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ADD: General Medication Questions

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Should the dosage be set based on weight?
Not necessarily--at least not for the stimulants. Weight is a starting point for calculating dosage, but not the whole answer. That's why two patients who weigh the same may end up with very different dosages.

For many medications, dosages are calculated based on body weight, so that a child weighing 50 pounds would receive one third the dose of a man weighing 150. But several studies of stimulants suggest that body weight doesn't always make a difference. For example, one study looked at how well different doses of Ritalin controlled symptoms of ADHD in a large group of children. When researchers looked at the dosages in terms of body weight, there was no clear pattern of which doses were most effective. But when they ignored body weight and simply looked at the dosages, the results were dramatic: The optimal dose was usually between 10 and 15 mg, regardless of the child's size.

Of course, that doesn't mean that every child will do best at this dosage, but it does suggest a good starting point.

This same general rule holds true for Dexedrine or other medications that we use to treat ADHD. In the final analysis, we are not treating a weight, but a person.

Should the dosage increase as my child grows?
Yes. Dosage will usually increase over time as the child grows through adolescence. It's important not to fall behind in the dosing. If the child outgrows the dose, she'll begin to lose her focus, and the symptoms of ADHD will re-establish themselves--often so gradually that you won't realize there's a problem at first. It's always preferable to head off these problems rather than trying to undo damage caused by loss of focus.

Are the effects of Dexedrine, Adderall and Ritalin the same?
No. Although all of these stimulants address problems of attention and focus, they're not completely interchangeable.

In about 70 percent of patients, they have similar effects. But other patients may respond to one of these drugs and not the others, or they may have unacceptable side effects with one and not another.

What's more, each drug has a "personality" in terms of how it affects the patients. In some, Ritalin acts like blinders on a horse, keeping them highly focused. It's almost as if Ritalin tells you, "You will pay attention." That can be useful, but the downside is that it leaves some patients feeling "flat," lacking zest. Parents sometimes tell me that their child seems "sad" on Ritalin, but it's not really sadness; it's more like their spirits are dampened. They don't feel quite themselves. That's one reason why many adolescents don't like to take Ritalin.

I've found that Dexedrine and Adderall often produce a more "natural" response in patients. Instead of forcing you to pay attention, it permits you to pay attention. Patients may not get the same tight focus as they do on Ritalin, but they're looser and more spontaneous.

However, Dexedrine and Adderall aren't tolerated by everyone. They don't provide the same degree of control over behavior. Also, in some patients they can produce an edginess and anger--sort of the flip side of the flatness we sometimes see in Ritalin.

The upshot is that there's no ideal treatment for everyone. For some patients, Ritalin is clearly the drug of choice; for others, it's Dexedrine or Adderall. The goal of treatment isn't to impose a one-size-fits-all approach, but to find out what's best for the individual.

What should I do if my child gets the wrong dose?
If you miss a dose, there's really nothing to worry about. Just give the next dose when it's scheduled. Don't double up to "make up" for the missed dose.

If you accidentally give your child too much medication, call your doctor. A double dose may cause short-term problems such as irritability, loss of appetite, and sleep difficulties. It's not likely to cause any long-term harm, but check with your doctor or pharmacist just to be sure. A major overdose--for example, if a younger sibling accidentally gets into the medication--can be much more serious. Call your doctor, your local Poison Control Center, or 911 immediately.

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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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