While Ritalin has certainly proven to be effective for the treatment of ADHD, its many short-term and possible long-term side effects, including addiction, can lead to concerns about the use of methylphenidate. There are other procedures and educational tools that can be used as alternatives that are worth exploring.

Behavior Modification Therapy

Rather than simply beginning with Ritalin to treat hyperactivity and a lack of social skills, behavior modification therapy can also bring about improvements in children’s behavior. Behavior modification involves teaching children methods for dealing with hyperactivity and sensitivity towards others.

In the case of moderate restlessness a treating physician or psychologist may suggest that a child uses an object such as a rubber ball to hold onto and squeeze throughout the day. The action helps release a need for activity while still maintaining a level of concentration and self-control during class time. It also reminds the child that a sense of focus is needed to remain on-task.

Behavior modification also teaches children about treating others with sensitivity and empathy, two qualities that appear to be lacking in the ADHD child. Specifically the therapist offers positive and negative reinforcement to various behaviors displayed by the child during counseling sessions. Sometimes the therapist will visit the child’s classroom before sessions begin, without the child’s knowledge that he or she is being observed. In this manner, the therapist can accumulate information on the difficult behaviors exhibited by the child and specifically work to modify them.

Results vary with behavior modification and depend upon both the effectiveness of the clinical process and the ability of the child to absorb and put the modification into action.

More information about behavior management and behavior treatment plans is available at ADHD and Parenting.

Alternative Schooling for Children

Some regions actually offer special behavioral schools for children with various social and academic challenges that encourage a child to attend school without the use of medication. During the school day, the itinerary may be divided into brief sessions that the ADHD child may find easier to focus within. Teachers counsel children one on one about their behaviors and their emotional reactions to various stimuli. Children have the option of choosing their own subject matter throughout the day at different times. However, they have to visit different academic centers before the day is over and cannot remain only at one (unlikely with the ADHD child!). Over time it is likely the child’s academic schedule will become more regulated, either through teacher counseling or the child’s own inclinations. There is no grading process. Rather, teachers assist children and parents in setting the child’s academic goals and learning techniques to reach them.

It comes as a surprise to many that often children do not regress in their academic progress using this alternative schooling. Clearly not all children will learn at the same pace, but this is also true of many children without ADHD in the mainstream public school system.

Home Schooling the ADHD Child

Sometimes home schooling is an effective alternative for the ADHD child. The child is in a familiar, caring environment. The child has time for play and breaks in between academic sessions. These can be impromptu, rather than determined by a structured school itinerary. Furthermore, a parent who chooses to do the tutoring knows their child’s own limitations and strengths and can be a very effective educator. There are a plethora of materials available through school boards and online to assist parents with home schooling their children. Many resources through school boards are free and curriculum guidelines in order to maintain state achievement levels are included as part of the program. 

Multi-Sensory Handwriting

A technique known as Multi-Sensory Handwriting is used to retrain the ADHD brain without the use of drugs. The philosophy behind this unique approach is that until a child is able to gain control over the emotional lobe of the brain, rational programming is difficult and therefore controlling symptoms of ADHD is challenging. This technique uses calming influences as an alternative to discipline and the use of drugs.

During lessons, therapeutic soothing music is a means of empowering the child to exert self-control and focus on academics. Handwriting is key in assisting the child gain behavioral control. The “higher brain” in a human requires movement and increased learning to developing memory, emotion and learning. This theory states that a rhythmic, constant motion involved in handwriting provides the stimulation needed to enhance self-control and learning. The use of music provides another motivational tool and assists the child in remaining focused.

Non-Stimulant Medications (Strattera)

Several other medications have been used to treat symptoms of ADD (non-hyperactive ADHD) with varying levels of success. Such medicines include atypical antidepressants, certain blood pressure medicines, and Strattera. Strattera is the only non-stimulant approved for ADHD treatment. It works on the neurotransmitter norepinephrine, which is believed to offer important input into the central nervous system (CNS). The CNS is responsible for the development and control of emotions, restlessness, control of attention, and blood pressure, among other functions. Strattera lasts over 24 hours making it a good option for some children. It is often used with children who are also suffering from depression or anxiety. The area where Strattera appears weakest is treating hyperactivity.

