Wednesday, May 18, 2011

Ritalin: The jury remains out

Sandra in Brevard
Grumpy Educators

In a study funded by Irish pharmaceutical Shire, a manufacturer of ADHD drugs, University of Pennsylvania researchers determined that kids who take medication for ADHD are “at no greater risk for heart problems than kids not taking ADHD medications.” The lead researcher says the findings of the study should "reassure parents that drugs such as Ritalin and Adderall aren’t associated with an increased risk of cardiovascular events." However, the researchers noted that "it was not possible to definitely rule out an association between ADHD drugs and increased rates of heart problems."

On the other hand, Dr. Steven Lipshultz, professor and chair of pediatrics at the University of Miami Miller School of Medicine is concerned these published results may be misinterpreted. HealthDay Reporter Steven Reinberg interviewed Lipshultz and presented his evaluation of the study this way:

This study wasn't able to look carefully at where the major concerns are," he added.

The study did not specifically separate those children with heart disease from others, Lipshultz said, adding that the FDA's greatest concern was with the use of these medications in patients with underlying heart disease. In fact, the drugs may be contraindicated for such children, he said.
These drugs are a great benefit to children with ADHD, Lipshultz said. "On the other hand, there are still considerable safety concerns about the use of stimulant therapy in children, especially children with underlying health conditions," he said.
In 2007, the FDA ordered manufacturers of ADHD drugs to produce a "medication guide to alert doctors and parents" of heart-related risks associated with these medications. The results of FDA directed research on these risks are forth-coming. Manufacturer Shire supports the "careful medical evaluation of cardiovascular risk by physicians for patients diagnosed with ADHD as they seek appropriate treatment."

Fifteen years ago, Dr. Lawrence H. Diller, wrote a book “Running on Ritalin” describing what he viewed as an over-diagnosis of ADHD and over prescription of Ritalin and similar drugs to many children “who would respond well to family therapy and tailed programs and routines at home and at school.”
“Diller warned that as harried parents, teachers and physicians attached the ADHD label to more and more children who were dreamy, unmotivated, forgetful, restless, impulsive or distractible, the nation's tolerance for children's natural temperamental variance would narrow. Instead of helping children work around weaknesses and choose strategies and paths that played to their strengths, society's growing inclination to medicate them, Diller cautioned, could turn many into lifelong patients.”

Diller has just released a new book, “Remembering Ritalin”, in which he describes the lives of ten of his former patients now adults.

Watch one of those former patients from website

In a L.A. Times interview, Diller maintains his view on over diagnosis and over medication while noting value in medicines having prescribed them for 32 years:

Pills represent efficiency, and effective nondrug interventions like special education or behavior-modification value engagement with the child. The medical and educational systems value efficiency. Parents, when offered a choice initially between efficiency and engagement, almost always choose engagement. However, when offered the choice of only a pill or nothing, they'll take the pill. And that's often the only choice they're given.

So I remain a relatively lonely professional voice pointing out this moral dilemma. But it is greatly edifying that when people hear the full message, they invariably say, "You know, he's right."

For more information on Dr. Diller and ADHD, visit his website here.



  1. Around here, the jury has decided that Ritalin (or Concerta) has completely changed lives for the better. Everyone with whom I have spoken whose kids are on Ritalin agrees that not only did it help them academically, but also socially and consequently, psychologically.

    Once the proper dosage has been determined (sometimes it takes experimenting), it does its thing.

    I have never heard of anyone whose heart was negatively affected, and I do know that at some point in their teens when many stop taking it, they continue just fine without it.

    Others may have different experiences with Ritalin, but this is the case with the families that I know.

  2. Yishai. In Israel, are roughly 10% of the countries boys under 18 being medicated, with some people suggesting the number should be much higher?

  3. This is what I found:

    Two percent of Israeli children - around 51,000 - are diagnosed with attention problems, and some 35,000 Ritalin or Concerta prescriptions are filled every year. Five percent of children with attention disorders do not respond to Ritalin or Concerta and need medications not included in the government-subsidized "health basket," including Adderall, Vyvanse and Strattera.

    Singificantly less than 10% overall. As to the breakdown of boys and girls, I have no idea, but I know both boys and girls who take it, and it really helps.

  4. Yishai - How are kids screened for ADHD in Israel, do you know?

  5. Sandra, sound like they're better screened than here

  6. Curious as to the process.

    From what I see here, mostly teacher observation, school records and parent observation for AD, ADHD, or AD/HD. Three issues. A co-worker has ADHD and gets befit from medication, but when her son was recommended for AD, she declined. The boy was sad and depressed...divorce and disruption. Love and patience took care of that. Seems like if a child study team gives the recommendation, the doctors write the script in the U.S. I wonder about other countries.

