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.
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
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 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.