"But I’ve heard all kinds of bad things about using Ritalin?"

There are a number of myths concerning stimulant medication that discourage many parents from considering its use for their child. These myths are summarized in an excellent book titled Attention Deficit Disorder and Learning Disabilities: Realities, Myths, and Controversial Treatments by Barbara Ingersoll and Sam Goldstein (highly recommended) and include the following:

• Children treated with stimulant medications will become addicted to it and are more likely to abuse other drugs.

  There is no data which indicates that addiction to stimulant medications is a problem or that children treated with stimulants are more likely to abuse other substances.

• Stimulant medication stunts growth.

  The available literature indicates that ultimate height appears to be unaffected if treatment is discontinued in adolescence. However, there have been no studies of growth in children treated continually from childhood into young adulthood so caution here is warranted.

• Stimulant medication works by turning children into "zombies".

  Some children do become sluggish and withdrawn when on medication, but these symptoms generally indicate that the dose is too high, or that a co-existing condition such as a mood problem has not been identified. Studies have shown an increase in prosocial behavior in ADHD children treated with stimulants, which would not be the case if it simply turned children into "zombies".

Factors to consider in deciding on the use of medication:

1. What other interventions have already been tried?

   Some children with ADHD can have their symptoms effectively managed via other means including appropriate behavioral and educational interventions. If you are concerned about using medication with your child, make sure that non-medical interventions have been tried first. This is an important issue to discuss with your child’s physician.

2. How much difficulty are the child’s symptoms actually creating?

   The degree of impairment in academic, social, and behavioral functioning caused by ADHD can vary substantially. If the impairment experienced by your child is on the modest side, medication may not even be necessary.

3. What is the child’s attitude towards taking medication?

   It is very important to discuss the rational for using medication with the child. The child needs to know why it is being suggested and how it can be helpful. This is especially true for older children and adolescents, who may have concerns about being teased should their peers find out that they are taking medicine. If children have strong objections to taking medication, these should be discussed and understood. Should these objections persist, using medication may not be productive.

4. Will objective information about the effects of medications be provided?

   In my opinion, this is critical. Despite the well-documented benefits of stimulant medication, as many as 20-30% of children do not experience significant benefits. In addition, many parents are surprised to learn that when children with ADHD receive only a placebo (i.e. medication that appears to be the real thing but is not), teachers frequently report significant improvement in the child’s behavior. This means that some children may receive stimulant medication for a sustained period even though they derive no objective benefit from it, or fail to receive the most beneficial dose.

Fortunately, it is not hard to conduct a careful trial that provides more objective information about a child’s response to medication. This is accomplished by having the child receive different medications doses as well as a placebo over a 3-4 week period. At the end of each week, the child’s teacher completes ratings of the child’s behavior and academic performance. Because neither the child nor the teacher know what the child was receiving each week during the trial, the teacher’s ratings provide more objective information. By comparing the ratings made each week one can determine whether:

1. medication was clearly superior to placebo
2. what dose produced the optimal response
3. whether any adverse side-effects were observed (sometimes children report what appear to be side effects when they are only getting a placebo)
4. what problems with behavior and academics may remain even if medication clearly helped, and which need to be targeted via other means.