ADHD Drug Holidays: Should Your Kid Get One?
Experts debate the pros and cons of giving kids a break from ADHD drugs.
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.''
Deciding on a Drug Holiday
Again, flexibility is important when discussing drug time-outs with the doctor, Wolraich says.
That conversation should happen at the time the child is diagnosed with ADHD and placed on medication.
"We have a discussion right from the beginning," Wolraich says. "I get a sense of the family's and patient's preference and we come to a decision about when they need meds. We'll review when children are having problems and need coverage, and weigh the benefits of covering those other times of the day.''