ADHD and Medication Discontinuation
Medication Discontinuation in Youth With ADHD: What Families and Clinicians Should Know
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood psychiatric conditions. For many children, it doesn’t simply disappear with age. Research suggests that up to two-thirds of individuals diagnosed in childhood continue to experience symptoms into adolescence and adulthood.
At the same time, most medication studies are short-term—lasting weeks or months, with some extending a year or two. In real life, however, children may take stimulant medication for many years, sometimes into adulthood.
That leaves families and clinicians with an important question:
How long should a child stay on stimulant medication—and what happens if we stop?
Why Discontinuation Is a Growing Conversation
Stimulants are considered first-line treatment for youth with ADHD. Their short-term effectiveness in reducing symptoms is well established.
What is less clear is:
the optimal duration of treatment
when discontinuation is appropriate
what risks and benefits are associated with stopping
Over the last 20 years, psychiatric medication use in children has increased significantly. At the same time, concerns about long-term medication exposure and polypharmacy have grown. This has led to increased attention to “deprescribing”—a structured approach to reducing or stopping medications when risks may outweigh benefits.
Deprescribing is not simply stopping a medication. It is a thoughtful, collaborative process that weighs:
ongoing benefit
side effects
changing developmental needs
patient and family preference
new evidence or clinical insights
What Happens When Stimulants Are Intentionally Stopped?
Few studies were designed specifically to answer the question: When should we discontinue stimulants? However, randomized withdrawal studies offer helpful clues.
Across studies:
Stimulants consistently reduced symptoms and relapse rates.
Most children who stopped medication experienced a re-emergence of ADHD symptoms, often within two weeks.
But an important finding emerged:
Approximately 30% of youth tolerated discontinuation without significant relapse.
In one observational study, about 26% of children showed no clinical deterioration after stopping medication for one month.
This suggests that while many children need continued medication support, a meaningful subgroup may not.
Does Age Matter?
One study found that older adolescents (older than about 13–14 years) were less likely to experience symptom recurrence when switched to placebo compared to younger children.
This aligns with developmental research showing that:
executive functioning improves with age
working memory, planning, and problem-solving strengthen
compensatory strategies develop over time
For some youth, brain maturation and learned coping skills may reduce reliance on medication.
What About Long-Term Outcomes?
Large administrative database studies—while not proving causation—suggest that during periods when ADHD medication is filled, youth are:
less likely to experience unintentional injuries
less likely to visit emergency departments for trauma
less likely to experience substance-related events
less likely to have criminal convictions
more likely to perform better on academic measures
These findings highlight that medication may have protective effects beyond symptom control.
However, database studies are correlational and may be influenced by selection bias.
Lessons From the MTA Study
Long-term follow-up from the Multimodal Treatment Study of ADHD (MTA) provides additional nuance.
By 6–8 years:
Initial treatment type did not strongly predict later functioning.
Many youth had stopped medication.
Researchers identified different developmental trajectories:
One group gradually improved.
Another maintained gains.
A third returned to near pre-treatment levels.
This suggests ADHD is not a uniform condition. Some youth may naturally improve, while others continue to need support.
Drug Holidays and Structured Trials
Practice guidelines support periodic trials of discontinuation, often suggesting an annual medication-free trial when appropriate.
Drug holidays—planned short breaks on weekends or school holidays—can:
help assess continued need
reduce side effects (e.g., appetite suppression, insomnia)
support growth if concerns exist
Research suggests weekend drug holidays do not impair school performance and are generally well accepted by parents.
Long-term observational data indicate that consistent stimulant use over many years may be associated with modest decreases in height and increases in weight, reinforcing the importance of periodic reassessment.
How Should Discontinuation Be Done?
Discontinuation should never be impulsive.
Important considerations include:
timing (avoid high-stress academic periods)
comorbid conditions
family preferences
school input
developmental maturity
racial and ethnic disparities in treatment patterns
Most relapses appear within two weeks, meaning that discontinuation trials can be brief but must be closely monitored.
While stimulants have short half-lives and can sometimes be stopped abruptly without withdrawal symptoms, a conservative approach favors a gradual taper over weeks to reduce the risk of rapid symptom return.
One research protocol suggested:
a 1-week drug-free trial with multi-setting assessment
if unclear, a longer monitored trial
But clinical decisions should be individualized.
Possible Risks of Stopping
Most children experience symptom return rather than severe withdrawal.
Rarely:
temporary movement disorders may emerge
effects may differ between short-acting and long-acting formulations
Importantly, abrupt withdrawal of stimulants has not been shown to worsen tics in controlled trials.
Still, careful monitoring is essential.
Shared Decision-Making Is Central
There is no universal “right” duration for stimulant treatment.
The decision to continue or discontinue should involve:
youth
caregivers
clinicians
teachers (when appropriate)
Conversations should review:
current functioning
academic demands
side effects
goals
family values
long-term plans
Medication discontinuation is not a verdict about ADHD. It is an experiment in fit.
The Bottom Line
The evidence suggests:
Most youth relapse quickly after stopping stimulants.
Around 25–30% may tolerate discontinuation without major deterioration.
Older adolescents may have greater success with stopping.
Continued treatment may reduce injuries, academic failure, and risky outcomes.
Periodic, structured discontinuation trials are supported by guidelines.
Decisions must be individualized and closely monitored.
ADHD is a long-term condition—but treatment does not have to be static.
Reassessment, reflection, and thoughtful trials allow families and clinicians to find the minimum effective support needed at each developmental stage.