Should my child take an ADHD drug holiday?

If your child is being treated for ADHD, you may have heard about an “ADHD drug holiday” or an “ADHD medication vacation.” A drug holiday is a planned break from stimulant medication. It might be for a weekend, a vacation week, or the entire summer.

The idea for ADHD drug holidays was based on the premise that kids didn’t need to focus as much when they weren’t in school. Taking a break from medication would give them a break from possible side effects. 

But experts are now questioning the benefits of medication vacations. Many don’t recommend them anymore, especially if the medication is working well with few side effects. 

“We’ve known for a long time that ADHD can impact a child’s learning and school performance,” says Liz Harstadt, MD, MPH, on an episode of Understood’s podcast, Parenting Behavior With Dr. Andy Kahn.

“We now also know that it could impact a child’s self-esteem, social interactions, and safety,” adds Harstadt, a developmental-behavioral pediatrician at Boston Children’s Hospital and an Understood Expert. “We want kids to do the best they can every day of the week, not just on school days.” 

Drug holidays are most commonly used when medication affects physical growth. Research suggests that stimulant drugs may reduce growth in height in some kids with ADHD. A 2021 analysis showed a drop in growth of 1 cm (one-third of an inch) per year in the first three years of taking the medication.¹

In cases where growth is a concern, Harstadt works with families to give appropriate breaks. “Having a few days, whether weekends or summer days, without the medication allows the child to be free from those side effects,” she explains on the podcast.

A common side effect of stimulants is decreased appetite. This can lead to weight loss in some kids, especially in the first year of taking the medication.¹ But before recommending a break, prescribers may try other strategies.

“I often recommend taking the medication with or right after breakfast and to start the day with a sufficient and healthy meal,” says Dannah G. Raz, MD, a developmental-behavioral pediatrician at Phoenix Children’s Hospital. She also suggests adding healthy calories to meals with foods like avocados and hummus.

Sleep problems are another side effect that drug holidays are meant to relieve. Research suggests that stimulants could make sleep issues worse. But trouble with sleep is a common side effect of ADHD itself. So it’s clear now that kids with ADHD can struggle with sleep with or without medication. 

“If your child is experiencing sleep issues after starting an ADHD medication, a drug holiday may not be the best approach,” Raz says. Instead, your child’s prescriber might recommend fine-tuning the dosage or switching drugs. They might also recommend melatonin supplements. 

Another reason for taking a drug holiday is to see whether a child still needs the medication. A 2021 review of studies notes that 30 percent of kids didn’t have their ADHD symptoms when they stopped their medication.² 

It’s common for kids with ADHD to have periods of “remission” as they move toward adulthood. In about 30 percent of kids, symptoms are reduced to the point where they don’t meet diagnostic criteria for the time being.³

Remission typically doesn’t last, though. Symptoms usually return at some point, but they may look different as kids get older. Stopping medication at times, even briefly, can show if symptoms are still causing difficulties.

“Many stimulant medications wear off after a number of hours,” Harstadt explains. “So just a day or two without the medicine can help us to know, are these ADHD symptoms still impacting a child?” If not, she adds, “Maybe we want to reconsider the need of medicine.”

The main reason to avoid medication vacations is that they make life harder for kids. ADHD can cause challenges in all aspects of a child’s life, from sports to social activities to summer camp. Without medication to reduce symptoms, kids can face daily struggles. 

Here are some ways drug holidays can affect kids with ADHD:

Drug holidays typically take place at times when kids don’t have to face the demands of school. For most kids, weekends and school breaks are times to relax, recharge, and enjoy activities. But when kids with ADHD aren’t taking their medication, time away from school can be more stressful than time in school. 

ADHD medication helps keep kids with ADHD safe. It reduces symptoms that can put kids at risk, like hyperactivity, impulsivity, and distractibility. Kids with ADHD are more likely to do dangerous things when they’re not medicated. For example, they might dart into the street, jump on a bicycle without a helmet, or drive way too fast.

Research suggests that when kids and teens with ADHD are on stimulant medication, their risk of trauma-related injury goes down. The results were the same for boys and girls.⁴ 

When you’re thinking about medication vacations, consider what’s going on in your child’s life at the time. Major life changes, stressful circumstances, and times when kids are already depressed or anxious are difficult to begin with. Being off their meds can make tough situations harder to handle. 

Drug holidays may not make sense for kids who are sensitive to the initial side effects of ADHD medication. Every time they restart the drug, they have to adjust to it all over again, Harstadt notes.

If you’re weighing a drug holiday for your child, Raz suggests asking your prescriber these questions: 

• Is this medication appropriate for a drug holiday?

• What are the potential benefits of a drug holiday for my child?

• What are the potential downsides for my child?

• What will it look like if a drug holiday is not working out?

• What signs indicate that we should restart the medication?

You want to make sure that a drug holiday is a good idea for your child’s needs and that it won’t create more problems than it solves.

If your child takes a break from ADHD medications, there are steps you can take to make it go more smoothly. First, talk to your child about what it might feel like to be off medication. 

“Discuss ways to feel more regulated without it, such as taking deep breaths, asking for a hug, going into a quiet room — whatever works for your child,” Raz says. “Come up with some problem-solving strategies ahead of time so that everyone in the family can be prepared.”

More tips for managing ADHD symptoms during a drug holiday:

• Create a routine to help your child stay on track.

• Help them stay organized. Create homes for all their belongings.

• Help them break down plans or tasks into manageable steps.

• Use clear, brief directions if you need them to do something.

• Use lots of praise and positive reinforcement to reward their efforts.

• Plan extra physical activity to improve ADHD symptoms.⁵

There’s a lot to think about when you’re deciding on drug holidays. Your child’s prescriber can offer guidance tailored to your child’s needs and circumstances.

It used to be common for kids with ADHD to take “drug holidays” from their stimulant medications. Pausing medication over weekends and holidays gave kids a break from possible side effects like poor sleep, low appetite, and slow growth. 

The thinking was that kids didn’t need to focus as much when they weren’t at school. But health care professionals now recognize that ADHD symptoms affect kids in every area of life. And they’re less likely to recommend drug holidays.

Health care professionals have also learned more about the side effects of ADHD medication. Research shows that for most kids, any reduction in height is slight. Kids with ADHD often have sleep issues with or without medication. And changes to diet can help with weight loss.

Every child is different. Breaks can be helpful for kids who have significant side effects. It’s important to talk to your child’s prescriber before you make any changes to treatment plans.

Understood is not affiliated with any pharmaceutical company.