Ritalin, or methylphenidate, is a stimulant drug that affects the central nervous system. It is used to treat a variety of disorders including ADHD, ADD, narcolepsy and chronic fatigue syndrome. Patients who use methylphenidate tend to become more focused, alert, aware and able to control a plethora of symptoms associated with these disorders.

Ritalin belongs to a class of mind-altering drugs known as psychotropic drugs, or amphetamines. Ritalin increases the extra-cellular dopamine levels in the brain causing the user to feel more aware of his or her environment and consequently, the task at hand. At the same time, Ritalin lessens other cells that function in the brain’s “background”, causing even more attention to be placed upon necessary tasks. It achieves this by activating the part of the brain stem and the frontal lobe that either produces or uses dopamine for various functions.

Negative Side Effects on the Brain

For many years, it was believed that Ritalin only had short-term effects on the user as there was no solid research confirming the long-term effects. However, many scientists are beginning to take a closer look at the effects of this drug and if there are any potential concerns or long-term risks. Researchers at the University of Buffalo have conducted an experiment that found that extended Ritalin use affects some functions of the brain. The study was conducted using rats that received Ritalin doses equivalent to the ration of what a child would receive who was using Ritalin for therapeutic purposes.

It was found that the brains of the rats were altered over time, leading to additional questions. While there is still much more research necessary, this opens the door to the fact that there may be effects on cell function that go beyond the short-term effects that we see through the child’s behavior. Continuing research will need to be conducted to determine if those effects are damaging.

Positive Side Effects on the Brain

Some people who argue that since any stimulant of a child or teenager’s brain is undesirable, Ritalin has few if any positive effects. However, it is undeniable that children who successfully use Ritalin show improved academic performance, increased social skills, an ability to focus in and outside of school and an overall improved sense of well-being. Children are sometimes taken off of Ritalin on weekends and during the summer months in order to promote a healthy growth rate.

Physical Side Effects

Appetite Disturbance

One of the most common side effects, changes in appetite are usually most noticeable in younger children. When Ritalin is first introduced, it seems to have the greatest affect on the users appetite. Once the body has become more accustomed to the medicine, appetite usually improves and goes back to normal. If the problem persists, speak with your pediatrician or physician about the possibility of using a lower dosage. There is also the option of using a non-stimulant medication, such as Strattera, which does not affect the appetite.

Stomach Aches

Stomach aches most often occur when the medicine is taken on an empty stomach. To relieve these pains, ensure that the patient receives something to eat prior to taking Ritalin.

Headaches

Another common effect of Ritalin, headaches should improve with time. If they persist, it may be a sign that dosage is too high or a different type of medication would be better. In this case, talk to you pediatrician or physician to explore alternate options. In other cases, headaches are caused from lack of caffeine as many users dramatically decrease caffeine intake when starting Ritalin. This withdrawal headache from caffeine is sometimes mistaken as an effect of the Ritalin.

Stunted Growth

Though it was previously thought untrue, new research has found that long-term use of Ritalin does affect a child’s growth. After three years of using Ritalin, children are approximately 1 inch shorter and 4.4 pounds lighter than their peers. This has been found in the Effects of Stimulant Medication on Growth Rates Across 3 Years in the MTA Follow-Up study, which was published in the Journal of the American Academy of Child and Adolescent Psychiatry in August 2007.

Rebound

While the medication helps control the symptoms of ADHD while it is active, when it begins to wear off, sometimes there is a rebound period. The behavior that takes place during this rebound period can range from mild to severe, depending on the individual. If difficulty arises as the medicine wears off, talk to you doctor about taking doses closer together, adding a smaller dose after a large final dose or switching to a long-acting stimulant.

Difficulty Sleeping

Prior to starting Ritalin, it is helpful to keep a sleep diary to document any issues with sleep. ADHD can cause difficulty sleeping and a diary will help to determine if the ADHD or the Ritalin is the cause of the problem. A major cause of sleep problems is that the medicine has not worn off by the time the individual is ready to go to sleep. To amend this problem, your pediatrician or physician may recommend a different type of Ritalin that has a different length of effectiveness. This will ensure that the stimulant has worn off by the time the patient is ready for sleep.

