Ritalin in Neurotypical Children

[ponderingturtle]

In the recent Autism thread there where statements made about the response of children with ADD to Ritalin differing from neurotypical children. The idea is that children with ADD find the stimulant calming while neurotypical children would not be calmed by a stimulant.

As some of the more medically sophisticated posters have not responded to this question, I am asking it in its own thread.

So what is the evidence for this claim and does it hold?

 

[Alareth]

All I know is I took ritalin like candy as a child. It's effects we ...

OOOOOOOOO!!!! Shiny!!!!

 

[Pipirr]

It's a good question. I'd heard that the reaction to ritalin can be diagnostic of ADD in and of itself. Neurotypical individuals get a kick out of it, whereas ADD individuals see improvements in attention etc.

No link I'm afraid, as I literally heard it in conversation, and as a general rule people don't cite when they talk...

 

[Slimething]

I have two sons and both of then have been diagnosed with ADHD. I once questioned one of the treating psychiatrists whether or not there was a sure-fire diagnostic for ADD or ADHD and he told me there was not. He told me that Ritalin was used to control the randomness of brain activity, not its total activity and that anyone taking Ritalin would be able to think more clearly but the side-effects of the drug were prohibitive of that type of activity.

I have no citation on the above either, sorry, and I'm at work and don't have the time to do the research. Maybe later.

 

[JoeEllison]

It's a good question. I'd heard that the reaction to ritalin can be diagnostic of ADD in and of itself. Neurotypical individuals get a kick out of it, whereas ADD individuals see improvements in attention etc.

No link I'm afraid, as I literally heard it in conversation, and as a general rule people don't cite when they talk...

That's not my exact understanding of it... but, often, that is at least part of the diagnostic toolkit that they have to work with.

I DO know a few people with "issues" that are being treated with different sorts of drugs, and there is always sort of a "trial and error" phase with the drugs, to see which ones have the best effect with the least side effects.

 

[ponderingturtle]

I have two sons and both of then have been diagnosed with ADHD. I once questioned one of the treating psychiatrists whether or not there was a sure-fire diagnostic for ADD or ADHD and he told me there was not. He told me that Ritalin was used to control the randomness of brain activity, not its total activity and that anyone taking Ritalin would be able to think more clearly but the side-effects of the drug were prohibitive of that type of activity.

I am finding that last sentance unclear, could you please clarify?

 

[skeptifem]

from what i know its calming to kids who have the hyperactivity along with attention problems(adhd instead of just add). kids who just have add concentrate better on ritalin but have some of the responses regular people do to the drugs, but its still not quite the same experience. im not an expert and this is based on what medical proffessionals have told me.

I have two sons and both of then have been diagnosed with ADHD. I once questioned one of the treating psychiatrists whether or not there was a sure-fire diagnostic for ADD or ADHD and he told me there was not.

its as 'sure fire' as any other dsm criteria diagnosis(outside of ones with physical manifestations which isnt very many). meaning its not like a tumor where you can physically see whats wrong (although there are some brain scan technologies that can aid a add/adhd diagnosis), but observed behavior can fit the criteria, and most of the dsm criterias for mental illnesses are pretty definate. the most important criteria for most mental illnesses is that it interferes with the persons life, and add/adhd usually does.

about add/adhd diagnosis- i do know they are changing the diagnostic criteria due to boys being over diagnosed and girls being underdiagnosed. i guess the samples used to create the diagnostic criteria was 75% or more boys and so the current dsm definition has gender role bias. i agree based on being in school when add medication became prevalent for children.

 

[Nick73]

OK let me start by saying im not an expert

BUT

IIRC Ritalin (like caffeine) is an adenosine receptor antagonist. That means that it sits in the receptor and stops other melcules (adenosine in this case) having an effect.

Now in most cells adenosine acts to reduce the 'activation' of a cell, in otherwords adenosine is inhibitory...generally. Thats why it (like caffeine) is classed as a stimulant because in most cells the blocking action prevents this calming effect.

Now there are different types of adenosine receptor. Most, act as described above. some have the opposite effect and are stimulatory. These tend to be found in parts of the brain. It is thought that kids with ADHD have too many (over expression) of these types of receptors in the brain. As a result there are too many adenosine - receptor interactions an these parts of the brain are over stimulated. In these areas an adenosine antagonist will help reduce the increased activation of the cells.

interestingly caffeine and nicoteine have similar properties. And guess what lots of kids with ADHD drink coffee and smoke. evidence of self medication...well the juries out, some of them may just have crap parents!!


Anyway, Ive tried to keep it as understandable as poss. and if anyone knows better Im happy to be corrected as Im not a pharma expert

Nick

 

[Slimething]

I am finding that last sentance unclear, could you please clarify?

Sure. Sorry to be so cryptic. The doc said that Ritalin stimulates the brain's activity in such a way as to normalize the brain activity of people with ADD/ADHD. That is, there are certain brain activities that are suppressed in ADD/ADHD sufferers and by stimulating the brain in toto the suppressed portions are able to influence the over-active pathways.

