January 3, 2014
For children who take medication for ADHD (attention deficit hyperactivity disorder), is discontinuing their medication for travel a sensible option?
Here are some thoughts:
1. You’re not alone in having to face this question. One in ten American children have been labeled as having ADHD. Four to five million take medication. And the numbers are climbing: children with ever milder behavioral issues are being classified as having ADHD, more schools are recommending children be medicated, and there is less stigma than in the past about having ADHD and being on medication.
2. Believe it: human behavior is profoundly affected by drugs. The vast majority of health professionals, teachers, and parents believe that the correct medication, properly dosed, improves focus and reduces activity, impulsivity, and inattention. This in turn prevents children from developing anger and hopelessness, for example, due to repeatedly being disciplined for behavior that they are unable to control.
3. Why then even consider discontinuing ADHD medication for travel? Medicating children remains controversial, and rightly so. (See NY Times, December 15, 2013. The Selling of Attention Deficit Disorder.) Medications may have serious side effects. Discontinuance is the only reasonable way to judge if medication is still necessary. Medication is given mainly to control school behavior. Non-school periods may be less stressful – and may be the best time to judge if kids can function drug-free.
4. But travel may be just the time that children with ADHD need medication most. Travel eliminates the cornerstone of behavior modification: routine, routine, routine. Worse, it substitutes situations that trigger impulsive behavior – eating meals in restaurants, dealing with strangers, and sleeping in new surroundings, for example. If discontinuing medication does cause problems, those problems are best handled at home. There is some evidence that continuous medication controls symptoms better than stopping and starting.
5. Discontinuing medication should be based on three considerations. One: the child’s chief issues. If it is lack of focus with little or no hyperactivity or inappropriate behavior, a “drug holiday” may be reasonable. If the main issue is hyperactivity, impulsiveness, and fearlessness, discontinuance in new surroundings increases the risk of accidents, getting into trouble, and becoming lost. One positive sign for discontinuing is that the child has been well controlled with medications in recent months and did well on previous drug holidays.
6. The 2nd consideration: practical issues. How much structure and discipline can you provide on the trip and are you prepared to deal with serious behavior issues should they occur? Does your upcoming trip involve features that could be troublesome (for example, long car rides or overnight flights)? Will poor behavior adversely affect other children in your family or host families you will visit? Does the child want to stop medication (many will not)? Does the child have other issues, anxiety or depression, for example? Consult your child’s health professionals.
7. The 3rd consideration: which ADHD medication is your child taking? More than a dozen drugs exist and fall into two categories, stimulants and non-stimulants. Stimulants – Adderall, Concerta, Ritalin, and Vyvanse, for example – lend themselves better to stopping. They become effective within hours of starting and stop working hours after stopping. Non-stimulants – chiefly, Stattera – require days to become effective and remain active, with decreasing effectiveness, for many days, perhaps weeks, after the last dose.
8. Travel-related activities may change the desired effect of ADHD medication. Medications are dosed to control behavior at specific times of the day when “meltdowns” tend to occur (school hours, late afternoon, and bedtime), but not interfere with sleeping. Travel can change meltdown hours and bedtime, especially if travel is through many time zones. Travel-related medications (anti-motion sickness substances, for example) may alter the desired effects of ADHD substances. Check with your prescriber.
9. Carrying certain ADHD medication may cause problems abroad. Keep items in their original, labeled containers; carry only a reasonable amount; and have a letter from the prescriber. Many ADHD drugs are derivatives of amphetamines, a substance tightly controlled or banned in some countries. However, reports of travelers having legal problems for carrying these drugs are extremely rare. If you carry a three-month supply, for example, check with the consulate of the country you visit.
10. Should you stop medicating ADHD children for summer camp? Some parents do so without informing the camp. This can place the child and a whole group at risk. Camp activities require children to be focused, alert and cooperative. Making friends is often an issue. Camp directors are generally familiar with ADHD issues and should be included in discussions about discontinuing medication.