Starting and Stopping ADHD Medications

ADHD Basics

A teen waiting to see his pediatrician.
Talk to your pediatrician before stopping your child's ADHD medication. Photo by Getty Images

ADHD is a condition that is well-recognized by most parents, teachers, and pediatricians.

Kids with ADHD symptoms typically have problems paying attention, get easily distracted, and/or are hyperactive and impulsive.

Starting ADHD Medications

It is often clear when a child needs to start ADHD medications, as their ADHD symptoms are causing some form of impairment so that they have:

  • trouble in the classroom and are falling behind at school

For these children, an ADHD medication -- usually a stimulant -- is the recommended ADHD treatment to target these core ADHD symptoms. Behavior therapy, instead of or in addition to a stimulant, is also sometimes recommended.

Stopping ADHD Medications

It is usually a lot less clear whether your child should be taken off ADHD medication after he has been doing well for some time.

Should he take them for the rest of his life, which might seem reasonable to some parents as many adults are now getting diagnosed and treated for ADHD?

Or should your child stop taking his ADHD medications:

  • because he is having too many ADHD medication side effects, like a decreased appetite, insomnia, feeling too calm, or moodiness?
  • when he doesn't want to take it anymore, often when he becomes a teenager?
  • at the beginning of every school year to see if he actually needs them anymore?

By themselves, none of those are really good reasons for a child to stop taking his ADHD medications. For example, if he is simply having too many side effects, a lower dose or medication change might be better than just stopping medications altogether.

Unfortunately, once a child is on an ADHD medication and doing well, many parents and pediatricians don't want to "rock the boat," and will continue the medication from one year to the next, never really considering if it is still necessary.

It is important to keep in mind that the American Academy of Child and Adolescent Psychiatry (AACAP), in their practice parameter on treating kids with ADHD, does state that:

"Patients should be assessed periodically to determine whether there is continued need for treatment or if symptoms have remitted."

As a part of this assessment, some signs to look for that could indicate that your child might be able to stop his ADHD medication include that:

  • He has been well-controlled and free of ADHD symptoms for at least one year while taking medication.
  • You haven't needed to increase his dose of medication, despite the fact that he has grown and gained weight in the past year or two.
  • ADHD symptoms are not noticeable on days that you don't give him his medication or he forgets to take it.

    Keep in mind that not every child is going to be able to stop taking his ADHD medication when he gets older. ADHD symptoms likely are never outgrown, although hyperactivity symptoms often decrease as a child gets older. Some children, depending on the severity of their ADHD symptoms, may be able to manage without medication. Others continue to take medication all through high school and even when they go off to college.

    When to Stop ADHD Medications

    If you, together with your pediatrician and your child, decide that stopping his ADHD medication might be a good idea, it is important to choose a good time to try it.

    Stopping an ADHD medication at the beginning of a new school year or other high-stress time is rarely a good time, and almost sets your child up to fail a trial off medication.

    Instead, wait for a low-stress time when your child is in a good routine at school -- perhaps after a round of tests, when school might be a little easier. Even a vacation might not be a good time, since your child won't have the same demands as he would at school, such as reading, going to class, studying, etc.

    Once you do stop his medication, be sure to regularly check and make sure that your child is continuing to do well. If his ADHD symptoms become more apparent and affect his school work, how he interacts with his friends and family, or other things, then consider talking to his pediatrician about restarting his medication.

    Don't just wait for your child's next report card, though. Instead, give each of your child's teachers an ADHD questionnaire to fill out in about two weeks, such as the Vanderbilt Assessment Follow-up form. A parent form is also available, and both can be scored by your pediatrician to make sure your child's trial off his ADHD medication is really working.

    Teens and ADHD Medications

    Since the non-medical use of stimulants or abuse of Ritalin and Adderall is an increasing problem in teens and young adults, most parents likely wouldn't think that getting teens to take their prescribed ADHD medications would be a problem.

    Unfortunately, compliance with taking their ADHD medication often becomes a problem for teenagers, both for teens who have been taking their medication for years and those who are just starting to take something. In fact, growing feelings of independence among teenagers often make them resistant to taking any medications for chronic conditions.

    You might be able to improve teen compliance, if a trial off medication isn't a good option, by:

    • getting your teen involved in the decision on whether or not to continue taking his medication, instead of simply trying to force him to take it
    • making sure your teen understands that his ADHD medication isn't a cure or crutch and is like taking any other medication for a chronic condition, like using an inhaler for asthma
    • talking to your pediatrician and making sure your teen doesn't have another problem, such as depression, anxiety, oppositional defiant disorder, drug use, etc., that is contributing to his non-compliance
    • adjusting your teen's medication dosage or changing medications if side effects are a problem, even settling for a reduction in ADHD symptoms instead of trying to get rid of them all together
    • considering allowing your teen to take breaks from his ADHD medication on weekends and other breaks from school
    • getting help at school or after school, such as extra tutoring, when trying a trial off ADHD medications

    Extra counseling and behavior therapy are also good options if your teen resists taking his medication and his grades, relationships, and behavior at home begins to suffer.

    Sources:

    AACAP. Practice Parameter for the Assessment and Treatment of Children and Adolescents With Attention-Deficit/ Hyperactivity Disorder. J. Am. Acad. Child Adolesc. Pychiatry, 46:7, July 2007

    American Academy of Pediatrics Clinical Practice Guideline. ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. 108(4):1033.

    Wolraich ML. Attention-deficit/hyperactivity disorder among adolescents: a review of the diagnosis, treatment, and clinical implications. Pediatrics. 2005 Jun;115(6):1734-46.

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