Several arguments are often given to justify "Just trying
Ritalin to see if it works" when we need to help a child who
suffers from symptoms of ADD or ADHD.
ARGUMENT I:
"If someone suffers from diabetes, of course you would
give him insulin," so, of course, you should give a child
methylphenidate if he needs it.
This comparison is inaccurate.
Firstly, diabetes is a thoroughly researched and well
understood illness caused by an inability of the pancreas to
produce insulin. Treatment is to give insulin because that is
the deficiency of the body. The level of sugar in the blood
can be precisely tested and the effect of the insulin can be
monitored accurately.
However, ADD and ADHD are not medical deficiencies of
methylphenidate. The makers of Ritalin themselves state that
the specific etiology of this syndrome is unknown. ADD and
ADHD are only terms given to sets of symptoms and there is no
single diagnostic test. Furthermore, after 50 years of
clinical use, the makers of Ritalin still admit that they do
not understand how it works.
A family physician once told me that when parents come to him
with a request from the school to prescribe Ritalin, he
prescribes vitamin tablets and tells the parents not to tell
the school or the child, so they both think the child is
taking Ritalin. He keeps accurate records and finds that the
improvements of the child's performance are consistently as
good as if he had prescribed Ritalin.
Secondly, even insulin is only prescribed to a diabetic when
it is clear that the situation cannot be controlled through
alternative treatment such as diet. The doctor does not say,
"Let's try insulin and see if it works." If insulin is
prescribed when it is not necessary, it can cause the
pancreas to produce even less insulin and exacerbate the
condition.
Thirdly, insulin helps all diabetics who need it, whereas
methylphenidate does not help all ADD and ADHD sufferers.
ARGUMENT II:
Methylphenidate is only a very mild stimulant and is
harmless.
When taken in tablet form, methylphenidate is considered to
be non-addictive because it is absorbed into the blood stream
slowly and it is claimed that it does not reach the brain in
sufficient concentration to cause addiction. However, when
absorbed directly, it has the same effect and the same
potential for abuse as the major narcotics. Therefore, it is
classified as a Schedule II stimulant by the FDA.
Substances in Schedule II have a high abuse potential with
severe psychological or physical dependence liability, have
an accepted medical use in the United States, and are
available for practitioners to prescribe, dispense and
administer.
Schedule II narcotics include morphine, codeine and opium.
Schedule II stimulants include amphetamines (Dexedrin,
Adderall, methamphetamine-Desoxyn, and methylphenidate-
Ritalin). Cocaine is another Schedule II substance.
ARGUMENT III
Ritalin has been used on millions of children for many
years and has been proven to be perfectly safe.
This is not correct. Stimulant medication was first used in
1937 and the drug known as Ritalin (methylphenidate) has been
used since 1958. However, over forty years later, the makers
of Ritalin themselves still say that the safety of
methylphenidate for children less than six years has not been
established and the long term effects of Ritalin in children
have not been well established. They also say that drug
treatment should not and need not be indefinite and usually
may be discontinued after puberty.
ARGUMENT IV
It has no serious side effects. Even over-the- counter
medications are packed with little notes giving long lists of
possible side effects. The makers have to do that to protect
themselves from the one-in-a-million chance of a serious
reaction and so the list of possible side effects should not
be taken seriously.
Firstly, over-the-counter medication should not be used for
extended periods of time. In contrast, methylphenidate is
administered for months and even years.
Secondly, a large controlled clinical study with patients
using a slow-release form of methylphenidate packaged to have
reduced side effects reported that the most common side
effects reported were headache (14%), upper respiratory tract
infection (8%), stomach ache (7%), vomiting (4%), loss of
appetite (4%), sleeplessness (4%), increased cough (4%), sore
throat (4%), sinusitis (3%) and dizziness (2%), which totals
54% of the patients! Other reported side effects include
agitation, irritability, depression, pyschosis and a `zombie'
effect causing lack of spontaneity and alertness, increased
blood pressure and changes in blood constituency.
Other reactions include hypersensitivity (including skin
rash, urticaria, fever, arthralgia, exfoliative dermatitis,
erythema multiforme with histopathological findings of
necrotizing vasculities, and thrombocytopenic purpura),
anorexia; palpitations; dyskinesia; drowsiness; blood
pressure and pulse changes, both up and down; tachycardia;
angina; cardiac arrhythmia; abdominal pain; weight loss
during prolonged therapy. There have been rare reports of
Tourette's syndrome. Toxic psychosis has been reported.
A report published in theNew England Journal of
Medicine stated that decreased appetite is reported in
approximately 80 percent of children, but it is often mild
and limited to daytime eating, and intake increases in the
evening. About 10 to 15% of children have substantial weight
loss. Insomnia has been reported in 3 to 85 percent, with
sleep delays of about an hour. Abdominal pain, irritability,
headaches, dry mouth, dizziness and depression are less
frequent. Cardiovascular effects, limited to variable
increases in heart rate and blood pressure, are most evident
at rest and diminish with exertion.
The high incidence of these side effects indicates that we
are not dealing with a `one in a million' chance of a side
effect but with a medication which is far more toxic than a
regular over-the-counter medication. The makers themselves
and government agencies such as the FDA and NICE recommend
regular blood pressure checks and periodic CBC, differential,
and platelet counts during prolonged therapy.
Many of these symptoms get less with continued use, as the
body adapts itself to the medication, but it is clear that
the body is having to make drastic changes to adapt to a very
invasive medication.
ARGUMENT V
Methylphenidate is the most proven and effective treatment
for ADD and ADHD.
Studies show that administering methylphenidate is effective
for 70% of ADHD sufferers. However, the same tests also
showed that administering a placebo is effective for 17% of
the sufferers. Reducing sugar intake is effective for 5% of
the sufferers. Other studies involving giving breakfast and
increasing sleep and dietary interventions all show
significant effectiveness.
ADD and ADHD are terms given to sets of symptoms and are not
at all diagnostic. There are many ways to deal with the
symptoms.
Firstly, there are very many factors which have been proven
to cause ADD and ADHD symptoms. These include insufficient
sleep, allergies, food additives, vision deficiences,
dehydration, fluorescent lighting, unclean air conditioner
filters, heavy metals, sugar, magnesium deficiency, junk
food, zinc deficiency, social stress, stress from school,
Vitamin B6 deficiency, lack of stimulation from school, poor
teaching and over stimulation from computer games.
For example, when one district introduced school breakfast,
administrators reported that the school breakfast played a
major role in the 40-50% decline in discipline issues.
Researchers also noted a general increase in composite math
and reading percentile scores.
Correcting the core issue automatically remediates the
symptoms.
Secondly, there are many alternatives available, including
exercise, coffee, herbal remedies, the Feingold diet, and
high nutrition dietary additives. For example, the
Australia Pediatric Journal reported that 72.7% of 55
children put on a six-week trial of the Feingold Diet
demonstrated improved behavior. 26 (43.3%) remained improved
following `liberalization' of the diet over a 3-6 month
period.
Thirdly, many different forms of therapies, including
behavioral therapy, One-Brain kinesiology and neural bio-
feedback, claim proven success in alleviating symptoms.
Another aspect of resorting to only using a drug to remedy
the situation is that core issues are not dealt with. The
makers themselves state that careful supervision is required
during drug withdrawal, since severe depression as well as
the effects of chronic over-activity can be unmasked. Long-
term follow-up may be required because of the patient's basic
personality disturbances.
The makers themselves stress that medication should be given
only after all other options have been considered and then it
should be administered only as part of a general remediation
program.
[Readers are invited to tell of their experiences with
Ritalin, pro and con.]
