Table 3.

Case reports of discontinuation of psychostimulants in children with ADHD.

Study	Age and sex	Medication	Discontinuation	Adverse reaction	Clinical pearls
Benjamin 2005	9-year-old M 9-year-old M 13-year-old M	MPH 15 mg TID, risperidone 1.5 mg TID, clonidine 0.1 mg QHS, valproic acid 250 TID Dextroamphetamine racemic 10 mg TID, risperidone 1 mg BID, clonidine 0.1 mg QHS, valproic acid 125 mg qam and 250 mg QHS Fluvoxamine 150 mg BID, MPH 54 mg/day, guanfacine 1 mg BID, risperidone 0.5 mg TID	MPH stopped suddenly AMP stopped suddenly Missed MPH dose over 1 day	Observed dystonic reaction resolved with benztropine Observed dystonic reaction resolved with benztropine Dystonic reaction resolved on own in 24 h after restarting MPH	Sudden discontinuation of stimulant medication used concomitantly with an antipsychotic may lead to acute dystonic reactions.
Guler 2015	9-year-old M	MPH 54 mg, risperidone 1.5 mg BID	Missed dose of stimulant	Dystonic reaction observed 6–7 h following missed dose
McLaren 2010	11-year-old M	Aripiprazole 15 mg BID, OROS MPH 108 mg qam, lithium 600 mg qam and 300 mg QHS, clonidine 0.2 mg BID	Abrupt cessation of OROS MPH	Acute dystonic reaction 33 h after last dose that resolved with IM diphenhydramine
Parraga 2015	9-year-old F 7-year-old M	MPH CD 50 mg qam and MPH 5 mg every afternoon, aripiprazole 1 mg BID Dextroamphetamine-racemic 30 mg/day and aripiprazole 2 mg daily	Abrupt cessation of MPH CD and MPH Abrupt cessation of dextroamphetamine	Dystonic reaction occurred that responded to diphenhydramine and discontinuation of aripiprazole Dystonic reaction occurred several days after and resolved with decrease in SGA and restarting stimulant
Connor 1995	9-year-old M	Perphenazine 16 mg/day, dextroamphetamine 40 mg/day, fluoxetine 20 mg/day, diphenhydramine 50 mg/day	Perphenazine tapered by 4 mg/day, then stopped. Fluoxetine and diphenhydramine suddenly stopped without tapper. Dextroamphetamine continued.	AIMS score became elevated at day 2 from discontinuation of the perphenazine and continued to worsen after 10 days off of the antipsychotic. Stimulant was tapered over 2 days with rapid improvement in AIMS score	Concomitant use of stimulant may increase risk for neuroleptic withdrawal dyskinesias on stopping antipsychotics
Connor 1998	11-year-old M	MPH 10 mg BID, thioridazine 150 mg/day,	Thioridazine tapered over 3 weeks, MPH continued	One week after stopping thioridazine, increase in abnormal muscle movements and AIMS elevation.
Hollis 2007	7-year-old M	Risperidone 1.5 mg, MPH 36 mg	Abrupt discontinuation of risperidone and subsequent initiation of MPH 36 mg 12 h later	Within 8 h, dyskinesias observed that resolved with restarting risperidone
Bernard 2015	16-year-old M	Long-term MPH at 30 mg/day	MPH stopped suddenly	After stopping MPH, dramatic increase in weight gain and subsequent development of an eating disorder	Cessation from stimulant medications may cause withdrawal symptoms that impacting GI and neuromuscular systems.
Cuskun 2013	13-year-old F	IR MPH 20 mg qam	Missed MPH dose	Painful muscle cramps 24 h after missed dose of IR MPH. Switched to OROS MPH and cramps resolved on drug-free days
Krakowski 2018	11-year-old F	1st Trial—OROS MPH 36 mg 2nd Trial—Lisdexamfetamine 50 mg/day, guanfacine ER 3 mg/day, fluoxetine 20 mg/day.	1st—Abrupt cessation of OROS MPH 2nd—Taper off lisdexamfetamine by 10 mg	1st—Acute vomiting and light sensitivity noted following cessation of OROS MPH. 2nd—Reduction in stimulant caused migraines and malaise for a 2-day period following each reduction