Irritability

Irritability is often due to ADHD or another psychiatric disorder, not Ritalin. If it is clearly the Ritalin that is causing this disruption and the irritability is affecting the user’s lifestyle, talk with your pediatrician or physician about possibly reducing the dosage or switching to a different medication.

Anxiety

Traits of anxiety can be increased by the use of Ritalin. If this is the case, it may be best to treat the anxiety and then start Ritalin to treat ADHD or other disorder. Speak with your pediatrician or physician to determine the best choice for you.

Jittery Feelings

Jittery actions and feelings are most commonly a side effect when there is another stimulant present such as caffeine or other stimulant medications. Eliminate any other stimulants and ensure the the user is eating regular meals. If the problems persists, contact your doctor.

Depression

Though more common with long-acting medications, depression is an effect that can occur early or late when using Ritalin. If there is a family history of depression, it may be necessary to treat the depression and then start the use of Ritalin. If Ritalin is causing the depression, your doctor may recommend switching to an alternative medicine.

Blood Glucose Changes

If the user is a diabetic, it is imperative that they keep a close watch on their blood sugar levels. Stimulants can cause an increase in blood sugar. If the user’s appetite has been affected, the lack of food can also affect their blood sugar.

Blood Pressure Changes

Blood pressure concerns usually occur in individuals who are taking high doses of Ritalin. If you have any blood pressure problems, discuss them thoroughly with your doctor prior to using Ritalin.

Paranoia/Psychosis

Psychosis and paranoia are not common side effects of Ritalin, but do occur in some cases. They are often more prevalent with individuals who suffer from bi-polar or other psychotic disorders. Taking a dosage of Ritalin that is too high can also induce these reactions. If these effects occur, stop taking the medication immediately and contact your pediatrician or physician.

Seizures

Individuals with Epilepsy should consult with their doctor prior to taking any stimulants. In many cases, a dosage can be arranged to be taken safely when the Epilepsy is well controlled. Contact your doctor immediately if any seizures occur and stop taking the medication.

Death

Though rare, Ritalin has been known to cause sudden death in a few individuals. While many times there are additional factors that lead to this fatal ending, it is a dangerous effect to be aware of.

If the decision to place a child or teen on methylphenidate isn’t difficult enough, there is also the concern about correct dosage. An incorrect dosage can produce one of two effects. Either there is little or no improvement in behavior and academic function whatsoever or the child appears sedated. The other possibility is very alarming. One child who attended a Kindergarten class went from exhibiting behavior that was extremely aggressive and restless to sitting in the Kindergarten circle during lessons in a slump, shoulders and head facing downwards and the voice a robotic monotone. Of course once the dosage was lightened the child’s behavior improved significantly, but the initial effect was quite disconcerting.

At one time doctors believed it was a simple matter of matching dosage to body weight. It is now understood that body weight has very little to do with Ritalin dosage and/or its effects. It is a matter of matching the dosage amount to how efficiently a child’s brain metabolizes Ritalin rather than simply the child’s body mass.

Beginning Ritalin

Since every child metabolizes Ritalin differently, most doctors choose to begin with the lowest dosage possible, approximately 2.5 mg. The logic behind this is to start small so that the lowest dosage required to show significant improvement in a child can be determined. If this dosage is effective, then there is no need to medicate at a higher dosage. If the child shows very little or no improvement, then the dosage needs to be adjusted to the next level, usually 5 mg or twice the lowest dose. 2.5 mg is a very low dosage. Most children end up receiving a higher dosage as very few children tend to benefit from this amount of drug in their system.

Monitoring Ritalin Dosage

Ongoing monitoring of every child, teen and particularly young children of preschool age, is critical in maintaining an accurate Ritalin dosage. Doctors frequently must rely upon feedback from families and educators. In some cases teachers will use what is known as a “take-home” book with notes containing observations of the child’s in-class behaviors to give to the parents.

The average dosage of Ritalin is between 20 mg and 30 mg daily. It is usually divided into 2 or 3 medication periods during the day. However, with extended release forms of Ritalin, children can take the medicine only once a day, making it easier for both the child and the parents.

