How to keep ADHD kids happy and healthy all summer long. Plus, is summer the right time for a medication vacation?
By Denise Mann
WebMD Magazine – Feature
Reviewed by Amal Chakraburtty, MD
When her son Anthony was diagnosed with attention deficit hyperactivity disorder (ADHD) at age 6, Mary Robertson quickly became an amateur travel agent during his summer vacations.
She didn’t have much of a choice. “One day Anthony came home hiding a handsaw behind his back because he had sawed down a neighbor’s tree to see how old it was,” recalls the oncology-nurse-turned-ADHD-patient-advocate. “I realized pretty quickly that to stay at home and not have something planned was not gonna work.”
Robertson’s challenge is one all parents face, especially during the summer, and doubly so for those who have kids with ADHD, a behavioral disorder that affects about 2 million children in the United States, according to the National Institute of Mental Health in Bethesda, Md.
ADHD is marked by inattention, impulsivity, and/or hyperactivity, which means that children with the condition may act quickly without thinking; can’t seem to sit still; will walk, run, or climb around while others are seated; and are easily sidetracked by what is going on around them. For these reasons, they may have difficulty at home and school, and in forming and maintaining relationships with their peers.
“During the summer, you have to have a plan. You can’t just wake up in the morning without an itinerary, or [ADHD kids] will figure out things to get into,” says the Lexington, Ky.-based mother of Anthony, now 20, and his sister Samantha, 17, who both have been diagnosed with types of ADHD. “The best thing you can do is to take them somewhere,” she adds. “We have been to every park that there is. My son’s kindergarten teacher even complimented me on the fact that Anthony was so worldly.”
ADHD Summer Tip 1: Stress Structure
“If children with ADHD don’t have a structured day or week, they can get into trouble because they may try to create stimulation for themselves in a way that might result in mischief,” says Karen Fleiss, PsyD, co-director of the New York University Summer Program for Kids and an assistant professor of clinical psychiatry at New York University in New York City. “Kids with ADHD can be sensation-seeking, careless, and more impulsive than children without this behavioral disorder.”
Left on their own, “they may say ‘Let’s bake’ and then get distracted, forget about it, and go outside and play,” Fleiss adds. The result? You guessed it: a four-alarm fire.
Marshall Teitelbaum, MD, a child, adolescent, and adult psychiatrist in private practice in Palm Beach, Fla., agrees. “Kids with ADHD are more likely to get hurt over the summer than during the regular school year. There are a lot more accidents if a child is distracted or impulsive.”
Adds Stephen Grcevich, MD, a child and adolescent psychiatrist at Case Western Reserve School of Medicine in Cleveland: “They misjudge time, procrastinate, and test limits more.”
That’s why a regular routine is so important. “Kids with ADHD are a little less able than kids without ADHD to structure themselves, so they need a little more external support,” says Joel L. Young, MD, a psychiatrist in Rochester Hills, Mich., and the founder and medical director of the Rochester Center for Behavioral Medicine.
ADHD Summer Tip 2: Consider Day Camp
Parents of ADHD kids should try to find “structured activities where children will have the opportunity for interaction with peers, and where they can have a consistent day-to-day routine, such as summer camps, religious camps, or sports-related activities,” says Grcevich.
And camps don’t have to cater exclusively to children with ADHD, he says. “Some kids, especially in the group with predominantly inattentive symptoms [such as being easily sidetracked or daydreaming, rather than being hyperactive or impulsive] of ADHD, will do well in many nonacademic settings or activities.”
Still, kids with ADHD who have marked social difficulties may benefit from a specialty camp. “Many of these camps — especially the summer treatment programs run by the larger academic medical centers — do a nice job teaching kids skills to help them in making and keeping friends.”
Of course not every family has the funds for such diversions. “Camp is great if you can afford it but not all families can,” says Young, author of ADHD Grown Up: A Guide to Adolescent and Adult ADHD. Instead, “try making a play date in the morning with a friend, and generally having something on the agenda -whether it’s visiting a friend’s house or taking a trip to a local zoo. It’s also really good to encourage creativity. Arts and crafts projects can be helpful.”
ADHD Summer Tip 3: Make Lists
What if you are a working parent who is not at home to oversee such daytime excursions? According to the U.S. Census Bureau, 60.2% of married women were in the labor force in 2005, making activity-planning one more item to add to parents’ already-extensive “to-do” list: “I would recommend that parents sit down with their child care providers and explain the special circumstances and specific expectations regarding daytime structure,” Young says.
To do this, “a schedule or a list would be very helpful and effective,” he says. Don’t be too draconian. “You want them to have plenty of fun during the summer and not simulate the school day. Lists, along with a general time frame of what needs to get done during the day, will be helpful.” For example, 7-8 a.m. is breakfast time, followed by a 9-11:30 a.m. visit to a friend’s house, and reading time at 2-2:30 p.m.
