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Do You Recommend Ritalin?
Q: What is your opinion of Ritalin? Does it have any side effects? Many parents ask me advice on this. I have mixed feelings about putting young children on drugs.
A: I am with you as far as being cautious about using any medicines in children and about minimizing the amounts of medicine that we do prescribe. It is usually wise to use the lowest dose that gives the desired result in order to minimize side effects.
With attention deficit hyperactivity disorder, Ritalin (also known as methylphenidate) happens to be a good choice when used appropriately. One first needs to be sure that the diagnosis is accurate before placing a child on stimulants. Be sure that a child first gets a thorough evaluation, including assessments by both parents and teachers, before using any medications. Most frequently, the lowest dose possible is given in the morning and before lunch on school days. Sleep problems and decreased appetite are common initially; these tend to go away after using a stimulant for a couple of weeks, as you sort through whether it is working or not. Some other side effects of Ritalin include weight loss, headaches, bellyaches, dizziness or some irritability. It can also affect blood pressure or cause problems with the rhythm of the heart. Although growth suppression has been considered a potential side effect, studies suggest that children treated with stimulants achieve the same heights as those who were not treated.
It is also meaningful to understand that while Ritalin may help in school, it is not a cure. This disorder should never really be managed by medication alone--behavior management and education are also critically important. Parents need to work closely with the school to help make things easier for their child in the classroom. Decisions regarding use of stimulant medications should be individualized. Adequate support and close follow-up can also have a very positive influence in the long-term management of the disorder.
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Henry Bernstein, M.D., is currently the associate chief of the Division of General Pediatrics and director of Primary Care at Children's Hospital, Boston. He also has an academic appointment at Harvard Medical School.