Expert: Dr Billy Levin - 7/5/2010

Question
My 11 yr old son takes 18 mg of Concerta during the school year to help him with focus and organization.  He has been taking it since the spring of '09 (his 3rd grade) and it has made a tremendous difference in his ability to stay focused on the teacher and tasks at hand.  His confidence level has increased and socially he is doing great.  During the school year he would not take Concerta on the weekends so that his appetite would increase.  We also discontinue its use during the summer.  Lately, however, I have been noticing he seems very lethargic.  We try to stay active as a family with swimming, biking, tennis, etc.  When we take part in activity he is often weepy and tired.  When I asked him about it he said he just feels so tired.  This is not typical behavior for an 11 yr old boy.  Does this lethargy go alone with ADD and if so should we be giving him Concerta through the summer?  Our hope is that he will grow out of the need for it and summer is a great time to observe behaviors around the home without negatively affecting grades.  On the other hand, it doesn't seem healthy to go throughout the day struggling with lack of energy.

Answer
Firstly the most important comment is ADD is not a part time condition. Thus it is very detrimental to give part time treatment. It can only create problems as you are experiencing now. The lethargy could be depression or lack of stimulant treatment on week ends and holidays. An optimal dose is vital to success. As you have not mentioned how the 18mg was decided on, I do not know if it was evaluated or guessed.   The weight problem is of little importence as it eventually catches up. No child on stimulants ever developes malnutrition and reassurence is all that is necessary. A doctor should be advising you when to stop treatment as many eventually out grow the need to be treated. Until then it is advisable to give treatment every day!