ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Tuesday, December 3, 1996 TAG: 9612030065
SECTION: EXTRA PAGE: 1 EDITION: METRO
COLUMN: Health Notes
SOURCE: SANDRA BROWN KELLY
In the past week the public learned that the military turns down for service anyone currently taking Ritalin or who has ever taken Ritalin.
That eliminates a fair number of individuals, given that the drug has become almost trendy as a treatment for Attention Deficit Disorder and that it's also being abused by some young people looking for a buzz.
However, the military's revelation raises questions that every parent needs to ask a doctor who suggests Ritalin as treatment for a child. Is this medication really necessary? Are there alternative treatments for ADD?
Ritalin, methylphenidate (generic name: methylphenidate hydrochloride), is a stimulant that can calm the hyperactivity of a child - or adult - suffering from ADD. In addition to excessive fidgeting and running about, the symptoms of ADD are habitual failure to pay attention, difficulties with school work, inability to organize, excessive talking and frequent interrupting. Unfortunately, all of these symptoms are also evident at one time or another in every child so the line between which children are ADD and which are normally acting out can be very thin.
A Roanoke Valley school nurse said she sees children all the time who have been almost turned into zombies because of being put on Ritalin for ADD. Another school nurse said she advised a parent to refuse to give her daughter Ritalin, but the parent said the child needed it because she couldn't sit still when she got home from school. Neither nurse wanted to be quoted for this column.
Considering that the child had been in school all day, the after-school activity seemed normal to the nurse. The parent went ahead and gave the child Ritalin, the nurse said, and the little girl now shuffles her feet when she walks.
That could be an extreme. Parents of children suffering from severe ADD know the anxiety they and their child suffer, and they welcome treatments that create a more normal life. The problem is that some parents, and some doctors, have been overeager in deciding which children need treatment.
Before a diagnosis is made, ``The Medical Advisor," published by Time Life, suggests that a doctor should:
* Take a complete medical and social history of the child and his family;
* Do a physical exam and neurological assessment, including screenings of vision, hearing and verbal and motor skills, as well as tests for blood levels of lead;
* Do a quantitative evaluation of intelligence, aptitude, personality traits and processing skills;
* Perhaps check a child for allergies.
The tests also might include a PET, or positron emission tomography, scan of the child's brain.
If medication is considered the answer, then the medicine should be monitored at least twice a month to check for the appropriate levels and side effects.
Possible side effects include addiction, if the drug is taken over a long period of time; nervousness; inability to fall or stay asleep; loss of appetite; abdominal pain; abnormally fast heartbeat. Other more severe effects, such as Tourette's syndrome (severe twitching) are less common but have been noted in children taking Ritalin.
Are there alternative treatments?
Homeopathy, treatment with natural herbs, has worked for some families; biofeedback has been used in behavior modification. Also, "The Medical Advisor" points out that although nutrition and diet restrictions are controversial as treatment for ADD, some doctors do recommend a high-protein, low-carbohydrate, sugar-free diet. Also, some children have benefitted from B-vitamin supplements, pyridoxine and possibly thiamine. Even caffeine can be helpful.
But none of these should be tried without a partnership between the family and the family's physician.
There also are things that can be done at home to simplify an ADD child's life, and they're just as useful in dealing with children who don't have ADD. Parents should:
Praise and reward good behavior. Be consistent with discipline. Make instructions simple and say "brush your teeth" and "get dressed" rather than "get ready for school." Have set routines. Encourage a child to participate in sports and other activities and not let homework monopolize the child's total time. Simplify your child's room by storing toys out of sight.
Also, if parents would like to share their success stories in managing a child's ADD, this column would welcome them.
You can contact Sandra Brown Kelly at 1-800-346-1234, x393, or at 981-3393, or at biznews@roanoke.infi.net.
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