For the last 20 years, the diagnosis of Attention-Deficit Hyperactivity Disorder (ADHD)-and the use of the drug Ritalin for its treatment-have been steadily on the rise. In 2008, the Centers for Disease Control and Prevent (CDC) estimated 5 million children (ages 3 to 17), or 8 percent of that population, were diagnosed with ADHD. But recent research is raising new concerns about health issues associated with the condition.

Children with ADHD, a mental health disorder, suffer from inattention, hyperactivity, and impulsivity. If you have a child with ADHD, he probably has trouble learning, making and keeping friends, and participating in after-school activities. Stimulants, such as Ritalin, do not cure ADHD but control the symptoms as long as the drug is taken.

Unlike many other medications, Ritalin is not dosed by weight. Most physicians start by prescribing a low dose and carefully monitor the child. Adjustments to the medication are made as needed. The best dose is the one that helps a child perform better in school with minimal side effects. Common side effects include: weight loss, sleeping difficulties, stomach ache, headaches, and anxiety. A small percentage of children develop tics, which are sudden, repetitive motion or sounds. Ritalin can be used for short periods (3 to 5 hours per day) or longer ones (8 to 12 hours) depending on the individual situation. Many families don't use the drug on weekends and during other times when school is not in session--in the summer, for example.

The Dangers of Stimulants

While Ritalin is an effective treatment for controlling undesirable behavior, critics contend that not enough is known about the risks and long-term consequences of the drug. Researchers at Harvard University conducted a study on rats, which concluded Ritalin can be harmful when used on children who do not have true ADHD.

According to the findings which were presented in December of 2004 at the annual meeting of the American College of Neuropsychopharmacology, Ritalin can affect the brain in ways that will impact adult health--specifically, the inability to experience pleasure and increased feelings of despair. These characteristics are consistent with adult depression. More research is necessary to understand the implications.

Ritalin and other ADHD medications, have also been linked to cardiovascular (heart and blood) and psychiatric problems. Upon review of data, the FDA found that ADHD patients with existing heart conditions had a slightly higher risk of strokes, heart attacks, and/or sudden death when taking the medications. An increased risk in medication-related psychiatric problems such as hearing voices, having hallucinations, becoming suspicious for no reason, or becoming manic (an overly high mood) was also revealed. As a result, in 2007, the FDA started requiring all makers of ADHD medications to develop Patient Medication Guides with information about these risks. The FDA currently recommends that any treatment plan for ADHD include an initial health history and examination for existing cardiovascular and psychiatric problems.

In 2008, the American Academy of Pediatrics (AAP) followed suit releasing new recommendations about the use of heart tests-including an electrocardiogram (ECG)-for children with ADHD before starting treatment with stimulant drugs. If a patient's medical history raises concerns, the AAP now recommends an ECG.

Proceed with Caution

These recent steps remind physicians of the need to be extremely cautious in diagnosing ADHD and treating it with stimulant drugs. If you have questions or concerns about your child's treatment strategy, or think he may be taking Ritalin unnecessarily, get a second opinion. ADHD is often misdiagnosed.

Dealing with ADHD affects the whole family. Behavior therapy can be effective for families dealing with the challenges of ADHD. A trained therapist can teach children coping mechanisms for when the medication wears off and parents stress-management techniques when their patience starts to wane. Unfortunately, therapy is not covered by most insurance plans but a short course of 8 to 12 weekly sessions can be enough to make a noticeable impact on the quality of life at home.



McLean Hospital

KidsHealth/Nemours Foundation

National Institutes of Mental Health

Centers for Disease Control and Prevention