An adolescent who abruptly stops his medication for attention-deficit hyperactivity disorder.

CASE Robbie was one of those kids pediatricians look forward to seeing in the office. At 11 years old, he was evaluated by his pediatrician for academic underachievement, inattentiveness in the classroom, hyperactivity, and disruptive behavior limited to the classroom. A comprehensive assessment demonstrated a moderate, language-dependent learning disability and attention-deficit hyperactivity disorder (ADHD) without evidence for significant anxiety, depression, or family disharmony. After the initiation of methylphenidate, a tutoring program, and close interactions between his parents and teachers, Robbie’s academic performance and interpersonal skills improved dramatically. He tolerated a moderate dose of methylphenidate over the next 5 years. At 15 years of age, he announced to his parents and his pediatrician that he would no longer take the medication. He said, “I don’t need it . . . I’m fine . . . I don’t see why I should take it.” Robbie denied any medication side effects, other drugs, or alcohol use. His A/B grades were stable. He purposefully did not take the medication for a few weeks and said he could not tell the difference. However, his parents observed that his test results, when off the medication, were below his standard scores. They also noted that he was more distractible and less attentive when doing his homework during that time. Robbie’s pediatrician tried to engage him in a dialogue about the decision to stop medication. His response was limited: “I’m fine . . . I don’t need it.”