Ritalin – friend or foe?

I am often asked to give my opinion on the use of Ritalin (and it’s counterparts) in the treatment of children with ADD or ADHD.  The question usually comes from parents whose children have recently been diagnosed, confused by the multitude of conflicting reports and opinions on the subject. Truthfully, I hate being asked this question.  I am not qualified to prescribe medication and would much rather have the professionals who are, give their answers. But I’ll tell you what I’ve seen:

I’ve seen how it can virtually be a life-saver for those children whose incredible potential had previously been hampered by their inability to concentrate.  I’ve seen how they grow in confidence and how their self-esteem improves. How their social circle widens as their impulsive behaviour is curtailed and they are no longer constantly in trouble with the teacher.  I’ve seen them arrive in the morning neater and cleaner than in the days before Ritalin, when mom had to keep reminding them to get ready for school or to put their dirty laundry in the wash.  I’ve also seen how much neater their books and bags are from not constantly being forgotten out on the sports field or on the bus and I swear, I’ve even seen their handwriting improve in some cases.

But, I’ve also seen the ugly side.  The listless or zombie-like expressions some children get. The irritability and aggression.  The loss of appetite. The weepiness.

So now what? How on earth is that supposed to help you make up your mind about whether to medicate or not?

My advice is this:

1. Make very, very, very sure that your child is definitely suffering from ADHD or ADD before even considering medication.  Too often children are diagnosed by so called experts simply from the information given by parents on a questionnaire or by having a ten minute interview with the child.  Make sure you’ve had a complete psycho-educational assessment done to screen for any other possible causes of distractability or low academic performance and have your child examined by a neurologist, rather than a psychiatrist, if at all possible.  And get a second or even a third opinion if you don’t feel comfortable.  Medicating a child is a big decision and you need all the information you can get.

2. Try the alternatives first if you’re not happy to medicate.  It has been my observation that the alternative treatments such as the Feingold diet, Omega-3 based supplements and other homeopathic remedies, neurotherapy, etc are not as effective as medication. But it’s still worth a shot as some children do respond really well to these treatments. And many of these treatments work wonders when used in conjunction with the correct medication.

3. Get everyone on board.  There is a huge stigma attached to the use of Ritalin and parents are often shunned as being “bad” parents who don’t know how to handle their “spirited” child. Crap! I’d like to see how these people cope after they’ve been running around after a hyperactive, impulsive  child all day. Parenting a child with ADD or ADHD can be very difficult and you need to make sure grandparents, aunts, uncles and teachers are all on the same page as you.  Sit them down and tell them about your decision to medicate and be firm if you have to. You will need their buy-in support later to make sure that your little one gets his correct dosage at the correct time when he’s visiting.

4. Check-in with your neurologist regularly and tell him about any concerns you may have.  The initial stages might include quite a bit of “tweeking” of the medication to find the correct drug and dosage.  This can be a little frustrating, with medication often being changed every few weeks, but is well worth it. I’ve seen children flourish when the neurologist (finally) hits on the correct dosage and medication / combination.

5. Stick with it.  Parents, in two minds about the use of medication, are often guilty of not giving medication regularly or not giving the long-acting medications over a long enough time period to kick into effect.  Once you’ve made up your mind to give your child the medicine set your alarm to go off at the times he needs to take it and commit to giving it to him every day as prescribed.

This is a difficult decision to make, but armed with accurate information and a supportive relationship with all involved can be a very positive experience.  Best of luck!