He said that anyone would do better on Ritalin so that Ritalin was not diagnostic in itself. However, the fact that ADD and ADHD sufferers could basically operate effectively with Ritalin, Adderal (sp) or other stimulants was a major indicator in favor of ADD and ADHD diagnosis. A doctor would not prescribe stimulants to someone who did not demonstrate the other characteristics of hyper-activity because the stimulants have considerable potential for harm. Not only do they suppress apetite but they could also mess with liver enzyme balance.

My kids had their blood drawn every three months when they first started on stimulants to make sure that they were not developing anemia and that their liver functions were unaltered. However, as the experience becomes less novel, the blood monitoring diminishes to once every year or two.

 

[kellyb]

He said that anyone would do better on Ritalin so that Ritalin was not diagnostic in itself.

That's basically what I read. (I was the one who made the comment that inspired this thread).

 

[Slimething]

its as 'sure fire' as any other dsm criteria diagnosis(outside of ones with physical manifestations which isnt very many). meaning its not like a tumor where you can physically see whats wrong (although there are some brain scan technologies that can aid a add/adhd diagnosis), but observed behavior can fit the criteria, and most of the dsm criterias for mental illnesses are pretty definate. the most important criteria for most mental illnesses is that it interferes with the persons life, and add/adhd usually does.

Agreed. To understand my request to the doctor, you must step into my shoes. I'm a chemist and there are only a few things in my science that are "maybes". I deal in a world of stuff that is or isn't.

So, here come these guys who tell me my perfect kids may have a mental dysfunction. So, I argue and they tell me that the diagnosis is not based on any one thing but on a system of behavioral characteristics. Then, they tell me they're going to put my kids on speed. A bit much for a parent with my type of wiring, I'm afraid.

Anyway, the docs were very kind and patient with me and explained as much as I could absorb. Of course, I supplemented this with a lot of reading and have absolutely no doubt that these guys were correct, after all. Still, I wish there were a way to diagnose different syndromes with a simple test but that is not in our toolchest yet.

I'm not ready to admit that ADD or ADHD are illnesses, though. I believe they are maladaptations to our current society. One of my older son's psychologists observed that these maladies have probably been with us since time imemorial and that, in hunter/gatherer systems, the ADD/ADHD traits were probably benefits, not deficits.

 

[kellyb]

I believe they are maladaptations to our current society. One of my older son's psychologists observed that these maladies have probably been with us since time imemorial and that, in hunter/gatherer systems, the ADD/ADHD traits were probably benefits, not deficits.

I've always kind of thought that back in the day when kids started (for example) helping with the family farm, or learning how to blacksmith with dad at a pretty young age, the ADD traits would have probably been really useful.

The school thing is relatively new in our history, after all.

 

[calebprime]

That's basically what I read. (I was the one who made the comment that inspired this thread).

that confirms my hunch.

Agreed. To understand my request to the doctor, you must step into my shoes. I'm a chemist and there are only a few things in my science that are "maybes". I deal in a world of stuff that is or isn't.

So, here come these guys who tell me my perfect kids may have a mental dysfunction. So, I argue and they tell me that the diagnosis is not based on any one thing but on a system of behavioral characteristics. Then, they tell me they're going to put my kids on speed. A bit much for a parent with my type of wiring, I'm afraid.

Anyway, the docs were very kind and patient with me and explained as much as I could absorb. Of course, I supplemented this with a lot of reading and have absolutely no doubt that these guys were correct, after all. Still, I wish there were a way to diagnose different syndromes with a simple test but that is not in our toolchest yet.

I'm not ready to admit that ADD or ADHD are illnesses, though. I believe they are maladaptations to our current society. One of my older son's psychologists observed that these maladies have probably been with us since time imemorial and that, in hunter/gatherer systems, the ADD/ADHD traits were probably benefits, not deficits.

We've avoided putting our 9-year old son on Ritalin, even though there's been some pressure from the school. But there's no way any doctor or psychiatrist would suggest putting him on Ritalin without our say-so.

For one thing, he has some tics (which come and go) and we don't want them to get worse.

But the main reason is that he doesn't want it. That may sound odd, but he's an equal partner. We know some kids who really resented being put on Ritalin.

We would send him to a school with lower pressure, but it's an hour's drive.

So he's been put in a class for students with mild disability, even though he's in many ways very bright. He's not literally bouncing off the walls or disrupting things. Actually his anxiety is a problem, more than anything.

I have no doubt that Ritalin would help his performance even though there's nothing really wrong with him. He just isn't the kind of kid who does what he's told. He does what he loves to do.

I don't have a lot of faith in the diagnostic ability of the schools, and now they're under a lot of pressure because of the MCAS. They teach to the test.

I would give him Ritalin, except he and my wife are both dead set against it. I think it's a reasonably safe drug. It's been around for a long time, and as far as I know, nothing horrible has emerged over the years.

But I'd be very surprised if it is diagnostic. Just as I would be surprised if caffeine is diagnostic. I would think most people perform better, temporarily, on stimulants, including improved concentration. But that's just what I've read somewhere...

