Synopsis
Book by Shaya James Windell James Gilbert Holly Shreve
Les informations fournies dans la section « Synopsis » peuvent faire référence à une autre édition de ce titre.
Extrait
Chapter One: What Is Ritalin?
Millions of American children and adults begin each day by swallowing a central nervous system stimulant called Ritalin.
In the past twenty years, the little blue or yellow pill has become the drug of choice in treating attention deficit hyperactivity disorder (ADHD), the most frequently diagnosed behavioral disorder in children and one of the fastest-growing diagnoses of adults in the United States.
Experts estimate that as many as 12.5 million Americans suffer from various degrees of this condition, characterized by three primary symptoms of inattentiveness, hyperactivity, and impulsivity.
Ritalin is often the cornerstone of a successful treatment program; as many as 90 percent of children diagnosed with ADHD will be prescribed Ritalin in the course of their treatment.
Because of Ritalin's effectiveness, use of the drug is at an all-time high. Prescriptions increased 450 percent from 1991 to 1995, climbing from a nationwide consumption of 4,000 pounds to 18,000 pounds annually, according to the Drug Enforcement Administration (DEA).
What is Ritalin, Exactly?
Ritalin, the brand name for the drug methylphenidate, is a short-acting stimulant medication manufactured by Novartis (formerly Ciba-Geigy Pharmaceuticals). It's dispensed in 5, 10, and 20 milligram tablets that usually begin to work within a half hour after ingestion. Effectiveness typically begins to dwindle within four hours, as the drug clears from the body, making it necessary to take second and sometimes third doses during the day.
Because more than one dose is generally required each day, Ritalin is often dispensed in school. The educational community has been grappling with this issue and attempting to provide solutions to the problems that Ritalin dispensing can present. Leaving a child's medication program in the hands of a teacher or school secretary, for example, may be unsettling to the parents. You can find out more about how to deal with these situations in Chapter 7.
Sustained-release (SR) Ritalin can provide a viable alternative to the school dilemma. This longer-acting form of the pill--which has helped to increase Ritalin's popularity--delivers 10 milligrams immediately and another 10 milligrams about four hours later. Although the SR form is more practical, many children and adults find it's not quite as effective as the short-acting pill.
Most major health insurance companies recognize ADHD as a valid psychological diagnosis and offer some form of reimbursement for Ritalin. The pills themselves are relatively inexpensive, costing from 25 to 50 cents each, depending on where they are dispensed. There is a generic form of Ritalin called methylphenidate hydrochloride, which is less expensive than the brand-name drug. Some people report a noticeable difference in the way the generic and brand name drugs affect them--after taking the brand-name drug, for example, the equivalent generic may seem less effective. This is probably because differences in their potencies may be discernible. As Dr. Ruth Robin of the Attention Deficit Center in Southfield, Michigan, explains, "Generic drugs only have to be 75 percent as effective [as brand names]. If you start with generic, stay with generic."
To discourage abuse of Ritalin, the DEA has designated it as a "Schedule II controlled substance." This means it's subject to rigid yearly manufacturing quotas. As a consequence, supply, particularly in the past several years, hasn't always kept up with the growing demand.
Because of federal restrictions on controlled drugs, pharmacists scrutinize requests for Ritalin. Handwritten prescriptions are required and must be filled within five days of the physician's request. Refills are not an option.
Therefore it's in your best interest to make appointments for follow-up doctor visits in a timely fashion. Don't wait until your prescription has almost run out before trying to fit in a visit--if the doctor can't see you, or if there are any snags at the pharmacy, your prescription may lapse.
The Stimulant Paradox
The very idea of using a stimulant to remedy hyperactivity and impulsivity seems to fly in the face of common sense. But doctors discovered a long time ago that drugs like Ritalin actually work on the parts of the brain involved in attention. Ritalin helps people sort and prioritize the constant stream of information that bombards them every second. In effect, Ritalin allows the brain to slow down, filter extraneous information, and focus on the matter at hand.
Stimulants were first used to treat behavior problems in the late 1930s, when benzedrine was administered to a group of difficult children who had been confined to an inpatient ward. Their conduct improved, and so did their school performance. Subsequent studies produced similar results, and in the meantime, in the mid-1950s, Ritalin entered the pharmaceutical stimulant market. The drug crept along in popularity until the late 1970s, when it pushed other ADHD treatments, such as diets and vitamins, into obscurity. Although some still attempt to treat this disorder with diet and holistic medicine, research since the early 1970s continues to show no conclusive proof that such approaches work. (Alternative therapies are discussed in Chapters 6 and 9.)
