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Medications for ADHD in Summer

by Lewis D. Resnick, MD, Mason Pediatrics, Mason, Michigan

Article from the LDA Newsletter

 
With summer at hand, whether or not to continue medication for students with ADHD is again with us. As with so many other decisions the answer is not the same for everyone; indeed, the devil is in the details. The details include the child’s temperament, strengths and weaknesses as well as the family’s summer plans.

Kids playing
First of all let me clarify the terms since there has some variation in wording. We will stick to the definition used in DSM-IV which applies the label ADHD, Attention Deficit-Hyperactivity Disorder, to all persons who qualify for the diagnosis, whether or not they have hyperactivity, whether or not they show significant inattention.

 
Due, in my opinion, to the broadening of the definition and the greater appreciation of ADHD issues at the middle school level and above, the group is becoming larger each year. Estimates of the prevalence in the American population range from 4% to over 12%.

 
It is thought that a large percentage of students identified as L.D. meet the medical criteria for ADHD. A figure often quoted is about 30%. Thus, decisions about medication for ADHD are highly pertinent to those who deal with L.D. kids at school and home.

 
The most easily overlooked are those with only problems concentrating (DSM IV: ADHD, primarily inattentive type) who can have normal activity levels or are actually underactive. This is more common in girls and presents more problems in the school setting than at home.
A group of ADHD youngsters who can have more behavioral issues in school but fewer academic ones are the individuals with the hyperactivity but much less trouble with attention and concentration (DSM IV: primarily hyperactive-impulsive type). These kids form a smaller group and may not be identified as ADHD but acquire descriptive adjectives such as restless, ambitious, difficult, etc. unless or until they start to fail.

 
The largest group within ADHD is the type who has all three traits, inattention, impulsiveness and hyperactivity (DSM IV: combined type). This is the group that first defined the syndrome when we called it “Hyperactive Child Syndrome” and “Hyperkinesis.” It is the group that comes to mind when most of use think of Attention Deficit Disorder.

 
In short, there are three major divisions within ADHD as defined in DSM-IV.

 
Then, of course, there are traits which are not used to define ADHD but bring a disproportionate amount of negative attention to these folks. The oppositional students who want to do the opposite of what they are asked or have an unexplainable instinct to disagree regardless of what is said or proposed. And there are the ones with Conduct Disorder who behave outside the rules of conduct, whether it is just accepted behavior or, actually, the Law.

 
This brings us to the major purpose of the article that is the decision about continuing medication through the summer. The decision relates directly to the kind and degree of ADHD one is trying to deal with. For the primarily inattentive child whose problems are largely academic, one would think medicine would not be necessary. For the underactive-inattentive child the stimulant nature of the meds might bring the activity up to the normal level. In the case of the hyper-impulsive child, medicine might be advisable but its use would be influenced by some factors that will be discussed below. For the oppositional child or easily frustrated one, medication would probably be a good idea. Though for some teens who want more control or resist taking medicine, it may not be worth the fight. In people with Conduct Disorder it is likely that a stimulant will not control all their issues. Even if it did, what happens after med wears off in the evening?

 
The summer situations are another important factor. Should the student be enrolled in summer school, the same factors that influence the decision during the school year would likely apply. If medication helps the child concentrate, complete work in a room full of children and exercise self-control, then it would be appropriate. The proper drug could help the child complete homework more efficiently during the summer just as during the school year.

 
Lets look at the situation of the child with combined-type ADHD who has benefited from a stimulant drug during the school. Suppose the child is busy with a soccer league and spends the rest of his time riding or doing mechanical work on his bike or glued to his Play Station. In what situation would it be necessary to medicate such a kid? I would guess probably not except, perhaps, when the family is cooped-up driving to Mt. Rushmore for the family vacation.
 
In summary, the factors that affect the decision to use medication for a child with ADHD need to be considered in a thoughtful way. The factors include the child’s temperament, strengths and weaknesses as well as the particular summer plans. Some will need medication in certain summer activities but not in others. As is generally the case, we are all better off without drugs unless there is a clear benefit by their use. Medications are very successful in the management of ADHD but they do not necessarily need to be continued year round for all children.

 

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