Should my child try a “drug holiday”?

If your child is on medication for ADHD, you may have heard of a medication vacation or a drug holiday. In short, it means taking a break from their usual medication — for a few days, weeks, or even months. It sounds simple enough, but deciding whether it’s right for your child is a different story.

On this episode of Parenting Behavior, host Dr. Andy Kahn talks with Dr. Liz Harstad, a pediatrician at Boston Children’s Hospital, to get the scoop.  

We’d love to hear from you. You can email us at ParentingBehavior@understood.org.

Related resources

• All about ADHD medication 

• The difference between stimulant and non-stimulant medication for ADHD

• A history of ADHD medication  

Timestamps

(1:30) Why would someone take a “drug holiday”?  

(2:29) How has thinking evolved over time?

(3:42) What are the impacts of a break?

Episode transcript

Andy: If your child is on medication for ADHD, you may have heard of a medication vacation or a drug holiday. Now, what this means is taking a break from their usual medication, whether for a few weeks, few days, or a few months. Sounds simple enough, but deciding whether this is right for your child, that's a different story.

This is "Parenting Behavior," and I'm your host, Dr. Andy Kahn. I'm a parent and licensed psychologist with over 20 years experience working with kids and families.

Today I'm joined again by Dr. Liz Harstad. Liz, how are you today?

Liz: I'm great. Thanks for having me.

Andy: Liz is a developmental behavioral pediatrician at Boston Children's Hospital and an associate professor at Harvard Medical School. She's been caring for children with learning and attention differences in developmental conditions for more than 15 years.

And today she's gonna talk to us about medication vacations. Before we jump into things today, I wanna say that we are not here to provide medical advice. Our aim is to provide high-quality information to help you learn more about ADHD medications and to feel better prepared to ask your own provider about these pieces of information.

Our aim is to provide high-quality information to help you learn more about ADHD medications and to feel prepared to ask good questions with your child's provider. Please don't make any changes to your child's current medications or treatment plan without consulting with your doctor or medical provider.

(1:30) Why would someone take a "drug holiday"?

All right, Liz, let's go into a few questions here today. Now, what are some of the reasons why someone would consider taking a medication vacation, or holiday?

Liz: Sure. Well, generally with stimulant medications, we do recommend consistent use of the medicine as long as it's a medicine that is working to reduce ADHD symptoms and has fairly minimum side effects.

Sometimes in talking with the child's health care provider, a decision will be made to take a break from the medicine perhaps to see if the medicine is still effective and needed for the child, or in situations where the best fit medicine is still associated with some side effects that we want to limit with having the medicine not be taken on a weekend or in the summer.

Andy: Gotcha. Now, I know that clinicians' understanding of medication vacations has sort of evolved over the years because of the scientific findings. Previously, breaks from ADHD and medication were thought to be a good thing, especially during summer, but now it seems to be a bit more hazy. Can you tell us about how things have changed and why?

(2:29) How has thinking evolved over time?

Liz: Sure. Well, in the past decade or so, there's been more and more research that just shows all the different ways that ADHD can impact a child. So we've known for a long time that ADHD can impact a child's learning and school performance. We now also know that it could impact a child's self-esteem, social interactions, safety.

An example is where do they choose to cross the street? Do they use a crosswalk or bolt across the street? And so, with that knowledge, we want kids to do the best they can every day of the week, not just on school days.

Andy: So, if people are gonna try a medication vacation, is there a typical length of a break that people would be using for their kids?

Liz: Well, it generally depends why we're deciding to take a break from the medicine. With stimulant medications, there are medicines that work quickly in your system and then wear off after a number of hours, depending on which medicine is being used. And so, just a day or two without the medicine can help us to know, are these ADHD symptoms still impacting a child, or does it seem as though they're not impacting a child as much as they used to, and maybe we wanna reconsider the need of medicine?

(3:42) What are the impacts of a break?

Andy: Gotcha. Gotcha. So, the idea of having this short half-life gives us the advantage of being able to see pretty quickly what's happening. Now, what are some of the risks of going off medication and then starting it up again? Well, as I said before, we know that ADHD symptoms can impact a child every day, not just on school days, and there are real safety risks of having significant impulsivity, hyperactive behaviors, distractibility.

I mentioned the example of crossing the street for adolescents. There are concerns about safety and driving, and risk-taking behaviors. For younger children, there could be risks that if ADHD symptoms are not treated, that may negatively impact their social interactions and ability to function in the family setting or in extracurriculars.

For each child. This is an individual risk benefit, but I think there are real risks of having the untreated ADHD symptoms if we know that a medication could reduce those symptoms.

Andy: Gotcha. So, in terms of the symptom management, obviously that's really important. Are there any medical impacts or any physiological impacts of going off the medication for periods of time and coming back on it?

Liz: That's a great question. For most people, they will tolerate or kind of not really notice a significant difference of stopping the medicine and then going back on it. Kids that are sensitive to some of the side effects of the medicines may reexperience them again if they've been off the medicine and are starting it up anew.

Andy: What types of children might benefit most from having a medication vacation?

Liz: Well, that's always an individualized decision that should be discussed with your child's health care provider. But situations in which I've commonly worked with the family to talk about a break from medication may involve a situation in which we wanna give some time without the medicine to see if the child's ADHD symptoms are still persisting and still warrant treatment or a situation in which the best fit medication for that child is still associated with some side effects, perhaps, decreased appetite and trouble with weight gain.

And so, having a few days, whether weekend days or summer days without the medication, allows the child to be free from those side effects.

Andy: That's so, so helpful. So, if someone's interested in [00:06:00] some of the benefits that could come from a medication vacation, but they don't necessarily want to take a break from the meds themself, what other options are available to them?

Liz: Well, keeping in mind how quickly the medicines work and how quickly they get out of your system, do have, for most kids, a few hours of time, at least each day, where we're seeing how they're functioning without the medicine. So, if we're wondering how helpful the medicine is and it's an eight-hour, you know, lasting medicine, we may wanna look at how they're doing later in the evening when the medicine wears off. So, if the question is really looking at how helpful the medicine is without missing a day of the medicine, we still probably have some time where we can monitor that.

Andy: So, parents gathering that data sort of behaviorally to know what that looks like throughout the day for their child is helping them better collect information to help them make good decisions, it sounds like.

Liz: Absolutely. Yeah.

Andy: OK, gotcha. Liz, thank you so much for joining us and sharing your expertise.

Thanks for listening to this episode of "Parenting Behavior" with Dr. Andy Kahn. We'd love to hear from you. If you have any thoughts on the show, you can email us at parentingbehavior@understood.org. I'll put the email in the show notes too, where you can also find more resources in links to anything we mentioned.

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