The notion that he's anxious in response to some home situation or that we're rotten parents is a non-starter. What's different these days is the schools and the philosophy about medication.

 

[Slimething]

calebprime,

I agree with your approach. If your child's schooling is not suffering, there really is no reason to put him on any medications. That really is what drove us to agree to the Ritalin.

Like your son, my kids are very bright. Putting them in with educational settings with teachers trained to deal with "outliers" would have placed my kids at a disadvantage in their education. So, we had to choose between a wild (and I'm not joking) child who would have been placed in with the "slower" kids or an attentive-but-drugged kid who would someday be able to be mainstreamed into advanced-placement curricula.

If your child already has nervous tics, I would be a little warier of stimulant treatment because tics is one of the signs that the doctors tell you to watch for that signals an overdose. I would recommend that, if you feel that some remediation may be necessary, consult with a pediatric psychiatrist to see what they think and tell them "NO DRUGS". There are alternatives and schools are not the best sources of information on alternatives.

In any case, best of luck to you!

 

[ponderingturtle]

Agreed. To understand my request to the doctor, you must step into my shoes. I'm a chemist and there are only a few things in my science that are "maybes". I deal in a world of stuff that is or isn't.

So, here come these guys who tell me my perfect kids may have a mental dysfunction. So, I argue and they tell me that the diagnosis is not based on any one thing but on a system of behavioral characteristics. Then, they tell me they're going to put my kids on speed. A bit much for a parent with my type of wiring, I'm afraid.

Anyway, the docs were very kind and patient with me and explained as much as I could absorb. Of course, I supplemented this with a lot of reading and have absolutely no doubt that these guys were correct, after all. Still, I wish there were a way to diagnose different syndromes with a simple test but that is not in our toolchest yet.

I'm not ready to admit that ADD or ADHD are illnesses, though. I believe they are maladaptations to our current society. One of my older son's psychologists observed that these maladies have probably been with us since time imemorial and that, in hunter/gatherer systems, the ADD/ADHD traits were probably benefits, not deficits.

No one is saying that they are an illness, they are a disorder, in that they are a collection of symptoms that strongly correlate. But the issue should be if you will alleviate their symptoms with say cough medicine, why would you not alleviate their less physical symptoms?

 

[ponderingturtle]

I've always kind of thought that back in the day when kids started (for example) helping with the family farm, or learning how to blacksmith with dad at a pretty young age, the ADD traits would have probably been really useful.

The school thing is relatively new in our history, after all.

As someone with ADD and who is a blacksmith, I am not sure if ADHD would be that helpful.

 

[kellyb]

As someone with ADD and who is a blacksmith, I am not sure if ADHD would be that helpful.

I'm a blacksmith, too. (sort of...not very good yet)


It would probably depend on the kind of work you're doing, I'd imagine. I don't see young kids in the past being the ones to do really complicated projects involving extremely specific measurements.

 

[ponderingturtle]

I'm a blacksmith, too. (sort of...not very good yet)


It would probably depend on the kind of work you're doing, I'd imagine. I don't see young kids in the past being the ones to do really complicated projects involving extremely specific measurements.

It is that hyperactivity does not seem to lend itself to the process, and if you are thinking about real child work with blacksmithing you are looking at things like making nails for say 12 hours straight.

As for the blacksmithing well my parents made the mistake of saying I could have an anvil when I could pick one up. They forgot I was running in the 95% of hight and 99% of weight(stocky heavyset) so I was no problem at 13 being about 6' tall.

 

[ponderingturtle]

Here is the problem, some people have had profeshionals describe the reaction to ritalin as diagnostic, and others have had the same people classify it as not diagnostic.

I think if it helps the child that is all that counts, so if it provides a substantive benefit why are so many opposed to it?(many of those opposed are definitely strongly in the alt med camp as well)

 

[Slimething]

But the issue should be if you will alleviate their symptoms with say cough medicine, why would you not alleviate their less physical symptoms?

PT, I can only speak for myself but the two situations are not analogous in that you're trying to equat an acute and a chronic condition. If you have a child with a cough related to a transient disease, yeah, cough medicine is what you reach for. A couple of days on cough medicine administered per label directions won't hurt.

However, for psychological syndromes, you're dealing with much longer term treatment and side-effects cast a much larger shadow on your choice of drug and its dosage. When you take a medication for years, as opposed to days, even the impurities in the product become worrisome. Another concern of mine was that, by dosing my kids regularly, they would develop the misapprehension that happiness and success come from pills. Counterbalance that, though, with the specific observation from several experts that my kids have extraordinarily bad cases of the hyperactivity component.

I take a very conservative approach towards drugs as I have seen how powerful they can be. I would caution anyone thinking of chronic treatment for themselves or their kids to do the research required to detect unwanted effects from the specific medication used. I can't really stress that enough.

I'm not anti-drug. Far from it. I'm a chemist who is amazed by the benefits of modern pharmacology but also knows the tremendous harm that can come from misapplications.