Should My Child be on Medication for ADHD in the Summer? 

by Jay D. Tarnow, M.D.

As we move closer to summer, the question on many parents' minds is: "should we keep our child on medication for ADHD this summer, or should we take a 'medivacation'?" There is not a simple answer to this question, as it depends on the individual child. What are the needs of the child? What side effects does the child have when taking the medication? Just as important: what side effects will the child have when not taking the medication?  Will his behavior be so difficult that he will be getting negative feedback from family and friends? Feelings of competence and confidence are keys to effective self-management, and negative feedback can act like Kryptonite, damaging the child's self-esteem. Low self-esteem can lead to depression, anxiety, and even substance abuse in adolescence.

Many parents wonder if the child will learn appropriate behavior and Self-ManagementSM skills while on a medivacation. Countless research studies and my own experience have shown that children with ADHD learn better on stimulants. Thus, for children who need to continue developing skills in the summer or on weekends I recommend staying on the regular medication routine. The question becomes more complicated when the child has a predominantly inattentive type of ADHD. Inattentive children do not often have the same behavioral problems as hyperactive/impulsive children, but they still need to learn effective self-management. If these children are also struggling with Auditory Processing Disorders or Nonverbal Learning Disorders, they run the risk of missing a great deal of information. Untreated ADHD makes these disorders worse because the children cannot attend to all of the data being presented. They could benefit from staying on a medication that provides sufficient stimulation necessary for the brain to grow.

In cases where parents are worried about the side effects of medication, such as decreased appetite or weight loss, I would recommend using a lower dosage or using an alternating schedule of medication days. As long as behavioral problems are not an issue, children who go to summer camp may be able to come off of their medications completely. Summer camp offers a fun, stimulating atmosphere that will keep your child engaged, effectively replacing medication.

Another reason the summer is a good time to have your child take a medivacation is to evaluate progress and assess the effects of the medication. The summer affords an excellent opportunity for this evaluation because the heightened demands of school are not present. This is the time to ask: where were we at this point last summer? Was this past year better or worse? How? What are our goals for the upcoming year? How has the medication helped or hindered our attainment of these goals? What modifications do we need to make? Stimulants are the easiest medication to use in such evaluations. They only work for a circumscribed period of time and do not need to build up in the body to be effective. Negative side effects tend to diminish with regular usage, and there are minimal withdrawal effects, meaning that one medication can be stopped and another started with minimal transition. This means that different stimulant medications can be tried and compared during a time when experimentation will have little consequence for the upcoming school career. I use a sophisticated computer program in my office that takes only 30 minutes and gives me very helpful information about how a medication is affecting a child's cognitive functions.

In summary, summer is a good time for evaluation and new learning. It is the ideal time for your child to learn the types of things that he or she doesn't have time to learn during the school year. The time away from school gives us more of an opportunity to evaluate the past year and plan for the future. We can experiment with different stimulant medications to see which is more effective, or use the extra time to try Atomoxetine (Strattera), a non-stimulant ADHD medication that requires about 3 weeks to see the effects. This experimentation can also include decreasing dosage or taking a full medivacation altogether. It is important to remember, however, that any changes to your child's medication should only be made after consulting with your physician. Have a wonderful and stimulating summer!

Jay D. Tarnow, M.D.