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Tolerance is possible, although what looks like a tolerance may not be so technically. Meds stopped working for my son like clockwork, every two months. Each time we’d increase the dose and it would happen again, until we couldn’t increase any more because he couldn’t tolerate the higher doses. His doctor ended up adding Ammantadine and it helped for a couple years (then he developed a buildup of that and had extreme side effects so he had to stop). After puberty, meds seemed to be more steady. We couldn’t take med breaks because it was really hard for my son — each time he started again, it was like starting from scratch with mood struggles and trying to acclimate to it again. Some people do fine with med breaks though.