At a recent ADHD Curriculum Development Workshop sponsored by Johns Hopkins University Continuing Medical Education, Dr. Rubin proposed a change in the practice of drug holidays based on recent study results and newer medicine attributes. A "holiday" implies desire or need to get away from unpleasant or arduous circumstances. This practice came about from the days when the usual ADHD treatment was short acting stimulant control of disruptive school behavior. Medicine holidays were done when school was out, to "let boys be boys", and for relief of appetite and personality suppression side effects. However, modern studies like the NIMH Multi-Modality Treatment of ADHD show that continuous, not intermittent, medicine treatment has better behavioral outcome. We have also learned to recognize the need for treatment of ADHD symptom consequences and risks outside school settings. In addition, since poor compliance with medicine use frequently compromises benefit, fostering holidays in our practice procedures may encourage inappropriate lapses in treatment.

A more modern practice would be continuous treatment that includes monitoring for specific circumstances requiring medicine re-evaluation. Such planned medicine discontinuations should be done under the prescribing physician's supervision. For example, while the vast majority of children do fine with extended stimulant use, those having weight loss or growth velocity decrease require review of the medicine choice. Changing the medicine could be better than discontinuation with loss of all treatment benefit. We now have options of medicines with less growth concern to consider.   Alternatives are also available for patient and parent dissatisfaction with personality suppression effects. Other reasons for medically supervised re-evaluation include signs of combined mental health disorder occurrence, medical illness coincidence, ADHD changes at key developmental stages, and adapting medicine effects to an individual's changing life situation needs.

Dr. Rubin practices Child and Adult Psychiatry, directs The Clinical Study Center in Burlington Vermont, and serves as Clinical Associate Professor at the University of Vermont College of Medicine. Click here for more information about Dr. Rubin and ADHD.

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Comorbidities Common in AD/HD Parents
It's no secret that parents of kids with AD/HD often have the disorder themselves. But a recent study suggests they may have more than just AD/HD.

The University of California at Los Angeles study involved 435 parents of AD/HD children. Among parents who also had AD/HD, 87 percent had at least one additional chronic psychiatric disorder. Fifty-six percent had at least two additional disorders. In addition, the parents with AD/HD were more likely to suffer from depression and substance abuse, and were less likely to have a college degree.

The study was published in the September 2005 issue of the American Journal of Psychiatry.

Medication and Alcohol Don't Mix
Mixing alcohol with Ritalin and other AD/HD medications that contain methylphenidate can be deadly. After hearing of the deaths of two college students who drank alcohol after taking methylphenidate, researchers at the Medical University of South Carolina tested the effects of mixing the two. When the 20 subjects ingested alcohol along with methylphenidate, they absorbed the drug much faster, and their blood pressures rose to potentially dangerous levels. In addition, drinking seemed to amplify methylphenidate's side effects, especially in women.

The study was led by Kennerly S. Patrick, Ph.D., professor of pharmaceutical sciences at the university. It was presented at the annual meeting of the American College of Clinical Pharmacology.

This article was reprinted with permission from ADDitude Magazine.