  7. I have no doubt some (few) children could benefit from ADHD medication but I think it is over prescribed. I would never give my child medication based on a teachers observation. I admire most teachers but I have experienced a few who should not be in the classroom let alone near a child.

  8. Sandra,

    Generally it is done by a neurologist. As to details of the actual process, I don't know.

  9. There was no ADHD until someone discovered there is a profit in drugging children. SAY NO TO DRUGS. Generations of men and women evolved and left this earth a better place WITHOUT medication. Now, all of a sudden, everyone is drugging children with everything from cough medicine to cocaine and opiates. Lawyewrs are refusing to say my grandson was worth consideration because states have capped losses.
    Do not get caught up in "benefits" of druga, ANYTHING you put in your body has consequence, my little angel has been murdered!! HOW MANY MORE? If we were truly a civil society, ONE baby versus profit is a sin, how mnay more deaths before we stop the slaughter? If you want super kids, give them liver, spinach and exercise. But if you desire subserviant zombies, than go to hell and rot. So you won't have to hear some lawyer tell you someday that you child was not worth our time.

  10. Tyler would sit on my lap and watch G rated movies. He loved playing with bugs. He gave me hugs and kisses. Ther teacher would meet me at the bus stop offering financial aid to get Tyler medicated. I LOVED doing homework with him.
    He is dead, do you understand Yishai? Dead. No more anything, now he sits in a box to my left, about one foot square, and he is ssssoooo quiet.
    A family doctor doped him without a neurological profile or a physical. MURDERED a baby. My grandson, and if justice continues its indifference, I will bid all of you Adieu and do what is right. Than I too will be a victim of social engineering.

  11. Yishai - Neurologists are not involved in the U.S. A diagnosis is primarily based on the recommendations of the school child study team and parent observation. The doctor gives the prescription. It all depends on the amount of experience and expertise they have. We have a national problem.

    There had been a practice to give kids an EKG, but that seems to be up in the air and while it is up in the air. It is a $100 procedure and while up in the air, not likely to get covered under insurance or Medicaid.

  12. Madpole my heart aches for you.

  13. Thank you dear, I need your heart right now.

  14. I have intentionally stayed away from these blogs. I have seen instances where children should NOT be medicated and cases where they have benefitted. No question that far too often drugs are the hoped for be all/end all cure or the parental answer that they are doing all that is possible for their child. I personally might have been sterile had I been born a female. My mother had taken DES while carrying me due to earlier miscarriages. Having a wife, daughter, sister, and several other relatives who are teachers, they have seen the positive learning benefits of Ritalin. Not only to the child in question, but to the entire classroom. They have also seen instances where drugs were not the answer. In no cases though have they initiated with parents that their child should be diagnosed. Caring and involved parents should only accept drugs as a last resort. Madpole is a lasting testimonial of the terrible side affects than can and do occur. Every parent and grandparent has to ask all the questions, and understand the potential risks involved with all drugs. When your child or loved one is involved, a second or third opinion must be sought before allowing any type of drug use. My heart goes out to all who have to make such a difficult decision.

  15. Before mainstreaming was in vogue, my wife was a HS LD/BD teacher. She saw the affects of long term drug therapy up close and personal. That is the primary reason why she got her Masters in Reading Recovery. She has now been in Kindergarten/1st Grade for 22 years.

  16. For All:

    One important point is that giving Ritalin to a kid who genuinely needs it is NOT "drugging" him or her. What it does is UNdrug them by getting them back in balance.

    They then function properly, concentrate like any other kid, and so on.


    What happens here is generally like it is there, except instead of a GP, usually they will go to a GP who will then refer them to a neurologist to do testing. If needed, the neurologist will prescribe Ritalin. Future prescriptions will be issued by the GP.

    If the issue isn't really ADHD, then the doctor would probably recommend some sort of therapy.

  17. Sounds like your wife is one of the good ones USMC.

  18. Fishy - 42 years this November. I still can not believe she has kept renewing my option. I can be a bit obnoxious and opinionated at times. I know who really is my better half. :)

  19. Marine, I got 30 years in November, congratulations! My wife deserves all the medals for anyone to listen to so many dumb jokes and pretend I'm still funny is a hero!

  20. I am sure your wives are saints as am I. ;o)

  21. Yishai, how were we inbalanced for centuries but now we NEED doping? Dude, it is a manufactured illness to line the pockets of the snake oil salesman. When I was a kid, we would say that boy has an active imagination, now we drug them, for what? a lifetime of drug dependacy!! See the pattern? Follow the money. Sure the drugs work, they are Opiates!!! A swat to the ass works just as well yet the child does not have to be whooped forever!

  22. All women deserve the pedestal treatment. Or Else.

  23. Madpole As I recall, 30 was a milestone anniversary. Congrats, and I fully agree. To put up with us they qualify for Sainthood. Of course other dear ladies on this blog also qualify.