What Ritalin Can Do
Ritalin has become a popular treatment for ADHD simply because it works. Study after study has demonstrated that Ritalin may effect real, measurable short-term improvement in children's behavior, in their schoolwork, and in their social relationships. To cite just a few of them:
A 1992 study compared ADHD boys who were taking Ritalin with ADHD children who were not being treated with any medication. The children who took medication had higher academic self-esteem than the nonmedicated children.
In 1988 Russell Barkley evaluated the effects of Ritalin on young children's relationships with their mothers. He found that a high dose of methylphenidate significantly improved the children's willingness to obey their mothers.
Another study investigated the effects of Ritalin on the academic efforts and abilities of sixteen children diagnosed with ADHD. On a number of cognitive, academic, and behavioral measures, a majority of them showed improvements with increased accuracy, output, and efficiency.
The medical literature contains dozens of studies showing similar findings. More research has been conducted on the effects of stimulant medications on children with ADHD than on any other treatment method for any childhood behavioral disorder.
The most compelling testimonials to the effectiveness of Ritalin come from ADHD sufferers themselves. Before she was diagnosed with ADHD, "Anna Alden" was miserable in school. She found it impossible to stay in her seat or pay attention to her teacher. As a result, her grades were poor, and her attitude, not surprisingly, was completely negative. The worst part was that she suffered alone--she had no friends.
Now nine, the pigtailed third-grader tells stories about pajama parties and good grades.
Increasingly, doctors and psychologists are diagnosing ADHD in adults and achieving dramatic results with Ritalin treatment. "Susan Phillips," for example, mother of two, has a hard time imagining how she lived so many years with ADHD and without Ritalin. She says she was a "chronically frustrated child" who had to work twice as hard as her friends just to do half as well.
At 35 she was diagnosed with ADHD, and at 36, she says, she's now hitting her stride. She's finally in college and thrilled not only to be doing well but to "comprehend what I'm doing."
Taking Ritalin isn't necessarily a lifelong commitment. Sometimes the drug enables people to focus to such a degree that they are able to develop the coping skills necessary to manage the disorder without medication. In Chapter 10 we'll discuss the behavior modification therapies useful in developing these skills.
What Ritalin Can't Do
Ritalin can't make you or your child smarter.
Although a 1993 study indicated that for both children and adults, the use of Ritalin improved school performance, no drug has the capacity to raise IQ. When Ritalin is prescribed appropriately, it enhances the ability to learn by improving concentration, short-term memory, vigilance, impulse control, and fine motor skills. ADHD sufferers who take the drug don't get smarter, they just get more done.
Ritalin can't cure ADHD.
Nothing can cure ADHD. This disorder is caused by an imbalance in the brain's chemistry. Once a dose of Ritalin wears off, the brain chemicals return to their prior levels. Ritalin corrects the symptoms of ADHD, but only on a temporary basis.
Ritalin can't be used to diagnose ADHD.
A positive response to Ritalin doesn't establish the existence of ADHD. For some ADHD sufferers, Ritalin therapy simply doesn't work. And in rare cases the drug can actually mask indications of related disorders, such as learning disabilities and depression. An accurate diagnosis can be confirmed only by a series of assessments and evaluations performed by medical, psychological, and educational experts (as described in Chapter 4).
Ritalin's Side Effects
Although Ritalin has provided a huge breakthrough in the treatment of ADHD, some children and adults do experience certain side...
Présentation de l'éditeur
For all your questions about Ritalin--here are straightforward, medically sound answers.
Ritalin is the drug doctors prescribe most often for the millions of Americans who suffer from attention deficit hyperactivity disorder (ADHD). If you or your child has been diagnosed with ADHD--or if you suspect ADHD is present--you will want to understand ADHD and Ritalin. This comprehensive, authoritative guide explains all you need to know.
Filled with real-life stories and the latest medical findings, this invaluable reference explains how Ritalin works, what to expect if you or your child takes it, and what can increase its effectiveness at school, work, and home.
What You Need to Know About Ritalin includes:
How ADHD is diagnosed--and where to find a professional for assessment
What Ritalin can--and can't--do to control ADHD
Medical advice about dosage, side effects, and other drug therapies
How to make Ritalin part of a total treatment program with psychotherapy, parent training, and support groups
Best solutions to common problems with prescription refills, doses during the school day, working with teachers and school systems--and more
Plus comprehensive reference and resource sections
Les informations fournies dans la section « A propos du livre » peuvent faire référence à une autre édition de ce titre.
