Psychostimulant drug holidays for children with attention deficit hyperactive disorder prescribed by Developmental and Behavioral Pediatricians in Thailand.

Abstract

Background : Attention deficit hyperactivity disorder (ADHD) is one of the common problems found in child and adolescent psychiatry. Psychostimulants are used for the treatment of its symptoms. However, drug discontinuation in holidays (drug holidays) is used for many benefits, such as decreasing side effects. To date, there is no definite recommendation and practice about drug holidays.

Objective : To determine the practice, factors in decision-making about drug holidays and attitudes of developmental and behavioral pediatricians toward the use of psychostimulants in ADHD patients. Research design Cross-sectional descriptive study.

Method : Questionnaires were developed in order to collect data about practicing drug holidays. The questionnaires were sent to 106 pediatricians, including 91 developmental and behavioral pediatricians and 15 physicians who are currently training as the fellowship in developmental and behavioral pediatric departments,via e-mail or letter between December 1, 2014 and November 30, 2015. Seventy-six questionnaires were returned (71.7 %). All data in the questionnaires were included and analyzed.

Result : Most of the developmental and behavioral pediatricians who returned questionnaires considered drug holidays on a case-by-case basis (54 or 71.1%). Twenty always continued drug use (26.3 %) and two always practiced drug holidays (2.6 %). The factors most affecting pediatricians’ decision making included the severity of ADHD symptoms, family and relationship problems due to ADHD, comorbidity of oppositional defiant disorder, conduct disorder and behavioral modification in parents. Attitude toward the use of psychostimulants was quite strong. Some elements of the results were different from previous researches about child and psychiatry in Thailand.

Conclusion : Most developmental and behavioral pediatricians considered drug holidays on a case-by-case basis. There were varied opinions about practicing drug holidays. We suggest conducting studies for clarification of data in order to develop practical guidelines for utilization of drug holidays in Thailand that will result in the best benefit to patients.