A Pediatric Psychiatrist
Talks About Ritalin Use
by Terri Ricci
Access Press recently asked Dr. Steve Genheimer, a Health-Partners
pediatric psychiatrist, some basic questions in response to the articles
on psychiatric drugs printed in the August issue.
Access Press: Last month we printed an article regarding the new
Minnesota law that restricts schools from forcing parents to medicate
their children.
The National Alliance for the Mentally Ill in Minnesota had some
concerns about the article because it represents the views of the
Citizens Commission on Human Rights of Minnesota and the Church of
Scientology. According to the Church of Scientology, Ritalin is a
drug that is currently being sold on the black market and is a highly
addictive stimulant. To what degree is this true?
Dr. Genheimer: The use of stimulants has increased over the past
15 years, but there has not been any medication more studied than
Methylphenidate (Ritalin); there have been over 1800 individual studies
on this medication. There have been two long-term outcome studies
on adults who have been treated with stimulants for Attention Deficit
Disorder (ADD) as children and those adults have less indication
of substance abuse. Most studies are quite positive in response to
the use of the drug for ADD.
The use of Adderall has been linked to some risks, especially sudden
death, and was taken off the market in Canada for review. However,
as of last week the drug was put back on the market in Canada. This
medication can also be very effective for treating patients and the
studies are inclusive if the sudden death was a direct result of
the drug. I personally have not experienced any patient getting euphoria
using stimulants and I believe if ADD is treated correctly in childhood,
there is less chance of substance abuse as adults.
Access Press: There have been articles debating whether Ritalin
is over or under prescribed in children. What is your professional
opinion on the use of these types of drugs in children?
Dr. Genheimer: Again the long-term studies show that treating children
early with medication can be effective for the treatment of children
who have been accurately diagnosed with ADD... About 3 to 7 percent
of school age kids have ADD. However, ADD symptoms such as distractiveness
and a reduced attention span can be present in most children. Again,
however, the children with ADD are very distractable and often can
be impulsive and sometimes have hyperactive-ness. Not all of the
children with ADD need to be medicated, though; some of these children
are helped with medication. In general, all children need to learn
organizational skills and need a place that does not over-stimulate
them. Children with ADD need to do important things in a non-distracting
environment, and sometimes, having the parent, teacher and student
working together on getting the child a buddy to study with, a quiet
place to take a test, so they will be less distracted, and a regular
routine often helps many of these children.
Access Press: If there is a discrepancy on administering the prescription
of this drug, to what degree does the responsibility of screening
and evaluating the child/patient to determine if they need it belong
to:
1. the patient (the child)
2. the parent
3. the school
4. the physician
Dr. Genheimer: Most
teachers are pretty savvy on picking out a student with ADD. The
parent of a child with ADD takes on a lot of responsibility. I
often have the teacher and parent had set up an e-mail chat room
to discuss the student’s progress and the things needed from
the student. This helps the teacher and the parent understand the
expectations of the student, which thereby helps keep the student
on task.
Physicians need to evaluate the patient with ADD and talk to the
parents about the outcomes and possible progress in the treatment
of their child. The hyperactive component tends to improve first
in children with ADD, but half or more who continue to have ADD at
age 10 will have symptoms in early adulthood. Some of these will
continue to have results with medication in adulthood.
Access Press: Are ADD symptoms different in kids versus adults?
Dr. Genheimer: Physicians are often hesitant to administer these
drugs to adults because of the risk of abuse. ADD however, does not
start in adults. It most likely started in early childhood and was
not diagnosed. In my experience, if an adult self-refers, he or she
is often displaying depression symptoms not related to ADD.
Access Press: Understanding that medication is only one aspect of
recovery, what other support efforts can the parents, teachers, and
physician do to help patients become successful in school?
Dr. Genheimer: Medication,
if prescribed correctly, can be useful in the treatment of ADD.
First the individual needs a thorough evaluation, especially to
rule out other medical conditions that may resemble ADD. Sometimes
medication failure is due to lack of communication between patient
and doctor (and sometimes school) The doctor, patient and family
should be clear about exactly which symptoms they expect the medication
to treat. Patients should inform the doctor if there are side effects
or if the medication does not seem to be working. The patient’s
attitude therapy, community support, and coaching are all important
parts of treatment.
