Ritalin (Methylphenidate) in the Treatment of Attention Deficit Hyperactivity Disorder

Ritalin is a good medication with a bad reputation. Its name causes more fear in the hearts of parents than any other medication. It is the topic of radio talk shows, protests by the Church of Scientology, and negative newspaper articles. And yet, I wonder, if it is so very bad, why is it so "over-prescribed" as the critics claim? Let's explore the issue further, and give some information to parents who might want to know more about the medication.

Tips to remember about Ritalin:

We have seen hundreds of kids benefit greatly from Ritalin. But doctors and parents must be observant and conservative. We have also seen some horror stories with Ritalin. Start slowly and cautiously. It is not a toy.

The short-acting pill is better than the timed-release pill. Also, the brand name "Ritalin" is much superior to the generic "Methylphenidate." Always begin your "trial" of medication with the real stuff. If that works, then feel free to see if the generic will work as well as the "real stuff."

Ritalin begins to work in about 15 or 20 minutes. It peaks in effectiveness at 1.5 to 2.5 hours, and lasts for about 3.5 to 4.0 hours.

Some kids have "withdrawals" or a "trough period" from coming off of the dose at about the 4 hour mark. They may become irritable, tearful, emotional, or bratty. This lasts for about 15 minutes, and tends to be worse with doses of 15 mg. or more. The best remedy for this that we've found is a 12 oz. Mountain Dew at about the 3.0 hour mark. The caffeine "deflects" or "flattens out" the angle of withdrawal. This trick works well.

Ritalin works somewhat differently in the brain than do the amphetamines like Dexedrine or ADDerall. Ritalin seems to primarily impact on longer term vesicular storage of Dopamine, while amphetamines impact primarily the pool of newly synthesized Dopamine. It also has a different effect on Norepinepherine.

From the Physician's Desk Reference (PDR) 1997, page 867 we read, "Drug treatment should not and need not be indefinite and usually may be discontinued after puberty."

"Start with 5 mg twice daily, before breakfast and lunch?" "Administration of amphetamines for prolonged periods may lead to drug dependence and must be avoided."

Please understand that none of these statements from the PDR is supported by research. Most children with ADHD will still benefit from medications through their teenage years, and more than 50% of children with ADHD will still benefit from stimulant medications into adulthood.

Studies show that the medications work better if taken with or after meals.

Studies show, over and over again, that (1) ADHD kids who are never treated will have higher rates of drug use than non-ADHD kids, (2) ADHD kids that ARE treated, whether with medications, or biofeedback, or with anything, will have LOWER rates of drug us than non-ADHD kids. There is no evidence that using stimulant medications increases rates of drug use among adolescents or adults. Rather, the opposite is true.

We have seen Ritalin help hundreds of children, teens, and adults. Perhaps it can help you as well. But please be careful with it. And first, please consider some of the effective non-stimulant interventions than may be just as effective for you, but without the potential side-effects. Learn more about ADHD and the treatment options at the ADHD Information Library.

Douglas Cowan, Psy.D., is a family therapist who has been working with ADHD children and their families since 1986. He is the clinical director of the ADHD Information Library's family of seven web sites, including http://www.newideas.net, helping over 350,000 parents and teachers learn more about ADHD each year. Dr. Cowan also serves on the Medical Advisory Board of VAXA International of Tampa, FL., is President of the Board of Directors for KAXL 88.3 FM in central California, and is President of NewIdeas.net Incorporated.