Finally, whether your relatives help with child care, or they are simply around for a summertime visit, “it’s important that all family members agree to maintain the routines for children with ADHD to function well,” says Teitelbaum. This includes plans around medication and behavior modification, common treatments for ADHD.
ADHD Summer Tip 4: Set a Bedtime
Having fun-filled summer days often hinges on getting a good night’s sleep. However, many children with ADHD have difficulty sticking to a regular bedtime. They may get preoccupied with TV or computer games or just have difficulty winding down. As a result, they can be tired and unwieldy the next day. And that can drive parents crazy.
Bad bedtime habits are “more typical of kids with ADHD because their bodies are always active, and it’s harder for them to settle down to go to sleep,” Fleiss says. And no matter what time these kids go to sleep, they often get up at the crack of dawn, she adds.
A set bedtime is essential for kids with ADHD — and this should not change simply because the days are longer in summer.
“Set a bedtime Monday through Friday, then be more flexible on weekends,” Fleiss suggests, and encourage downtime for an hour before the desired bedtime. Read with your child, watch something relaxing on TV, or tell him or her a story to create a transition from an active phase to a sleep phase. And “give in once in a while. If you go to Great Adventure for the day, you don’t have to run home to get your kid in bed by 9:30 p.m.”
ADHD Summer Tip 5: Don’t Drop Academics
Making time for tutoring or other learning activities throughout the summer helps to maintain a routine, and provides academic continuity for maximum success in the fall, Teitelbaum says. “It is especially challenging for many kids with ADHD to get back into the flow when school starts, so a summer reading list or some kind of tutoring can make sure he or she [won’t be] miserable getting started again.”
“It’s important to include some kind of academic activity throughout the summer — even if that just means reading with your child for 20 minutes throughout the day,” echoes Fleiss. “Close to 33% of kids with ADHD also have other learning disabilities, and it can be easier to fit tutoring in during the summer than after a full day of school.”
Young adds, “Summer is a good time for your child to read what he or she likes — instead of books dictated by the school’s curriculum. Go to the library or book store for a book that piques his or her interest.”
While learning activities are important during the summer, kicking it up a notch just before school begins can make a huge difference in your child’s academic performance, says Grcevich. “First impressions among teachers have a large bearing on how the school year will progress,” he says. In the two weeks before school starts, “I would definitely recommend reinstituting bedtimes and wake-up times necessary during the school year. Kids will also benefit from engaging in the cognitive tasks required of them during the school year, such as reading and practicing math.”
Following these tips for kids with ADHD — structured activities, day camps, inspired lists, set bedtimes, and ongoing academics — can alter your attitude toward June, July, and August, says Robertson.
“If you organize your days, then by the end of the summer, you will not be jumping up and down for joy when he or she goes back to school,” she says.
ADHD Medication Vacation?
Another hot-button issue for many parents is whether to stop or adjust their child’s ADHD medication during the summer. Parents may crave the respite because these medications can have unwanted side effects, such as poor appetite, and many have an inherent fear of having their children on any medication — especially a stimulant-type drug. Some parents may just want to see how their child fares without medication when there are no academic pressures.
“Parents can consider using the summer to address concerns and questions that they have about their child’s current medication regimen,” Grcevich says. For example, “if parents see that the child gets benefit from medication but is having worrisome side effects, they can consider a trial of different medication in summer.”
The warm-weather months are a safer time to try this because “you don’t have to worry about your child failing tests or doing poorly academically during the summer, so it can be a good time to make these changes,” says Fleiss.
Robertson took her son off medication one summer. “While on medication, Anthony was better able to play patiently with peers, follow directions, and sit still without a major battle,” she recalls. “When we took him off meds for the summer, Anthony’s hyperactivity, impulsivity, and inability to pay attention returned with a vengeance. It became a full-time job to try to entertain him in an effort to keep him from creating his own entertainment.”
Off medication, with full-blown ADHD symptoms, Anthony used to burn ants and once lit the neighbor’s dry leaves on fire — among other things, she says.
But Nancie Steinberg, a New York City-based public relations expert, is still not sure what she will do about her son Austen’s ADHD medication this summer. “I gave him a reprieve during winter break as an experiment, but I think it showed me he needs it to stay focused and not restless,” she says. “I may try again this summer to see what he is like and determine if he truly needs to be medicated.”
If Steinberg or other parents decide to let their children take a medication break, Grcevich says, “We strongly encourage them to resume medication two weeks prior to the new school year so that kids are prepared to perform at their best from day one.”
Of course, ADHD is a condition with different levels of symptoms and severity. Every ADHD child is different and requires an individual assessment. Parents should speak with their child’s doctor about the best approach during the summer — and year-round.