Who benefits from methylphenidate drug holiday?

Ibrahim, Kinda (2013) Who benefits from methylphenidate drug holiday? International Journal of Pharmacy Practice, 21 ((Suppl_1)), 27-44. (doi:10.1111/ijpp.12029).

Record type: Article

Abstract

Attention deficit hyperactivity disorder (ADHD) can be managed medically with stimulant medication such as methylphenidate, prescribed increasingly since the 1990s. Whilemethylphenidate can tackle ADHD symptoms in the short term, long-term effectiveness remains unverified and serious side-effects such as growth retardation present legitimate concerns.[1] The National Institute for Health and Clinical Excellence recommends intentional breaks from medicinetaking (drug holidays) for dealing with side-effects and to test continuing need for therapy.[2] In Berkshire, shared-care arrangements ask doctors to encourage a two-week drug holiday after two years of methylphenidate drug use. But health professionals differ in their opinions about the usefulness of interrupting medicine-taking in ADHD. Our aim was to explore doctors’ interpretations and expectations about the temporary withdrawal of methylphenidate in children and adolescents with ADHD. Qualitative semi-structured face-to-face interviews with Child and Adolescent Mental Health Services consultants (n = 7) recruited from six clinics in Berkshire and general practitioners (GPs) (n = 6) recruited from West and East Berkshire Primary Care Trusts were carried out in 2012. All interviews were audio-recorded, transcribed and transferred to NVivo10 for analysis. The first level of analysis using grounded theory resulted in the emergence of a number of themes reported here. This work was conducted under the auspices of the Academic Pharmacy Unit bridging the University of Reading and the Pharmacy Department at Berkshire Healthcare NHS Foundation Trust (BHFT). It was approved by the University of Reading Research Ethics Committee, BHFT R&D office and the Thames Valley Primary Care Research Partnership. The first theme concerned clinicians’ perceived responsibility. Some questioned the necessity and usefulness of drug holidays per se, while others saw their role as information providers with families in charge of decisions. GPs took the lead from specialist colleagues. The second theme concerned categorisation of parents’ coping in the absence of methylphenidate. Two groups identified were those able to cope with children during breaks from school and those unable to cope in any setting. Severity of ADHD, ability to cope, past experience with poor adherence, fear of rebuke from school, comorbidities and poly-pharmacy were seen as determinants of decisions. The third theme concerned adolescent readiness to discontinue. Increased independence, stigma of medication, perceptions of medication ineffectiveness, and increased selfefficacy were among factors seen as driving adolescents towards treatment withdrawal. Neurological and psychological developments were identified by clinicians as evidence of adolescent readiness for drug holidays. Parents were seen in opposition, prioritising academic achievement and school performance. Doctors have a range of beliefs about the usefulness of methylphenidate drug holidays and analysis has identified three main themes encapsulating their views. These themes can be incorporated during axial coding and the generation of core categories to ultimately produce a grounded theory about doctors’ interpretations and expectations around methylphenidate drug holidays. The findings are limited to clinicians’ views and future work could examine patients and parental attitudes. Nonetheless, this work is relevant to practice as it could lead to the development of a valuable tool for formalising ADHD drug holidays.

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