A couple of days ago, Nicole, the mom of one of the ADHD kids in my practice visited my office for her scheduled blood pressure check. As soon as we finished evaluating her hypertension therapy, she asked if we could discuss a problem with her 11-year-old ADHD son Michael.
She told me that one of her best friends had told her that she was supposed to take her son off of his ADHD medications during all holidays, on most weekends, and during summer vacation “because his body needed to wash-out the drugs to keep from hurting him!”
On this advice alone, she stopped Michael’s Adderall two and one-half weeks prior to our discussion. Things reportedly went ok for the first 10 days, and she was sure he didn’t need the medication at all. In fact, she flushed the rest of his pills and told the family he wasn’t ADHD any longer.
Then, suddenly Christmas was over. Gone were the lights, the excitement, and all of the stimulation that came from everyone’s attempts to spread good cheer. She said within two days, Michael just seemed to fall apart.
He quit doing chores, wouldn’t clean his room, didn’t go to bed until 2 or 3 AM, had a hard time sitting still for more than a few minutes, and argued over the littlest things.
Michael was supposed to do a book report over the holidays. But his mom discovered just 5 days before the end of the holiday break that he hadn’t even started reading the book and had no idea where the book was. He argued that he hated book reports and that he didn’t care if he failed that assignment “because he had a B in that class and he only needed a C to pass”.
Nicole was furious, as they had worked so hard to raise his grades from “D’s” and “F’s” to “B’s” and “C’s” over the past year. All she could think of was that he was going to start making failing grades again. Everyone would once again think she wasn’t a good mother – it would be embarrassing!
Nicole and Michael were both victims of bad advice!
There are many reasons NOT to stop an ADHD child’s or teen’s medications abruptly. I’m sure you can think of a few right off the top of your head- like-abruptly stopping a stimulant ADHD drug can cause rebound impulsivity and irritability, a suddenly worsened recurrence of both behaviors.
Stopping ADHD Drugs For Holidays Can Make It Worse
Many parents are either talked into or decide for one reason or another to stop their ADHD son’s or daughter’s ADHD medication during holidays, during school quarter breaks, over the summer or on select weekends.
I try to discourage this practice and ask that they only discontinue their child’s ADHD therapy in cases of emergency, without first discussing their plans with me or my nurse.
Why? Well…. Think of ADHD drugs as being sort of like a blood pressure pill (some are actually based on pills that lower blood pressure). Or say Insulin, both medications meant to be taken on a regular schedule.
Just like these two therapeutic drugs, ADHD drugs don’t work best until they reach what is called a “steady state level” in the blood stream.
When the drugs are not given for 2 to 3 days at a time, blood levels fall below these therapeutic levels and it takes several days once the medication is restarted for it reach that optimum blood level and to become fully effective again.
What happens to your child when all of this is going on?
After the second day of not getting his or her ADHD medication, attention span starts to drop, impulsivity and bad attitude episodes recur and increase, and hyperactive behaviors start happening again or worse.
Of course, as your child’s ability to focus falls, so do his or her grades. Likewise, as impulse control suffers, he or she will act up in and disrupt class again!
It will take anywhere from 5 to 12 days for blood ADHD drug levels to return to “normal or therapeutic” and start to work again and during what will seem like forever, you will believe the medications aren’t working!
Guess what? Not giving an ADHD child their medication can cause confusion about whether the medication is actually working and as a result has caused many a teacher or parent to think the affected child has been misdiagnosed as ADHD. This usually happens when that parent or teacher didn’t know the ADHD drug had been stopped.
A word of caution: Suddenly stopping ADHD drugs derived from antihypertensive medications can cause a severe elevation of your child’s blood pressure called “rebound hypertension”. This can be a life threatening emergency and might cause hospitalization.
Always discuss your child’s medications with your doctor and thoroughly read all handouts given by your pharmacist.
Stopping ADHD Medications May Cause Social Behavior Problems
Within just a couple of days of stopping ADHD drugs, blood levels fall to almost zero and an ADHD or behavior disorder child will often start showing the very same symptoms he or she had when the diagnosis or misdiagnosis of ADHD was originally made.
Above I mentioned the social issues of stopping your ADHD child’s or teen’s medications during holidays and vacations. I’d like to explain what happens when an ADHD child is no longer able to control his or her impulsivity or concentrate sufficiently on maintaining his or her social interaction skills.
I’d like to explain what happens when an ADHD child is no longer able to control his or her impulsivity or concentrate sufficiently on maintaining his or her social interaction skills.
Many experts agree that behavior disordered kids have problems with social skills making and keeping friends playing with others-dating-meeting strangers working on a job with others. Because they don’t pay close enough attention to the little things required to interact with others.
When a child can’t pay attention or focus on his or her immediate surroundings they will often miss the words-(verbal cues)-the small hand and face gestures-and the body movements that allow the rest of us to understand what is going on in a conversation with friends, family, co-workers and other students. As a result, these kids often misunderstand how others are trying to relate to them and how they are perceived as interacting with those others.
The behavior-disordered child’s failure to be able to see and understand these clues may cause them to misunderstand simple invitations to do things like go to the mall and hang-out-participate in a ball game or join a sports team or take a date to a party. Well…I’m sure you get the idea by now.
When an ADHD child doesn’t get his or her medications during the holidays or summer vacation, they might just miss out on all of the social things that help them develop friendships, learn athletic skills and have fun. These just happen to be the things necessary for normal emotional and social growth!
Of course, if your behavior problem child was misdiagnosed as ADHD, when in fact, he or she really has something else causing their behavior problem.
Once a medication is stopped the real medical-social-psychological problem will pop back up! It could be one of the more than 53 things that mimic ADHD causing misdiagnosis and labeling.
ADHD Drug Vacations Can Cause Learning Problems
Stopping ADHD Drugs during vacations can cause severe learning problems and damage self-esteem.
As we’ve discussed, ADHD children need to be able to pay attention and avoid excessive impulsivity to absorb the social things that help them develop friendships and get along with others, even when they are not in school.
Likewise, these very same kids and teens, when behavior is normal, should be able to learn new things and adapt old skills during holidays and vacations that will help them make good grades when they return to school.
Normal Child Activities
A child’s normal emotional maturity, social growth, and academic growth require they be able to pick up on and use the little things that help them learn. These include:
• Being able to absorb and remember what others say or what the child sees, feels, hears or senses
• Having a heightened level of curiosity that pushes the child to discover new and stimulating things (Like-reading a book, taking a radio apart to see how it works, joining a ball team or a Scouting group, building a tree house, going on his or her first date)
• Restraining impulsivity and risk-taking behavior only to the extent that they avoid placing themselves in danger or harm others
• Picking up learning clues from other children (We know that about 25% of what a child in a classroom or in participation sports learns is learned by listening to and observing the other kids in the class or on the team and adapting it for their own use)!
When a child doesn’t take his or her ADHD drugs during the summer or over the holidays, all of these “extra learning senses” suffer and the ability to learn and adapt to the new and to the old drops like the proverbial rock.
This places your child at a great disadvantage when they finally return to school, as the non-ADHD children will have read books, formed new and interesting friendships, and absorbed and retained memories and skills that help them succeed in the coming school year.
He or she will feel frustrated by being behind or as one child, Jason, put it. “The other kids said I got dumber over summer, instead of smarter like them”.
You should always discuss your child’s ADHD medications with your doctor before stopping them.
It can take several weeks for both the blood levels and therapeutic effects of ADHD drugs to kick back in!