Caught in the eye of the storm: a qualitative study of views and experiences of planned drug holidays from methylphenidate in child and adolescent ADHD treatment

Background: Attention deficit hyperactivity disorder (ADHD) can be treated with stimulant medication such as methylphenidate. Although effective, methylphenidate can cause serious side-effects, including suppressed appetite, growth retardation and sleep problems. A drug holiday is a deliberate interruption of pharmacotherapy for a defined period of time and for a specific clinical purpose, for example for appeasing side-effects. Whilst some international guidelines recommend introducing drug holidays in ADHD treatment, this is not practised routinely. Our aim was to examine the views and experiences of planned drug holidays from methylphenidate with adults who have responsibility for treatment decisions in children and adolescents with ADHD. Method: In-depth interviews were carried out. Child and Adolescent Mental Health Services (CAMHS) practitioners (n=8), General Practitioners (n=8), teachers (n=5), and mothers of children with ADHD (n=4) were interviewed in a UK setting. Interview transcripts were analysed using grounded theory. Results: Methylphenidate eases the experience of the child amid problems at home and at school and once started is mostly continued long-term. Some families do practise short-term drug holidays at weekends and longer-term ones during school holidays. The decision to introduce drug holidays is influenced by the child’s academic progress, the parents’ ability to cope with the child, as well as medication beliefs. Trialling a drug holiday is thought to allow older children to self-assess their ability to manage without medication when they show signs of wanting to discontinue treatment prematurely. Conclusions: Planned drug holidays could address premature treatment cessation by enabling adolescents to assess repercussions under medical supervision.

Studies on particulate matter (PM10) and its precursors over urban environment of Reading, UK

The extent to which airborne particles penetrate into the human respiratory system is determined mainly by their size, with possible health effects. The research over the scientific evidence of the role of airborne particles in adverse health effects has been intensified in recent years. In the present study, seasonal variations of PM10 and its relation with anthropogenic activities have been studied by using the data from UK National Air Quality Archive over Reading, UK. The diurnal variation of PM10 shows a morning peak during 7:00-10:00 LT and an evening peak during 19:00-22:00 LT. 3 The variation between 12:00 and 17:00 LT remains more or less steady for PM10 with the minimum value of similar to 16 mu g m(-3). PM10 and black smoke (BS) concentrations during weekdays were found to be high compared to weekends. A reduction in the concentration of PM10 has been found during the Christmas holidays compared to normal days during December. Seasonal variations of PM10 showed high values during spring compared to other seasons. A linear relationship has been found between PM10 and NO, during March, July, November and December suggesting that most of the PM10 is due to local traffic exhaust emissions. PM10 and SO2 concentrations showed positive correlation with the correlation coefficient of R-2 = 0.65 over the study area. Seasonal variations of SO2 and NOx showed high concentrations during winter and low concentrations during spring. Fraction of BS in PM10 has been found to be 50% during 2004 over the study area. (C) 2005 Elsevier Ltd. All rights reserved.

Drug holidays from ADHD medication: international experience over the past four decades

Objective: ADHD is managed by stimulants that are effective but can cause growth retardation. Prescribers should ideally monitor children and trial a “drug holiday” to enable catch-up growth. Our aim was to map the experience of drug holidays from ADHD medication in children and adolescents. Method: A comprehensive search of the literature identified 22 studies published during the period 1972 to 2013. Results: Drug holidays are prevalent in 25% to 70% of families and are more likely to be exercised during school holidays. They test whether medication is still needed and are also considered for managing medication side effects and drug tolerance. The impact of drug holidays was reported in terms of side effects and ADHD symptoms. There was evidence of a positive impact on child growth with longer breaks from medication, and shorter breaks could reduce insomnia and improve appetite. Conclusion: Drug holidays from ADHD medication could be a useful tool with multiple purposes: assessment, management, prevention, and negotiation.