Q
My six-year-old was seen by two different psychiatrists and the Ritalin dosage they prescribed him differed by about 20 mg. How do they determine the proper dosage? I noticed that 10 mg a day had little effect on my son. The second doctor prescribed 30 mg a day, and I believe that's too much! Where do I start my research so I can feel comfortable with my son's prescription?
A
Appropriate dosage of Ritalin for children is a very confusing issue. At one time, dosage was linked to body weight, but now we know that the dose needed to reach clinical benefits is related to how rapidly each individual metabolizes the medication. Clinical observations are used to establish the proper dosage. Most doctors start the patient off on the lowest possible dosage (5 mg per dose, or even 2.5 mg per dose). If no benefits are noted, then the dose is gradually increased. Monitoring the effectiveness of the dose is critical. Feedback from both parents and school is most helpful.
For more information about medication and ADHD, have a look at Dr. Larry Silver's book, Advice to Parents on ADHD. Look in particular at the chapter on "Treatment with Medications." You can also look at the website for CHADD (Children and Adults with Attention Deficit Disorders) or call them toll-free at 1-800-233-4050.