Worried About Ritalin®

Our expert reassures a parent who hesitates to put her child on Ritalin® (methylphenidate).
I'm really worried about giving my son Ritalin®. Is there another solution? He has ADHD.
I certainly understand your concern about having your son take Ritalin?. There are a lot of children who are taking this medication who probably should not be (both legally and illegally). Also we live in a world in which parents and children hear constant warnings about the use of drugs. However, it's important to know that Ritalin? (methylphenidate) has been used successfully in the treatment of ADHD for several decades, and is helpful in alleviating the symptoms of about 85 percent of the children and adults who take the medication. When the medication is properly prescribed and monitored, the effect is quite often dramatic, helping to make learning accessible for many children.

A problem with the use of medication is that it is too often given too quickly without exploring other important ways to help a child with ADHD. First, parents and teachers have to make sure whether it is the inattention or the hyperactivity or a combination of these characteristics that is getting in your child's way. Then teachers have to make reasonable accommodations in the classroom (setting up the room to allow for "productive" movement; creating materials that captivate attention, etc.) At home, parents need to work as partners in the appropriate management of a child with ADHD. This may involve family therapy.

There are other treatments for ADHD, but none of the so-called alternative therapies are based on research which is solid enough or convincing enough to allow most traditional practitioners (physicians, psychiatrists, psychologists) to endorse these approaches. These include megadoses of vitamins and minerals, diet manipulations (including food additive-free, sugar-free, and yeast-free diets), and amino acid therapy. Biofeedback has gotten a lot of press lately, although there is no specific pattern brain activity in those with ADHD. Other treatments that may have some merit are:

  • Sensory integration (check with the occupational therapist at school);
  • Exercise (talk with the adaptive physical education specialist);
  • Self-monitoring (in which the child is taught how to "pay more attention to attention"); and
  • Psychoeducationally oriented therapy (in which the child is helped to understand the impact of the ADHD on learning, behavior, and social relationships).
Behavior modification is a well-established treatment used in schools and at home to reward appropriate behavior while ignoring (or at least not reinforcing) troublesome behaviors. This can be a very effective technique if a child's environment can be controlled. This is often difficult or impossible (who can stop the other kids on the playground from laughing at -- and reinforcing -- a silly behavior?) Also the use of behavior modification assumes that the behavior is learned and can be unlearned. A child with ADHD most often gets into trouble because he is impulsive and does things without thinking, not because he has learned to do them. He does learn that certain behaviors get responses that he likes, so he may do those again and again, but that's not really part of the ADHD per se. Also, many professionals feel that behavior modification is more effective for children with ADHD if it is used in conjunction with medication. That's because the medication allows the child to attend to the treatment!

Two books that will give you a lot more information about this important topic are: Attention-Deficit Hyperactivity Disorder: A Clinical Guide to Diagnosis & Treatment by Larry Silver, M.D. and Do We Really Need Ritalin?: A Family Guide to Attention Deficity Hyperactivity Disorder (ADHD) by Josephine Wright, M.D.

Jerome (Jerry) Schultz is the founding clinical director of the Learning Lab @ Lesley University, a program that provides assessment, tutoring, and case management services for children with learning challenges. Schultz holds a Ph.D. from Boston College, and has completed postdoctoral fellowships in both clinical psychology and pediatric neuropsychology.

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