When Sleepaway Camp Becomes an ADHD Medication Vacation

This year, parents of kids going to Eisner and Crane Lake Camps in the Massachusetts Berkshire Mountains can't say they didn't get the memo.

An e-mail went out recently stating, "The Union for Reform Judaism (URJ) Camping system requires that parents fully disclose on the camper medication form all medication that their child has been taking within the last six months. If it is the intention of parents to keep their child off certain routine medication for the summer – especially during their time at camp – we require that this be disclosed as well."

Why the need for this preemptive measure? Because URJ Camps have been burned before.

Apparently, some parents of children with Attention Deficit Hyperactivity Disorder (ADHD) have sent their kids to camp without their medication. On purpose. And without telling anyone at the camp.
The e-mail explains further: "We find that some parents of children with ADD/ADHD feel comfortable giving their children a medication break during the summer, as they believe that camp is more of a relaxed environment than school and that the need for the child to focus is reduced. At camp, children are in fact required to maintain focus at a level often higher than that during the school year. Most activities require campers to be alert, cooperative and task-oriented for much of the 24-hour day – whether on the ropes course, the bike trail, the tennis court or T'fillot (prayer). We want to ensure the children can participate fully and in a way that is safe for both them and those around them."

'Drug Holiday' practices changing

The practice of suspending ongoing medication for a select period of time is nothing new; in fact, it even has a name: Medication Vacation (or, alternately, Drug Holiday), and it's a practice that's been condoned by prescribing doctors themselves.

"In the past, doctors recommended that children take a break from ADHD medication after school, on weekends, and during the summer," states the ADHD Parents Medication Guide, prepared by the American Academy of Child and Adolescent Psychiatry (AAPAC) and the American Psychiatric Association (APA). "Now, many doctors recommend that children stay on their ADHD medication full-time to get the benefits at home and at play."

Why the change of counsel? The guide states that continuing medication outside of school is especially beneficial for teens, as it helps them make decisions about cigarette smoking, substance use and risky behavior.

"Not taking ADHD medication may put your child at risk," the guide warns. "Younger children are at risk for injuries and for having social issues when they are not taking their ADHD medication, and adolescents are more at risk for motor vehicle accidents and other risky behaviors."

'ADHD is a legitimate disability'

Louis Bordman, senior director of URJ Camps Eisner and Crane Lake, says he has unwittingly experienced campers on parent-imposed Medication Vacations. It isn't until he and other staff members notice a pattern of unusually disruptive behavior that they begin to suspect the child's parents have acted disingenuously.

"When there is some type of behavioral challenge or a child gets overly frustrated it causes us to work with the child more closely and investigate more closely," he tells ParentDish. "In some cases, we find that the child doesn't have these frustrations and challenges during the school year and (we think) 'Well, that's odd' and then we find out the reason the child doesn't have those particular challenges at school is because the child may take a particular medication."

According to Bordman, URJ's anti-Medication Vacation stance has been around for a number of years.

"I think there was a myth that campers needed different skills to succeed in camp than they need in school," he says. "But truth be told, they need many of the same levels of interaction and concentration to navigate through the social environment and the schedule of a camp routine."

Child psychiatrist Dr. Larry B. Silver, a clinical professor of psychiatry at Georgetown University Medical Center with more than 30 years of practice and research under his belt, tells ParentDish in a phone interview that he doesn't agree with the practice of drug holidays.

"To me, it's parallel to having a kid that's very nearsighted and not sending him to school with glasses," he says. "ADHD is a legitimate disability. ... If the medication is working and the child needs it, why set the kid up for failure by taking them off the medication?"

Silver says parents who talk about taking breaks usually have not been educated about what the medicine is and how it works.

"They're afraid the medicine is causing harm so they want to get off it whenever possible, rather than seeing it as a positive," he says. "We've been using these medications for over 60 years. They're very safe, they're very effective. For many kids it makes quite a difference in their ability to function in school and among peers."

Parents have their reasons

However, the reasons parents might want to give their kids a drug holiday are both varied and well-founded.

"Some children and teens have difficulty tolerating common side effects of ADHD medication," Dr. Stephen Grcevich, a child and adolescent psychiatrist in Cleveland, tells ParentDish in an e-mail. "Physicians may recommend that parents stop medication for children who struggle to gain weight during the school year. Many tweens and teens complain that they don't feel 'like myself' on ADHD medication. Friends complain that they're too serious on medication. Some kids with anxiety disorders co-occurring with ADHD may become more angry, irritable or emotional on medication."

Then there's the cost of medication.

"During the current economic downturn, families with less expensive health plans often face considerable out-of-pocket expenses for the most commonly prescribed ADHD medications," says Grcevich, president and founder of Family Center by the Falls. "They'll find the money for medication essential to their child's success in school but try to save by skipping weekends and the summer months."

Bordman says he and his camp staff certainly won't (and can't) force parents to comply with their policy, but he does try to explain his side of the story.

"Certainly, I'm not a fan of medicating kids, but when medications work, they help children to thrive," he says. "We need for the campers -- and the campers need for themselves -- to still be able to operate as though they were medicated.

"They're expecting someone other than the parent to be prepared for a child coming that needs to be on medication. And that really creates challenges," he says. "But the greatest challenge is for the child. When the child acts out, their friends don't want to hang out with them and they feel uncomfortable and they beat themselves up (saying), 'Why did I behave that way?' and 'I'm always in trouble.' The parents have taken them off and thrown them right into an extremely intense social environment with rules and guidelines and structure that they need to be able to observe and embrace. And that's a challenge for those kids."

The absence of medication is what "ultimately creates the negative attention," Bordman says. "Then the poor kid absorbs that and then is blamed for his or her behavior, but no, the parents or the physician should be blamed because they're not giving them the help they truly need."

If the parents are adamant, Bordman will make an exception but makes absolutely clear "if there are any challenges, they're going to need to put the child right back on medication."

Related: Ambidextrous Kids May be at Higher Risk for ADHD