Supporting Participants and Staff Traveling with ADHD Stimulant Medications

Written by Maureen MacConnell, PMHNP-BC, PSY-M, Mental Health Advisor for Cornerstone Safety Group

Attention Deficit Hyperactivity Disorder, or ADHD/ADD, is getting its due in the travel industry. 

As clinicians, we’ve learned much about this complex disorder in a relatively short period of time, due to the increased call for better support and understanding in domestic, school, and workplace settings. However, despite increased recognition, we still struggle (particularly in the travel and experiential education industry) to support participants and staff with ADHD. We know little about the impact of travel on ADHD symptoms. We don’t always have plans in place to help participants and staff manage the disorder. We also often overlook the importance of providing appropriate support from a place of parity and inclusion. 

The reality is that summer scheduling and planned travel often coincides with a “break” from medication, often known as a “drug holiday.” The decision to take drug holidays can be either personal or medical; in some cases, individuals are looking to stave off side effects of ADHD medications. While a participant or staff member may weigh the risk vs. benefits of medication, they may live with “tolerable” side effects, and extended travel allows them to take a break from the side effects they experience regularly. Travel programs can help applicants and staff make informed choices about the pros and cons of traveling with or without medication. 

As we prepare ourselves for the 2023 season, organizations are tasked with providing guidance for participants and staff about their decision to “take or break” from their ADHD medication during travel. If you’re reading this, you’ve likely muddled through this discussion in the past. Which begs the question, how do we appropriately navigate this conversation? 

In today’s blog, we’ll discuss safety precautions for participants and staff diagnosed with ADHD that are prescribed stimulant medications, with a follow-up discussion of the pros and cons of drug holidays in travel programs.

ADHD: A Brief Overview

ADHD is considered a cognitive disorder, and it is important to understand that ADHD is not considered an intellectual disorder.  In fact, individuals diagnosed with ADHD can have a wide range of intellectual ability.  When we talk about cognition, we often think about attention and concentration. However, it is important to understand that individuals can experience a diverse range of ADHD.  Some may experience hyperactive symptoms (ex/ talking or moving) or emotional symptoms (ex/ increased anger, quick changes in emotions, difficulty navigating perceived rejection, etc.) in addition to or independent of cognitive symptoms. 70% of individuals with a diagnosis of child or adolescent ADHD experience a resolution of symptoms by the time they reach adulthood. However, 30% of adults will continue to experience symptoms of ADHD through their lifespan. 

One myth I’m eager to dispel is that medication causes a remission of all ADHD symptoms.  In reality, the goal of treatment is to have a reduction of ADHD symptoms. This means that someone can be treated for their ADHD with medication but may still experience residual symptoms that may become more pronounced in new or unfamiliar environments.  This is important when we consider how to support participants and colleagues with an ADHD diagnosis since some may still be able to cope effectively with changes, while others may need more support. 

It is recommended to have a thorough understanding of the symptoms of an applicant’s ADHD and if the medication (or other strategies like counseling, organizers, timekeepers, fidget tools, etc.) are helping the applicant to manage their symptoms and can be provided during their program.

Supporting Participants and Staff Taking ADHD Medication 

 When we are supporting participants and staff taking medication for ADHD in the field, here are a few useful items to consider:

• Besides medication, have they had access to support to learn and build skills to manage ADHD symptoms?

• Can they take their medication consistently and unassisted or do they need support?

• Have they requested accommodations for their ADHD that your program can meet?

• Have they (or family members) provided a baseline height, weight, blood pressure and heart rate?

• Have they been medically evaluated and cleared for any personal or family history of cardiovascular issues (hypertension, cardiac abnormalities, sudden death)?

• Are there additional psychiatric conditions such as bipolar disorder, substance use, personality disorders, or sleep-related issues that the participant may need support for?

• If they experience side effects from their medication regimen (decreased appetite, sleep pattern changes, headaches, abdominal pain) do they have a management plan? Can your program accommodate this plan consistently and safely while in the field?

• Do they have a history of heat-related illness associated with their medication?  Or do they take other medicines that can make them sensitive to the heat?

Basic assessment questions can help your program determine the level of support a participant or staff member requires and the level of support they may need while in the field. This can mean social, psychological, and medical monitoring and support.  Medical monitoring of cardiac changes should continue on extended programs, with field staff periodically monitoring for changes in heart rate and blood pressure especially if they are on extended programs (>2 mos). Adults can self-monitor with a blood pressure cuff and record any changes and report concerns to field staff.

Special Conditions to Escalate to Medical Personnel for ADHD Medications

• Changes in baseline blood pressure, heart rate, or other cardiac-related symptoms

• Changes in alertness (confusion, coma, or seizures)

• Pregnancy

• Changes in mental status such as agitation, anxiety or panic, psychosis 

• Concerns related to alcohol or substance use (or misuse of prescription medicine). 

Field staff should be aware that children, adolescents, and young adults diagnosed with ADHD may be at an increased risk of road traffic and workplace injuries. Additionally, participants and staff should be monitored and made aware of the risk of  heat-related illness when taking stimulant medication.

Remember that ADHD is a cognitive disorder with hallmark features such as forgetfulness and inattention. In some cases, participants may forget to take their medication regularly. A timer or check-in system may be helpful in these cases to provide additional support while in the field.

Choosing a “Break” When medication is stopped abruptly 

While tolerance to stimulant medication is possible, it does not typically cause life-threatening withdrawal symptoms. Some symptoms to look for include depression, fatigue, changes in cognition, increased appetite, and weight gain (Lago & Kosten, 1994; Howland, 2010).  Field staff should reach out if they are unsure or need additional guidance on how to support participants experiencing these symptoms.

There are a few exceptions that field staff should remember. For example, if the participant or staff member discloses that they are taking higher than prescribed doses of medication or using other drugs like cocaine, methamphetamine, or herbs (khat). This has the potential for a more serious withdrawal, which may increase depressive symptoms and in some cases suicidality. Cases like this should be escalated to medical personnel as soon as possible. Alternatively, participants may be prescribed non-stimulant medications (clonidine or guanfacine) as a standalone or combined treatment for ADHD.  Field staff should be aware that medications like clonidine or guanfacine can cause hypertension if abruptly discontinued.

In closing, when your participants and staff get the green light for international travel, reminders to pack adequate supplies of medication and bringing a letter from the participant’s prescriber can be helpful to minimize obstacles that can put a damper on travel plans.  

Need more support or want customized training on this topic organized for your organization? Contact us at info@cornerstonesafetygroup.org to get started!