House Democratic Policy Committee’s Public Hearing on the Use of Ritalin

Home What'sNew Subjects Contents Feedback Search

Presented December 14, 1999 and Revised 2005

• Definitions of ADHD
• Associated conditions
• Treatment issues
• ADHD issues in adults

• No, the use and effectiveness of Ritalin is well established.
• Ritalin is referenced in 1157 studies in medical journals from 1960 to 1999 and the evidence overwhelmingly supports the therapeutic benefits.
• About 100 years ago Dr. Still, a pediatrician, defined the disorder.
• Original symptoms included hyperactivity, learning problems, inattention and conduct problems.

• The name is not as important as the key concept of inattention.
• Many names are associated with this problem of inattention.
• Minimal Brain Dysfunction (MBD) was an early name.
• Others include Hyperactive Child Syndrome
• Attention Deficit Disorder (ADD) was introduced in 1980
• Attention Deficit Hyperactivity Disorder (ADHD) since 1994

• No, a longstanding dysfunctional pattern is necessary.
• Symptoms or features must be distinguished from a life long pattern before 7 years old.
• Exuberance is different from symptoms way beyond average and causing dysfunction in life.
• Using standard rating scales such as Conners or others is necessary for assessment.
• Rule out other disorders that can cause similar symptoms

• Careless mistakes
• Not listen
• Fail to complete tasks

• Frequently interrupts
• Shouts out answers

• Fidgeting
• Out of seat
• Excessive talking

• Yes, boys are often inattentive and hyperactive. Girls do have the disorder but are usually not hyperactive or a conduct problem.
• Girls are mistakenly called lazy, slow or spacey.
• Women and girls are often misdiagnosed as anxious or depressed.

Will they outgrow it?

• Yes and no
• 70% persist from childhood to adolescence in some form.
• 30-40% of grownup ADHD children do well.
• 30-50% have persistent symptoms as adults.
• 10-20% have significant impairment and disability.
• 80-90% do not need medication as adults.

• Worst advice is to try harder as symptoms increase.
• Best strategy to try "different" and find new ways to do things.
• Brain imaging shows areas are inhibited by increased effort.
• Brain imaging demonstrates abnormal anatomy and physiology in ADHD as in other disorders, such as the medical abnormalities in diabetes or asthma.

• It is underdiagnosed especially in girls.
• 5-12% of all school-aged children have the disorder.
• Less than 1 in 8 (about 12%) are treated with stimulant medication.
• Adults get even less treatment, yet 2-5% or more have symptoms.

• No, it is physically based.
• It is a genetic or developmental disorder.
• Parents will best not search for external cause, but they can find external solutions in dealing differently to find solutions to problems.

• No, the problem is with they are not taking medication.
• ADHD boys treated with medication are 84% less likely to develop a substance abuse disorder than those not treated.
• Medication is safe, effective and has little abuse potential in prescribed doses.
• Adolescents should be monitored for abuse and a count kept of their medication.

• Social alienation
• Academic failure
• Antisocial behavior
• Legal problems
• Substance abuse

• Learning disabilities
• Conduct disorder
• Anxiety disorders
• Mood disorders
• Environmental factors
• Stress

• Not usually diet or allergy
• Sensory deficits
• Chronic illness
• Seizures
• Traumatic brain injury
• Fetal drug effects, especially alcohol

• Anxiety and mood disorders
• Bipolar disorder
• Conduct and oppositional defiant disorders
• Tourette’s disorder
• Obsessive compulsive disorder (OCD)

• A history of clear childhood symptoms
• Disorganization
• Poor concentration
• Not finishing projects
• Procrastination
• Anticipatory anxiety
• Impulsive outbursts

• Careless mistakes
• Failing to complete projects
• Sense of restlessness
• Impairment in functioning

• Depression
• Anxiety
• Substance abuse

• Family therapy
• Behavioral program
• Educational and vocational
• Cognitive therapy
• Medication when indicated

• About one-fourth receive special services at school.
• Nearly one-third receive behavioral therapy or psychotherapy.
• Less than 1 in 8 receive stimulant medication.
• Fewer than half of children receive the services that their parents think they need.
• Many with diagnosed ADHD receive no treatment.

• Methylphenidate (Ritalin) and longer acting (Concerta and Metadate)
• Dextroamphetamine (Dexedrine)
• Adderall and Adderall XR (combination medication)
• Focalin

• About 3 to 4 hours for cognitive enhancement
• About 1.5 to 2 hours for behavioral control
• Long acting types can last through the school day

• 70% of children respond to the first medication.
• 70% of children respond to the second medication.
• Always try at least two medications sequentially.

• Side effects gradually increase with dose and become a problem if the beneficial dosage is exceeded as shown above.

• Less overactivity
• Better attention span
• Less impulsivity and more self-control
• More compliance
• Less physical and verbal aggression
• Better social interactions with peers, teachers, and parents
• Improved academic productivity and accuracy

• Reading skills
• Social skills
• Learning
• Academic achievement
• Antisocial behavior or arrest rate

• Atomoxetine (Strattera)
• Bupropion (Wellbutrin)
• Clonidine (Catapres)
• Guanfacine (Tenex)

• Tricyclics antidepressants: nortriptyline, imipramine and others
• Pemoline (Cylert) - liver toxicity

• Ritalin and similar medicines are safe and effective when used appropriately as part of a comprehensive treatment plan including multimodal treatment.
• Attention Deficit Hyperactivity Disorder is a diagnosable disorder in medical practice and assessment requires information from parents and teachers.
• Proper evaluation includes assessing for other possible problems and associated conditions.

Home What'sNew Subjects Contents Feedback Search

The Child Advocate ADHD Page.
Copyright © 2000-2013 The Child Advocate All rights reserved.
Revised: January 01, 2013.