Pros and Cons of Ritalin (methylphenidate) as a treatment for ADHD


Attention Deficit Hyperactivity Disorder (ADHD), is the most common behavioural disorder in children which is characterized by increased motor activity and reduced attention span (Levinthal, 2005: 104) , and is being diagnosed in about three out of five children ( Kidd, 2006;Levinthal, 2005: 104). It also occurs three times more in boys than girls and the severity of the symptoms is much worse (Levintal, 2005:104).

Two thirds of school age children who have ADHD are diagnosed also with at least some other psychological disorder such as depression or anxiety, while forty to sixty percent of children whom have ADHD as a child, carry it on into adulthood (ibid). Thus, prevalence in adulthood is about three to four percent (Krause, Krause, Dresel, la Fougere, and Ackenheit, 2006). Treatment for ADHD consists of medication, usually stimulants and other non drug interventions. The most common medication used to treat ADHD is an amphetamine-like drug, methylphenidate (MPH) which is more commonly known as Ritalin (Levintal, 2005).
This paper will discuss how Ritalin works on the body and the impact it has on different aspects of one’s life, academically and psychologically. The paper will then discuss the effectiveness of Ritalin as a medication compared to other drugs that are used to treat Tourette’s or Tic disorders. Thus, it will conclude with the effectiveness in children compared to adolescence and adults along with other treatment available for ADHD and its effectiveness compared to Ritalin.
Ritalin, officially classified as a narcotic, is an amphetamine- like drug, thus used as a stimulant hence acting on the brain with a much slower onset similar to the effect of cocaine and amphetamines (Kidd, 2006). Ritalin raises levels of the neurotransmitter noradrenaline to aid in sharpening senses, yet it dulls the brain’s reaction to different distractions (Anon, 2006).
Although it acts much slower on the brain, the duration of its effects is not long, leaving the administration of it occurring twice a day, one in the morning and once during the day at school or wherever the child is at. By nighttime, it allows the effect it has on blood levels in our body to decline, thus allowing one to sleep (Levintal, 2005).
There are both pros and cons present when it comes to Ritalin being the choice medication to treat children with ADHD. Pros that are present are that by raising levels of noradrenaline, it reduces hyperactivity, thus allowing children with ADHD’s symptoms and signs to minimize (Anon, 2006).
Cons that are present are that although methylphenidate has a quick onset, this along with having a short duration requires administration to occur a couple of times a day. When a child is in school all day, this requires the school to take on a role in administering this treatment (Levinthal, 2005). Another con of Ritalin as a medication is that it has many side effects including things like agitation, nervousness, panic, paranoid delusions; withdrawal from activities and routines, aggressiveness, and it also is being researched as a potentially carcinogenic drug (Kidd, 2006).
An additional con is that as a stimulant it stunts growth through height and weight during the formative years, but not forever. It is typically solved when children stop taking medication for ADHD during breaks such as the summer. During this time, the medication isn’t needed due to not having to attain an attention span for a certain amount of time while in a classroom and with others (Levinthal, 2005). A further con is that there is a lot of controversy and research around developing tics, and its relationship with stimulant medications and the long term risk associated between the two ( Varley, Vincent, Varley and Calderon, 2001).
An added con is that Ritalin is becoming a drug that is beginning to be abused especially by high school and postgraduate students for recreational usages and taking it to stay awake at night so they can study and do better in school. This is done by crushing the tablets and snorting them as would be done with cocaine (Levinthal, 2005). This doesn’t necessarily affect children with ADHD who are taking it, but more so the pharmaceutical component of having Ritalin as a prescribed medication, although it shows its abuse potential among those who take it for ADHD.
Ritalin impacts children on different levels – developmentally as mentioned earlier, it suppresses growth spurts and weight gain during the years at which these are peak, yet when school is out for the summer, and children are off their medication because they no longer need to attain an attention span for a long period of time and don’t interact with so many people as much (Levinthal, 2005).
On a cognitive/academic level, there was a study done that looked at children in grades one to two. It also looked at children who didn’t have ADHD in the same grade with similar features such as IQ levels, family status etc. The result showed that those whom have ADHD performed lower than the regular standards in school before medication, and then after medication their grades continued to drop. Thus, this is showing medication has not shown to have much effect upon academic performance (Frankenberger & Cannon, 1999; Kidd, 2006).
It is also because of other comorbidities such as anxiety, tics, and Tourette syndrome that prevent them for performing as well. Although they are classified with these disorders, this study emphasized that these students did not have a special program just to suit their needs and was studied while taking part in the regular education program. Results showed that medication alone was not enough to allow them to be up to par with their level of education and a combination of medication/ non medicinal treatment such as behavioural therapy would be effective (Frankenberger & Cannon, 1999).
At a psychological health level, there are as mentioned earlier in previous aspects, other disorders may occur with ADHD including anxiety, depression, tics and Tourette syndrome. A study was done among children who were receiving treatment from different types of medication to treat ADHD and the emergence of tics in relation to that stimulant medication. Results showed that out of 555 subjects a total of 7.8% of the subjects treated with stimulants developed tics: 8.3% of those were treated with methylphenidate, 6.3 % with dextroamphetamine, and7.7% with pemoline (Varley, Vincent, Varley, Calderon, 2001).
It was also discovered that those whom developed tics were younger in age than those who did not. Dosage of medication did not play an effect on whether subjects were more likely to develop tics. Although these results were found, subjects may have developed tics irrespective of their medication, and this continues to be an ongoing controversy between intervention if tic development occurs during usage of stimulant medication and the long term risks (ibid).
Another study done found that ADHD exists in 35-90% of children who have Tourette syndrome (Erenberg, 2005). It also found that these children also were those who had tics, although those were established could be part of other factors such as internal distractions e.g. (pre existing co-morbidities). It concluded that psychostimulants were equally effective in improving the condition of ADHD whether it was connected to Tics or not (ibid).
ADHD continuing into adolescence and adulthood is on the rise with the rate of prevalence in adulthood is about two to four percent (Krause, Krause, Dresel, In Fougere, Ackenheil, 2006). As an individual grows older, one with ADHD shows that symptoms are most prevalent among them must change as well. With age, comes attention becoming more easily disturbed and hyperactivity diminishing. Adults can also present with co morbidity.
Imaging shows the activity of dopamine in the brain showing a strong presence of a high striatal dopamine transporter (DAT) which is present in adults with ADHD, but can be controlled by stimulants. Methylphenidate is the first- line drug in adult ADHD, yet there are other options such as noradrenaline reuptake inhibitors. Although there are treatments out there even for adults, Kessler, 2004 as cited in Chater, 2006 explains that even though half of the cases of ADHD continue into adulthood, only as little as 10% of people are receiving treatment( ibid). Thus, a combination of both medication and therapy has found to be the more effective treatment for treating adults (ibid).
Besides methylphenidate, there are several other types of medication available as a treatment including dextroamphetamine (Dexedrine), a combination of dextroamphetamine and amphetamine (Adderall), and Pemoline (cyclert) (Levinthal, 2005). Unlike Ritalin, Adderall lasts much longer, hence only needing to be administered once. Thus, it avoids any complications with people who would be involved in assisting to administer it during the day. They have both been understood to have the same effectiveness, yet are also both becoming a drug to be abused because of its form (pills can be crushed and snorted) and the high that can be obtained from it (Levinthal, 2005:104).
Strattera, a non stimulant that is fairly new within is able to be used for adults as well as children. It increases activity of norepinephrine in the brain showing that maybe there is relation between the levels of norepinephrine and its role in ADHD (ibid). Being a non –stimulant medication helps lay off the side effects the other medications have on individuals. This drug allows its administration to be once a day and works with norepinephrine levels, not dopamine (Chater, 2006).
The first and only non-oral form of medication for ADHD was introduced early in 2006 called Daytrana (methylphenidate transdermal system (MTS) used once a day to treat children ages six to twelve. Due to the administration method of this drug, it can be doctor controlled and side effects can be managed (ibid).
Non medicinal treatment that is available to treat ADHD is behavioural treatment, thus therapy. In a study done in 1999, they found medication was more effective in treating ADHD than behavioural treatment, than and just about as effective as a combined approach of medicine and behavioural treatment (Levinthal, 2005).
Overall, although Ritalin has widely been used for some time as the treatment of choice in treating ADHD individuals, new research has been unfolding causing the medical field from prescribing Ritalin and looking into alternatives that have an effect, but don’t have all the negative factors such as bad side effects, and potential for being an abusive drug.

