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Focus on Ritalin

Understanding the Method Behind the Medicine

At 1:20 p.m. every school day, Ryan, Alison, Michael and Amanda leave their kindergarten classroom and head to the nurse's office to receive their afternoon doses of Ritalin. Ten years ago, these children might have been branded as the troublemakers in their class. Their parents might have been called in regularly to discuss disturbing behavior. Worse, these children might never have been able to reach their full potential, academically or otherwise. But today, a five-minute round-trip journey to the school clinic is all that separates these four from their peers.

What is Ritalin?

Methylphenidate, or Ritalin, is a mild stimulant widely used to treat ADD, or Attention Deficit Disorder. Though many think it is a relatively new drug, Ritalin has been around for more than 40 years. Originally used to treat Narcolepsy, a disabling disease making a person feel constantly sleepy and fatigued, it is now commonly associated with children and adults with ADD or ADHD. The amount of Ritalin a child receives is up to the discretion of the prescribing physician. It comes in four different strengths: 5 milligrams, 10 milligrams, 20 milligrams, and a 20 milligrams slow-release version.

How Ritalin actually works in a child's body is highly debated. Ask four doctors and you'll get four different answers.

"The most prominent theory is that Ritalin stimulates the inhibition centers of the brain," says Dr. David Fay, a family physician in Illinois. "Its effect is paradoxical, somewhat like alcohol: alcohol is a CNS depressant, but appears to depress the area which allows one to control his functioning. Ritalin seems to stimulate the ability to stay still and pay attention."

Ritalin and Cocaine

Children on Ritalin are usually much more calm and focused. The affects of this drug are often compared to that of cocaine. The jury is still out on whether that is a fair comparison.

"It would be more realistic to compare Ritalin with amphetamines, as they are structurally related," says Dr. Fay. "Ritalin is a central nervous system (CNS) stimulant like cocaine, but it is much milder in its effects.'

Some researchers even believe that children treated with Ritalin may be more prone to try other drugs down the road. One study published in the Archives of General Psychiatry reported that Ritalin's effect on the human brain was almost identical to that of cocaine. Another study funded by the National Institute on Drug Abuse and the National Institute of Mental Health, and published in the journal Pediatrics, found that boys treated with Ritalin are less likely to abuse drugs later in life.

"Putting a child on Ritalin is the same as putting him on amphetamines (speed)," says Dr. Jenny Lewis, a primary care pediatrician and author of Don't Divorce Your Children (McGraw-Hill Companies, 1999)."It does not present the dangers of cocaine in its potential for addiction and most studies do not indicate that kids who take it are more likely to be drug users later."

While some argue that Ritalin should not be compared with hard drugs like cocaine, the DEA does classify it as a "Schedule II" substance. Schedule II drugs are defined as "having a high abuse potential with severe psychic or physical dependence liability." Amphetamines and cocaine also are included in this group.

Does It Work?

Ritalin is highly controversial not only in how it actually works, but if it works at all. Many parents feel Ritalin is their children's savior, and many feel it is abused, over-prescribed and does not work.

For Helen, a daycare director and mother of two boys, Ritalin was a lifesaver. Her oldest son, Max, had been diagnosed with ADHD, but her husband was against putting him on any medication.

"We went through three years of hell before he took Ritalin," says Helen. "He was labeled a bad boy in daycare, got kicked out of camp, had detentions in kindergarten – life was hell. Our family was falling apart."

After consulting a child psychologist for a year, Helen told her husband if they didn't put their son on Ritalin, she was leaving. "We tried it, and within the first day we saw Max in a different light. That day I found my husband sitting on our bed crying like a baby, apologizing, saying if he only knew we wouldn't have gone through the three years of hell."

Two years later, Max is still on Ritalin. Helen says his self-esteem is high and at school he is in a regular class with no special help. "He's come a long way. And our family is in better shape, too."

But not all have such good results. Joyce's son, Stephen, always had difficulty in school, despite the fact that he was very bright. "He simply could not follow through on any homework assignments," says Joyce. "We'd sit down in the evenings and I'd make sure he did the work, but then the next day he wouldn't turn it in because he'd left it in his locker."

Stephen's teachers thought he was a troublemaker – he would get into fights with other kids, and he could not pay attention in class. "To say we, as parents, were exasperated is a gross understatement," says Joyce. "We read books, we took him to counseling, until finally – after many years of frustration and a long record of failure – a doctor diagnosed him with ADD and prescribed Ritalin."

Joyce did not get the results she had hoped for. "He was on the drug for one month and if you saw him under its influence it would break your heart. He was dull, lethargic, depressed. We felt terrible because we felt we were turning him into a zombie."

Side Effects

As with any drug, the potential for serious to not-so-serious side effects are a possibility. Some of the serious side effects include an allergic reaction with symptoms similar to that of a food allergy; an irregular heartbeat; chest pains and/or high blood pressure; severe headaches; liver damage; and strange behavior or confusion. Less severe side effects include insomnia; nervousness, headache; drowsiness; loss of appetite; and weight loss. If your child experiences any of these, consult your doctor immediately.

Scott's daughter was put on Ritalin at age 12 and taken off 6 months later. "It caused her a lot of stomach cramps, and we also found that it depressed her emotionally," says Scott. "She got pretty cranky at times, and this caused her to do even worse in school. In addition, her friends told her she wasn't fun anymore, so she resisted the medication and got angry that we were asking her to take it."

Debbie's son was in Kindergarten when she started him on Ritalin. Debbie thinks Ritalin saved her son's childhood and has learned to manage his side effects. "If he takes his last dose later than 4 or 5 p.m., he can't sleep. His appetite was gone for a while, but now he seems to eat everything. He still has trouble at times with falling asleep. We switched to the sustained (time release) capsules and it works a lot better."

Loss of appetite seems to be the most common complaint. Barbara noticed a big decrease in her son's appetite while on the drug. Since she's taken him off Ritalin, he is steadily gaining his weight back. "My son has not gained a lot of weight in the past 3 years, but he is growing taller – and if you could see what he packs away at the supper table, you'd know that the pills take it right away from him."

Edwina's grown son, Stephen, was on Ritalin most of his childhood. Stephen is 5 feet, 7 inches tall, and blames Ritalin. But she admits that "there is no way to know" if his height is a direct result of the drug. "Of course, there are side effects, and they just have to be weighed against the possible benefits."

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