Side Effects of Non-Stimulants (Strattera)

As with all medications Strattera may also cause side effects in children and teens. These include:

• Headache
• Nausea
• Vomiting
• Dizziness
• Increased irritability
• Fatigue
• Abdominal pain

In order to deal with these effects, it is possible to adjust the time of day a child is administered the medicine and also to take it only with food.

There are more serious risks associated with taking Strattera. Like Ritalin, Strattera has been known to cause suicidal thoughts in children (although this has been reported only rarely). If a child appears subdued, withdrawn or has feelings or hopelessness this is a sign to visit the doctor. Liver damage has occurred in a very small percentage of children although it self-corrected when the children were taken off Strattera.

It can take up to a full month to see an improvement in ADHD children. Unlike Ritalin, Strattera doesn’t exacerbate anxiety symptoms or disorders in children. Strattera doesn’t interrupt sleep or cause sleep disorders. Since it is not a stimulant and therefore not a controlled substance, patients can phone-in further orders between doctor visits.

Of all topics concerning Attention Deficit Hyperactivity Disorder (ADHD) and the use of stimulants for behavior control, preschoolers and Ritalin is likely the most controversial of all. A child between the ages of 0 to 4 is considered to be a preschooler, partly because of the years and partly because the child isn’t registered in school yet. At this age, varying behaviors and personalities are to be expected, particularly among different cultures and within differing households.

Difficult to Diagnose

A child with few boundaries and free rein to do as s/he likes at home is naturally going to be very difficult to handle at daycare or in public. Consequently, a child with stricter and more consistent household rules is likely to display a more sedate temperament. The level of impact varies from child to child, yet it does significantly affect a young child’s behavior.

That being the case, making a diagnosis of ADHD or ADD can be difficult and requires a very close look at the cause of the behaviors. Let’s consider some of the major traits of ADHD: inattentiveness, aggression, immaturity and an inability to focus for long periods of time on a particular topic or event. Now consider a 2-year-old’s typical behavior: temper tantrums, excessive restlessness, an inability to focus for extended periods of time on a single topic or event. This is typical, normal behavior for all toddlers that closely mirror the symptoms listed in the Diagnostic Manual. Does this make all toddlers Attention Deficit? Obviously not.

The same can be true of a 4 year old who lacks discipline and boundaries at home. Temper tantrums are still possible in a 4 year old child who has difficulty expressing his or her emotions. This child reacts inappropriately when the expectations that everything s/he wants will be given to him or her are not met. While s/he understands the word “no”, when s/he hears it, the initial reaction of frustration and disagreement is expressed as a scream or sulk until s/he gets what s/he wants. Children at this age also appear to be restless and inattentive as soon as they feel “bored”. They are not attention deficit or hyperactive. They are typical preschoolers who need constructive activities to fill their time. Yet hypothetically, it would be very easy for a schoolteacher or even a physician to mistake such behavior for that of ADD or ADHD.

However, there are indeed children who begin early onset symptoms of ADHD. Their behaviors clearly must be so extreme and consistent across many situations that parents who do try to enforce discipline and boundaries discover that it is nearly impossible. There are several behaviors to watch for in preschoolers that may indicate ADHD:

• Energy Level – The most common aspect that highlights young children with ADHD is that they never stop, their energy level is on high all of the time. While it is normal for children to be active, their activity levels do not follow the normal pattern of highs and lows.
• Disobedience – Understand that testing limits is normal at this age, but when it goes beyond the normal level, then there may be a problem. The meaning of rules are lost upon ADHD children since they cannot focus their attention long enough to process that boundaries are indeed in place.
• Out-of-Normal Behaviors – Each child has a unique temperament and his or her own personality traits. However, sometimes there are distinct changes in the behavior or traits that are not typically portrayed. These may be noticed over time or as more abrupt changes. For example, a child can become excessively aggressive, not because the child is an angry, overly indulged child but because s/he is restless and is unable to control physical responses to various stimuli.

