A Pediatric Psychiatrist Talks About Ritalin Use

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.