  24. Yishai said...

    "For All:

    One important point is that giving Ritalin to a kid who genuinely needs it is NOT "drugging" him or her. "

    And I assume you have a clear cut way to diagnose a 4 year old to determine what he or she needs? Are you aware of the criteria used to put the babies on the drugs? It is NOT a diagnosis from a Psychologist after weeks of therapy n getting to the root of the problems. It is not someone taking time to work with the child to determine the needs. It is simply a worksheet with 18 questions. Now look at these, and try to think about when you were a child, dealing with long school days and boring teachers. Would you have met the "criteria" as a creative, energetic, high IQ'd, ADHD menace?

    Look the bottom line is a we have to be given the chance to develop. Did I have problems with my day dreaming and staying on task? You bet your ass, now what the schools seen as a problem with me gets me praise from the employment world. "high energy", "able to multi-task". I learned how to cope, and overcome my what they call a disability. At 4, 5, and 6 years old, they weren't even had a chance.

  25. Pole, you reminded me of my first year of school. I wasn't allowed to go to kindergarten because that was the year they de-segregated in Oklahoma and my father wouldn't allow it. I had a rather ugly old woman in comfortable shoes for a first grade teacher. I was left handed. She called my mom to school and told her I was a child of the devil. She slapped my hand with a ruler every time I picked up a pencil. Today I am right handed but I have never forgotten those flipping shoes. I don't remember what she looked like except for the shoes. Today the old bitch would probably have me drugged.

  26. ADHD is real and the medications are helpful to those who need it, are under the proper care, and properly monitored. It is a reasonable expectation that this happens. Unfortunately, it is not.

    This blog started out with the announcement by a Shire funded study that there is no reason to worry about heart failure. The results of the study should not be interpreted as suggesting there is no heart-related risk. We can do no more than be informed and help others to evaluate all information available as they make tough decisions.

  27. Does anyone here know that there are NATURAL remedies being used to treat ADHD that are JUST as effective? No of course not, the government doesn't own the copyrights to those..

    @Yishai I doubt you know anyone who was what you call "properly medicated" at ages 4-6 that could tell you that it really helped them. LoL How would they know? A teenager can tell you, man this stuff is great! They have actually tried life without it. Do you understand the difference?

    If you wanna turn your child into a drug dependant speed junkie, you go ahead, but don't come to a message board reciting some bs facts n telling little storied of people you know that this stuff helped. The organization I work with did a candle light vigil in the name of Gabriel Myers. A 7 year old that hung himself while on 3 of these kinds of medicines. Ya. That is not a typo. That is happening every day across the globe. The ones who aren't dying are having cerebral atrophy from the drugs. Do some research, then come back when you are prepared to apologize.

  28. @Sandra [quote]However, the researchers noted that "it was not possible to definitely rule out an association between ADHD drugs and increased rates of heart problems."

    That's the only part i seen..

    (i think that is why the FDA made them add it to the medication guide in 2004 after a black box warning was issued stating that the drug company must announce the INCREASED risk of sudden cardiac death to the public) The thousands of cardiac deaths every year would be my proof.

    By the way, do you understand what sudden means? These are 100% healthy people with NO medical problems. It kills men and women in their prime. Not just children. Doesn't anyone google?

  29. madpole,

    People once died of diabetes with no reprieve- until insulin.

    There's no pattern except for the possibility of progress and a better life.

    As I mentioned, I know kids that Ritalin completely changed their lives for the better, and there was no addiction. Bythe time they were teens, they didn't feel they needed it anymore and chose to stop taking it.

  30. polebot,

    I don't know what they do in the US, but here, doctors generally will not start prescribing Ritalin until around 6 years old.

    Not being a doctor myself, I don't make up the criteria, but I do know that it isn't a matter of simply asking 18 questions. It involves 3 hours of testing.

    Of course kids need to develop, but all have needs of different types. Some include Ritalin.

    As to knowing kids who it has helped, I do, and they include my own kids.

    None are "junkies", and as I have mentioned, by their teenage years, they themselves chose and choose to stop taking it.

    And you should know that they are fantastic kids. For instance, my oldest volunteers as an EMT on ambulances (and only a small percentage even pass the course) and is a counselor in a youth group for at-risk kids- besides doing well in school herself. She's not even 16 yet.

    Her life changed 180 degrees for the better when she started taking Ritalin at 6, and she decided to stop 2-3 years ago on her own.

    I know many other kids like that.

    True, not every story is a success story, but many are.

  31. See that little boy to the left of the home page? That was my grandson, you want to hear his success story? How he grew up and got better?
    You can tell others about his story and how it contradicts yours, OR you can ignore his death like the folks that murdered him.

  32. I'm sorry about your grandson.

    I believe that Ritalin saved my kids' lives- and others that I know personally.


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