Choosing a Treatment

In such a case, when a child is displaying these out-of-the-norm behaviors and sufficient observations and information have been gathered by the pediatrician, a treatment plan may be intiated. There are many non-medication treatments that will be tried initially. It is usual that a physician or a child psychiatrist will place a young child on a different diet or a non-stimulant medicine in a liquid form in an attempt to minimize the symptoms. This liquid is filled with vitamins and amino acids among other man-made chemicals. In some manner, they interact within a child’s brain to help counteract imbalances and can be very effective for some children. Therefore, no further treatment would be necessary.

In other children, however, these alternative treatments are unsuccessful and as another option, a child is placed on Ritalin or another form of methylphenidate. It is a difficult choice for a parent to make and likely there are many concerns about placing such a young child on a brain stimulant.

Benefits

While placing a young child on Ritalin is always a concern, it has been provent to be effective for many. When given a small dose, it has been shown to help 75% of preschoolers behave and interact like their non-ADHD peers.

ADHD preschoolers are prone to clumsiness, leading to frequent and often dangerous accidents. Typically an ADHD preschooler suffers frequent injuries due to fearlessness and lack of reasoning in terms of risk-taking. In one case, an ADHD boy of five suffered burns after he sat on a stove to see how hot it could get. With the use of Ritalin, some of these symptoms of impulsiveness, clumsiness and irrational thinking can be lessened to allow the child to make more thoughtful choices as well as gain better control of his or her body.

They lack social skills and have difficulty interacting with other children within their own age bracket. Consequently, they become unhappy and are often outcasts, not understanding why it is that no one wants to be their friend. With the use of Ritalin in various forms, including generic Ritalin, there can be noticeable behavior improvements. The impact of Ritalin varies greatly from child to child. Sometimes the changes are not as much as many families hope for in terms of social skills and dangerous behaviors. Still the benefits are there and have been helpful for many.

Risks

Young children are more sensitive to Ritalin than older children and teens. The children need close, ongoing monitoring by a medical doctor. Fifty percent of children develop strong, adverse side effects in the initial stages of Ritalin treatment.

One of the major concerns with placing a preschooler on methylphenidate is that of stunting growth. It is a fact that Ritalin can and does cause long-term delays with height and weight. In August 2007, the Effects of Stimulant Medication on Growth Rates Across 3 Years in the MTA Follow-Up study was published in the Journal of the American Academy of Child and Adolescent Psychiatry. It found that when young children used Ritalin for extended periods, they had a lower rate of growth. On average, after three years of use, the children were one inch shorter and 4.4 pounds lighter than their peers.

With some preschool children, Ritalin can have the same effects as it does in older children including:

• Weight loss
• Lack of appetite
• Stomach aches
• Headaches

Furthermore, an ADHD preschool child will likely benefit from a small dosage of the drug, but he or she requires closer doctor supervision than an older child.

There is also the fact that some preschoolers who do suffer from ADHD may simply benefit from ongoing behavior modification therapy, rather than use of a synthetic drug. Since it is difficult for physicians and families to know which treatment option will work best, there may be several trials to find the best solution for each child. ADHD is still a condition with many unknowns and much guesswork.

The fact of the matter remains that Ritalin is a drug that has strong effects on the neurotransmitters within a developing brain. What are the long-term implications for a child who is receiving this drug? Currently, no one truly knows.

To Medicate or Not to Medicate

The decision to use Ritalin on a young child will always be a difficult one and involves the treating physician, the family and the preschool educator. There are definite risks with the use of methylphenidate in the preschool child, yet there are also risks in not using Ritalin. It is a matter of weighing the pros and the cons for the particular child and his/her situation. Since the use of Ritalin carries numerous short-term side effects and its long-term effects are yet unknown, close monitoring is imperative to successful implementation. However, it is also true that not using Ritalin also carries its own dangers in terms of physical accidents and a lack of bonding with peers and family.

Source: Ritalin for Preschoolers, Web MD