When medication does appear necessary, methylphenidate, or “Ritalin®” is usually the first tried. Acting as a stimulant for most of us, Ritalin® has a paradoxical opposite effect on those with ADD, calming them down and allowing better focus for the majority of kids. Eighty percent of children with ADD who are medicated are on Ritalin®, and 85 percent of these kids show a positive short-term response. A recent study states that an estimated three million children with Attention Deficit Disorder - ADD are taking Ritalin®, which is double the number in 1990. A typical Ritalin® dose ranges from 5 to 40 milligrams per day, divided into one, two, or three doses. Ritalin® works fast, but lasts only about four hours, so that many children who take a breakfast dose show a good effect at 10am, but need a second dose at noon. The main side effect of Ritalin® is appetite suppression; therefore, growth is closely monitored while a child is medicated.
There has been an increase in the diagnosis of ADD. The number of prescriptions for methylphenidate, a medicine around since 1937, has tripled in the last several years. Whether this represents a true increase or a heightened awareness leading to the diagnosis of what was present all along isn’t known. What parents can do, however, to protect against over-diagnosis, is to be sure the proper guidelines are being applied. The diagnosis should only be made when the accepted criteria in a manual called the DSM3 are satisfied. Parents should be more wary of ADD as an accepted diagnosis in children under five. Lead poisoning and language disorders should always be looked at first and a full developmental assessment must be done. Medicines for this age group do not work as long and have more side effects.
In the short term, the appropriate use of medicines, in addition to behavioral, and educational management, may bring about improved behavior for almost 90 percent of children. A better school experience and academic success brings more confidence and a higher self-esteem. In this respect, the condition is “treatable.” Yet the long-term effects of medicine are unproven. ADD is a chronic condition, which changes with the situation and the development of the child, and treatment needs to be reassessed. It is reasonable to periodically stop medicines in most children to assess a child’s changing needs.
Are We Doing A Disservice to Our Children?
There isn’t an easy answer to this question. An accurately diagnosed and treated child can be helped greatly. A misdiagnosed one runs the risk of receiving inappropriate treatment and an unfair label. Parents, as advocates for their children, should make sure the diagnostic process conforms to accepted standards. They should be active participants in the behavioral and educational management efforts, asking for periodic re-evaluations of the treatments employed and never hesitating to ask questions and to give opinions. The American Association of Pedriatrics(AAP)and American Academy of Child and Adolescent Psychiatry (AACAP) have presented no guidelines for diagnosing children under the age of six; however, the Journal of the American Medical Association reported in February 2000, that the amount of psychotropic drugs prescribed to two to four year olds tripled from 1991 to 1995. Parents must be leary of doctors diagnosing ADHD or ADD and prescribing psychotropic drugs for toddlers. After all, they may be experts on ADD, but no one is ever more of an expert on one particular child than his or her parent.