Using Ritalin to Treat ADHD: Expert Q&A

Source: Using Ritalin to Treat ADHD: Expert Q&A « WebMD Interviews

Methylphenidate (Ritalin, Concerta) is commonly prescribed to treat attention-deficit / hyperactivity disorder (ADHD), but a new analysis finds children taking it are more likely to have sleep problems and decreased appetite, among other issues.

The researchers looked at the results of 185 previously published clinical trials involving more than 12,000 children and teens. They did find that the medication somewhat improved symptoms, such as reducing hyperactivity and impulsivity and helping concentration. They published the findings late last month.

But they noted problems with much of the research and said it was likely to be biased.

“At the moment, the quality of the available evidence means that we cannot say for sure whether taking methylphenidate will improve the lives of children and adolescents with ADHD,” the study authors wrote. And the study’s lead author says there needs to be more caution when prescribing it.

We asked a noted expert in ADHD treatment, Andrew Adesman, MD, chief of developmental and behavioral pediatrics at the Steven & Alexandra Cohen Children’s Medical Center of New York, New Hyde Park, to address questions about the new research.

WebMD: What did the analysis actually find?

Adesman: The bottom line … is that the medications seem to work, although not perfectly, and the medications have some side effects, but there’s no evidence of life-threatening side effects.

In terms of side effects, they point out the sleep [issues} but the more common side effect was appetite loss. They were relatively critical of the quality of the research. On the one hand, we have a lot of studies. The problem is, it’s in some ways hard to do a good, let alone perfect, placebo-controlled trial.

With the [analysis], you have a very credible source saying methylphenidate seems to be an effective treatment, but that the effects aren’t huge when you look at the larger array of studies that vary considerably, anytime from 14 months to one day. And they point out that some of the studies were funded by industry.

What the [analysis] is saying is that maybe the [research] isn’t as strong as it should be or we would want it to be.

I don’t think we need to have any more caution now than in the past. I think clinicians and families should pursue medical therapy when necessary and after considering a range of evidence-based treatment. It’s a matter of families and physicians deciding on a case-by-case basis what the most appropriate treatment is.

WebMD: Is this report surprising?

Adesman: This report is telling us what we [doctors] already know. There are some benefits and there are some side effects. … Not perfect, but the consensus of evidence is, there are benefits.

WebMD: What’s the bottom-line message or conclusion?

Adesman: It’s supportive of our approach to treatment but it also argues for better research. I think the challenge is that this kind of research is expensive, very expensive.

One could argue that given the number of children on the medication, that it’s a public health issue, to validate the safety and effectiveness.

WebMD: What do you recommend for ADHD treatment, and what is methylphenidate’s role?

Adesman: The younger the child, the more important it is to use behavioral intervention and non-pharmacological treatment. For kids ages 4 and 5, medications should not be used as a first line. For school age children, kids 6 to 12, either behavioral, educational or pharmacological approaches, families can pick one, two or all three. There are advantages and limitations to each of those.

For teenagers, typically, if the primary problem is ADHD and nothing else, medication is likely the single most effective treatment.

WebMD: What is the best advice for parents of kids with ADHD?

Adesman: They should become informed consumers. Parents have to be discriminating in what they read and where they go for information. Their pediatrician can often provide them with guidance and discuss treatment options. The treatment options will often include medication, but not every family has to use medication. Families need to know that children with ADHD will often have one or more additional problems such as a learning disability. It’s important not just to treat the ADHD as effectively as possible. They have to be on the lookout for other problems as well.

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