References

Anonymous. (2006). How Ritalin focuses children’s minds. New Scientist, 190(2554):19.
Chater, Amanda. (2006). Drug makers see growing market as adult ADHD gains attention. Drug Store News, 28(15): pp24.
Erenberg, G. (2005). The relationship between Tourette syndrome, Attention Deficit Hyperactivity Disorder, and stimulant medication: a critical review. Seminars in Pediatric Neurology, 12(4):217-221.
Frankenberger, William & Cannon, Christie. (1999). Effects of Ritalin on academic achievement from first to fifth grade. International Journal of Disability, Development & Education, 46(2): 199-221.
Levinthal, Charles. F. (2005). Drugs, Behavior and Modern Society (4th Ed). Boston: Allyn and Bacon.
Kidd, Parris. M. (2006). ADHD total health management the safe effective alternative to Ritalin. Total Health, 28(3):16-20.
Krause, J., Krause, K.H., Dresel, S.H., la Fougere, C., Ackenheil, M. (2006). ADHD in adolescence and adulthood, with a special focus on the dopamine transporter and nicotine. Dialogues in Clinical Neuroscience, 8(1):29-36.
Varley, C.K., Vincent, J., Varley, P., Calderon, R. (2001). Emergences of tics in children with attention deficit hyperactivity disorder treated with stimulant medications. Compr Psychiatry, 42(3):228-233.

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