 2 years of treatment. Their growth after that does not seem to be affected, and in some cases catches up, even if they continue taking the meds into adolescence.
"It's not all kids who don't grow. But if you look at the average, it lasts about a year or 2. The effects haven't been seen on long-term growth," Wolraich says. "That's why we recommend monitoring height and weight. If there is a decrease in growth, it's something being followed closely.''
Why stimulants delay growth in the first place is an unknown, Vitiello says. It isn't only because of a loss of appetite, but also may be due to changes in levels of testosterone. Vitiello cites a study involving monkeys in which the onset of puberty was temporarily delayed in those who were given Ritalin for 3 years.
"This may explain the slight delay in human growth," he says.
Will Your Child Need to Take ADHD Drugs Forever?
Maybe not. Another virtue of taking a break from meds is to see if a drug -- or the same dosage -- is needed, Vitiello says.
"ADHD is a developmental condition that oftentimes persists, but not necessarily; symptoms of hyperactivity, especially, tend to decline with time," he says. "I don't know how often it happens clinically, but it happens that children may really need the medication through a certain period of development, and after that they're more able to control themselves and need less of medication or none at all.''
The 1999 Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder, a landmark study conducted by the National Institute of Mental Health with 579 children aged 7-9, recommends a trial without medication if a child's symptoms have been stabilized after 2 or 3 years.