The Drug Bandwagon - Ritalin

This was meant to be a companion post to "the drug bandwagon" but I've been so sidetracked lately that it's slipped a little.

I've talked quite extensively about Ritalin in the past but I was answering some questions for someone recently and I figured that the information was worth sharing - even if it covers some old ground...

Disclaimer

As per usual, when I do a drug-style post, I just want to start with a quick disclaimer. I'm not a doctor, so any advice I give should be treated as lay-person's advice which should be checked by a professional.

The Question

The question I was asked was about Metadate CD however Metadate CD is just another name for "day-strength Ritalin" - as is Concerta. Ritalin and Concerta are brand names while Metadate CD is the generic (cheaper version).

Everything you read about Ritalin and Concerta holds true for Metadate CD.

(but of course, not everything you read online is true).

The Horror Stories about Ritalin...

It's true that there could be some nasty side-effects with Ritalin. The same goes for every single drug in history - including Aspirin which has a much, much worse track record. No drug is 100% safe so use any drug with caution and consider doing a test on yourself (either parent) first before you try your child. Unless your child is adopted, you're the closest genetic matches for your child and will be better able to assess the likelihood of side-effects.

Don't forget though that the adult dosage is probably much higher than the child's dosage. As a good starting point, the dosage is calculated by weight. If you weigh double your child's weight, then in theory, you'd need to consume double the quantity to get the same effect.

Of course, your doctor should be able to give you a much better idea of the ratios but if they are resistant to the idea for health reasons, then consider this - if your doctor doesn't feel that a particular medication is safe for you, how can he warrant that it will be safe for your child?

The Detractors of Ritalin

There is a strong anti-Ritalin movement however you'll find that it usually stems from two sources;

1. The Church of Scientology, which doesn't recognize Autism as a condition and which opposes the use of any drugs (including Aspirin).
   
   
2. Parent groups who are opposed to the use of any medication in children (and often think that everything comes down to either parenting or diet).

Understand that both groups are biased and that sometimes their information can be downright "lies". They use a lot of scare tactics and with a considerable amount of success.

The fact is that Ritalin has had over 50 years of clinical tests and it's arguably one of the safest medications of its type for children today.

Of course, that doesn't mean that you should write-off the advice of parent groups. Fish Oil and various dietary changes didn't work for my son but maybe they will for yours. Every child is different and perhaps one child's genes make him more susceptible to alternative medicines than another.

Even if the natural drugs don't actually work, sometimes the placebo effect is all takes.

Suitability for Purpose

I'm often told that people are on Ritalin because they have aspergers without having been told that the child also has ADHD. Ritalin is an ADHD drug - not an Aspergers drug. There is no drug which is known to be effective against aspergers. So, if your child doesn't have ADHD, then you probably shouldn't be giving him the medication.

There are two main types of ADHD.

• ADHD - Hyperactive: These are the kids who you see "bouncing off the walls" in Supernanny.
  
  
• ADHD - Inattentive: This used to be called ADD. In this case, the child isn't hyperactive at all. It's just very difficult to get their attention - and almost impossible to keep it.

ADHD is a very common co-condition for people with aspergers. Find out for sure whether your child has it or not. This will help you to decide on the issue of medication.

It doesn't work for everyone

Ritalin works differently in different people - which is one of the reasons why I suggest you test on yourself first. Some children react really well, while others don't. It's rare for a child to react poorly to ritalin but it's reasonably common for it to seem to have no effect. In these cases, you may find yourself under pressure to increase the dosage. Small short-term increases are acceptable but if you don't see changes quickly - it's time to discontinue.

Ritalin also affects people of different ages differently. A child who has no response on ritalin at a young age may respond better as he gets older (or vice versa).

Expect Results - or Discontinue

Ignore the information online about it needing to get into the system. You should see major behavioural changes within the first two weeks. If you don't, then discontinue use.

It takes about 1 hour to get into the system and the effects usually last for four hours. Of course, if your child is on a day strength variant, you may get 11-12 hours out of it. You will notice some significant mood changes as your son comes off the ritalin, so try to be tolerant at that time of night.

Too much, Too Little

Too little Ritalin and your child will be their usual disruptive or inattentive self. Too much and while they seem like the model student they will have actually "zoned out". This is what I call the "zombie effect". Your child needs exactly the right dosage to retain their personality and quirks while suppressing the attention deficit urges.

Teachers tend to love the zombie state, so be careful and test the ritalin at home before you let your child use it at school. You need to see the effects in order to gauge the correct dosage. The idea of the ritalin is to give your child more control over their own impulses - not to suppress them altogether.

Your child may also need more ritalin as they get older as it's often determined by body mass. If your child goes through a growth spurt, don't be surprised if the paediatrician recommends a higher dose.

Of course, the reverse is also true sometimes. As your child develops more and more self-control over their own impulses, they may be able to reduce the dependency on Ritalin. If possible, give your child a chance to operate without it - on weekends and school holidays. Of course, if there's learning involved (eg: scouting activities, weekend tutoring etc, you might consider giving medicating for certain occasions). Just be sure to use it to give your child self-control, not to make your job as a parent easier.

Make sure that your child's school knows about the ritalin and knows when you increase or decrease the dose. They can help to watch for "danger signs". You'll probably encounter a lot of different opinion about medicated children in school - both positive and negative. Be prepared for people who can't suppress their urge to comment and don't let it get to you.

Side Effects

There are a few side-effects to ritalin but the most well documented ones are loss of sleep and lack of appetite.

Remember that the tablets last for 12 hours and make sure that you don't have your child on medication close to bedtime. You may find that it helps to have a mix of both day-strength and half-day tablets. (not for the same day obviously but for days when you forget the tablet or need to give it to your child later).

Some parents give their children Melatonin to help them sleep after Ritalin. This is ok but it's counter-productive if the ritalin is still active in their system. If the ritalin is keeping your child up at night, try either giving him his tablet earlier in the morning or switching to two Ritalin tablets per day (you'll need the school's co-operation if you do this).

Ritalin also puts a bit of a horrid aftertaste in the mouth, so make sure that your child has finished their breakfast before you give them the tablet.

Ritalin does not bring about long-term change. In fact, it drops off quite drastically when you stop taking it. There are articles about traces lingering in the system but that's true of any medication. Any changes it makes to your child should be temporary.

Alternatives

There are obviously drug alternatives to ritalin but these are all at least a little more dangerous because they've had less clinical trials. Another thing which is commonly used in place of Ritalin is coffee. Believe it or not, coffee is often just as good with ADHD children.

Changes to diet can also help but only if a child has specific intolerances to various food colorings and preservatives etc. Sometimes it's worth a go though.

I hope these help anyway.

Ultimately, you have to make your own choice - and it's always difficult.