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Frequently Asked Questions About Ritalin and Other Stimulants

The most common side effects are insomnia, decreased appe- tite, weight loss (probably as a result of appetite suppression), headache, increased heart rate, slight increases in blood pressure, and an increased tendency to cry. Less common side effects include heart palpitations, dizziness, and anxiety.

With the doses used for treatment of ADHD, these side effects tend to be mild if they occur at all. If they do occur, they often disappear after a few weeks as the body adjusts. And if they persist, they can usually be managed by reducing the dosage temporarily or changing the time at which the child takes the medication (e.g., giving the medication earlier in the day to prevent insomnia). If insomnia still occurs from time to time, Benadryl at bedtime can help promote sleep. (Though Benadryl is usually used for allergies, it has a sedative effect and is safe for children.) Upset stomach can usually be managed by giving the medication with milk or about an hour after meals.

There have been several case reports of mania or psychotic episodes; it appears that in at least some incidents the drug worsened an underlying psychotic condition. Although high doses of stimulants can trigger seizures in people with epilepsy, the doses used for ADHD are usually too low to have any such effect. In fact, children who have both epilepsy and ADHD are usually treated with stimulants and an anticonvulsant medication.

Why prescribe a stimulant for a child who's already hyperactive?
Shouldn't you give him something to calm him down instead?

The short answer is that we don't use these medications in the way most people think of stimulants. We don't prescribe them as "pep pills" or to overcome fatigue. In fact, the doses are so low that you're unlikely to see any "stimulant" effect at all.

In a sense, the confusion comes from the term hyperactivity. The problem with ADHD children isn't that they have too much energy; it's that their energy tends to be uncontrolled. In fact, all of the key symptoms of ADHD--the attentional problems, the impulsivity, and the hyperactivity--reflect difficulties in controlling mental and physical activity.

If you look at studies of brain chemistry, you can see this loss of control reflected on the most basic cellular level. In people with ADHD, the cells in the part of the brain that control these behaviors have trouble communicating with one another. Treatment stimulates this "controlling" or "filtering" portion of the brain, making it work more normally.

What are the odds that treatment with stimulants will be effective?
These drugs are effective in more than 90 percent of cases, but about 15 percent of patients experience side effects that preclude their use. Sometimes these side effects can be overcome by switching medications or adjusting dosages. The bottom line is that treatment is successful in about 90 percent of cases.

How long have these drugs been in use?
The use of stimulants to treat ADHD and related disorders can be traced back as far as 1937. When a physician studying children in a residential treatment program gave them Dexe- drine, he found that the children--contrary to expectations--showed lower activity levels, better behavior, and improved school performance. In the 1960s, more rigorous studies, again looking at students in a residential school, found that the use of these drugs resulted in fewer conduct problems and better behavior and school performance.

However, at the time the concept of ADHD as a distinct disorder had not yet evolved; at this point it was simply known that for some children with conduct and school performance problems, stimulants seemed to help.

Ritalin was first commercialized in the early 1960s as a memory aid for geriatric patients, and some years later re- searchers, noting its chemical similarity to the amphetamines used in the earlier studies, began exploring its use for children with behavior and academic difficulties.

From The Attention Deficit Answer Book: The Best Medications and Parenting Strategies for Your Child by Alan Wachtel, M.D. Copyright © 1998. Used by arrangement with Penguin Group (USA) Inc.

If you'd like to buy this book, visit amazon.com or click on the book cover.


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