One of the hardest questions for me to answer is when a patient comes up to me and says: "My doctor said my child has attention deficit disorder (ADD). He wants to put my child on Ritalin. What do you think?
(Column: Ask the Pharmacist)
The Ritalin Controversy
Steve Kaufman, RPH
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ADD is a nervous disorder that usually affects children. The condition is characterized by very high levels of physical activity, impulsive and immature behavior and an extremely short attention span. While ADD does no physical damage to the body it can cause social and emotional problems. Since the affected children cannot sit still for long periods of time they often have trouble with schoolwork and may have trouble getting along with classmates, teachers and parents.

The diagnosis of a child with ADD is extremely difficult. There are no specific tests to diagnosis and the symptoms of ADD are present in all children to some degree. Since ADD is very vaguely defined, the symptoms displayed by a child must be carefully observed. A physician must single out children with ADD from children that are either bored with school or simply having some other behavioral problem.

We have all read in newspaper and magazine articles about the Ritalin controversy. The two most common questions are does it work and is it over-prescribed?

Let's first deal with the question of whether it is over-prescribed. My personal opinion is yes it is, but there are reasons for it. For many of us in the over 40 generation, we can probably think back to our days in elementary school and recall a number of classmates and friends who nowadays would be considered hyperactive. In today's world we have many more people diagnosing children with ADD. Many teachers and social workers have been trained to spot children who exhibit symptoms of hyperactivity. In today's world of managed care, many physicians do not spend the time that is needed to properly diagnose ADD and many children now come from homes where either both parents work or single parent households where the parent(s) just have a low tolerance for children with high energy levels.

Does Ritalin work? Many experts believe it makes no sense to give a hyperactive child a stimulant medication although controversial drug therapy has proved successful in treating ADD. Ritalin does seem to have a calming effect on children with ADD and does seem to increase their attention span. I have in my practice met many parents who swear by it.

Now how do you decide if your child should be put on Ritalin? The answer is simple, do research. There are hundreds of books and articles written on ADD and the pros and cons of Ritalin therapy. If you don't know where to look, ask your doctor or pharmacist for help. Also remember many times ADD disappears after puberty.

If you do decide Ritalin is the proper treatment for your child, here are some things to remember. Take the last dose before 6 p.m. (unless your doctor has given you specific instructions to the contrary) to avoid insomnia. If you miss a dose take it as soon as possible then take any remaining doses for that day at regular spaced intervals. Never double dose. The best time to take it is at
least 30-45 minutes before eating. Do not stop taking this medication or increase or decrease dose without first checking with your physician. Many doctors will require their patients to take a "Drug holiday" usually over the summer to give their bodies a break from medication.
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