For decades the stimulant drug Ritalin has been a mainstay in the treatment of attention deficit hyperactivity disorder, or ADHD. It is also sold under the generic name methylphenidate and brand names Concerta and Metadate. A reader recently pointed out that such medications can have serious side effects. that may be especially true for the youngest patients.
Three-Year-Old Reacted Badly to Ritalin
Q. When working in pediatric medicine several years ago, I remember a 3-year-old child who became psychotic because a child psychiatrist gave him methylphenidate (Ritalin). The child did not sleep for three days, and when he was brought into our clinic. he was screaming that snakes were all over his body.
Needless to say. the psychiatrist was reprimanded by the state health department. First and foremost, no physician should ever give a 3-year-old ADHD medication. If a child hasn’t slept in three days, we should expect them to have serious symptoms.
A. The FDA has approved short-acting Ritalin for children at least six years of age or older. Thank you for reminding us that very young children require special oversight when it comes to medications. For such young patients, nonpharmaceutical approaches are often more suitable. You can learn more about them in Show 1107: How to Manage ADHD Naturally.
Little Good Evidence That Ritalin Works for ADHD
An analysis of 185 randomized controlled trials by the highly regarded and independent Cochrane Review has concluded that the evidence of benefit for children with ADHD is poor (Cochrane Review, November 25, 2015).
According to one of the key authors of the report,
“Our expectations of this treatment are probably greater than they should be.”
The investigators noted that:
“Most trials were small and of low quality. Treatment generally lasted an average of 75 days, making it impossible to assess the long-term effects of methylphenidate.”
Side Effects of Ritalin
Side effects in the short term included sleeping problems and decreased appetite. In response to the analysis, the authors called for large clinical trials of non-drug treatments for ADHD.
We will look forward to seeing the results of such randomized clinical trials. In the meantime, parents and grandparents who would like to learn more about non-drug treatments might wish to listen to our hour-long interview with Dr. Sandy Newmark, director of clinical programs at the Osher Center for Integrative Medicine at the University of California, San Francisco, Medical Center and author of ADHD Without Drugs: A Guide to the Natural Care of Children with ADHD.