Concerns for Long-Term Use

An important fact to remember is that excessive use of Ritalin, over time, can lead to addiction. It is also possible to develop a tolerance to methylphenidate, creating a need for increased amounts of the drug. When a concern develops over either of these issues, it is necessary for a doctor to begin altering or even weaning a child or teen off Ritalin. This should never be undertaken by the family or patient alone.

Note: If you feel your child has been injured because of an incorrect dosage prescribed by a physician, and would like to speak to a lawyer, fill out our contact us form to find a lawyer in your area who is ready to assist you.

Although there are many known short-term side effects of using methylphenidate, including dangerously high body temperature, irregular heartbeat, high blood temperature, agitation and addiction, the long-term side effects are somewhat uncertain.

Future Drug Abuse

It is believed that those children and teens who are prescribed methylphenidate to treat ADHD symptoms are twice as likely to abuse other drugs later in life, specifically stimulant drugs such as cocaine and methamphetamine. However, aside from possible future drug addiction, there is little known about long-term side effects that result from Ritalin use.

Addiction

Certainly the increased probability of addiction to stimulants is very worrisome; however, it does not happen to every child or teen who is prescribed methylphenidate, in fact far from it. There are a good number of children who take Ritalin to treat ADHD symptoms and they do not become addicted to illegal substances in later years.

Stunted Growth

Though it was previously thought untrue, new research has found that long-term use of Ritalin does affect a child’s growth. After three years of using Ritalin, children are approximately 1 inch shorter and 4.4 pounds lighter than their peers. This has been found in the Effects of Stimulant Medication on Growth Rates Across 3 Years in the MTA Follow-Up study, which was published in the Journal of the American Academy of Child and Adolescent Psychiatry in August 2007.

Brain Function

Ritalin affects on the brain is an area that is gaining more and more attention. While we know that Ritalin affects the brain chemicals and functioning, more questions are being asked as to whether there are any long-term effects on the brain. For more information, please read How Ritalin Affects the Brain.

Illegal Ritalin Use and Long-Term Side Effects

The illegal use of methylphenidate is more worrisome than a prescribed usage by a health care provider. A user who does not understand the immediate and possible long-term risks may be in greater danger through the abuse of Ritalin than children and teens who are placed on the drug with medical supervision. Naturally people who abuse substances with the intention of “getting high,” along with other incentives, are uninterested and possibly unaware of the risks they take upon abusing drugs. The risk of a heart attack leading to death is the most dangerous and sometimes most imminent side effect of methylphenidate when it is used improperly and illegally.

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

Children and teens who have not been diagnosed with other emotional or mental disorders and who are not taking other medications can usually safely use methylphenidate as a treatment for ADHD. However, children suffering from various mental illnesses and emotional disorders need to be especially cautious when taking Ritalin, Ritalin-SR, Ritalin-LA, generic Ritalin and any other form of this drug. In cases where the disorder has not been identified, the use of Ritalin can exaggerate the symptoms making them more prominent. It’s important to monitor any psychiatric side effects and attend to them immediately. In many cases, if there are other emotional disorders present, Ritalin should not be prescribed.

Who Should Not Use Ritalin (Methylphenidate)

Anxiety Disorders and Ritalin

People with psychological disorders should not take Ritalin. These include individuals with severe anxiety disorders, such as obsessive-compulsive disorder, panic disorder, general anxiety disorder, social phobia and post-traumatic stress disorder. Should a person suffer from these conditions a doctor may avoid prescribing Ritalin altogether because the side effects of the Ritalin may increase their symptoms and make them worse. There are some instances where Ritalin is the optimal drug and needs to be offered. In these cases, if the anxiety disorder is treated first, Ritalin can often be used with minimal side effects.

Alcohol and Ritalin

People who drink should almost never use Ritalin. This is because alcohol increases the stimulant effect of methylphenidate. As a result, a person can lose the ability to concentrate, become jittery and highly irritable. Simple tasks such as driving a car, operating machinery, riding a bicycle and many others can become dangerous. Since Ritalin can also be abused people with alcohol problems are more likely to abuse Ritalin than those who do not drink.

Bipolar Disorder and Ritalin

The two main features of bipolar disorder (formerly known as manic-depression) are depression and mania. Depression is a mental illness often displayed as a severe form of sadness, and affects the body, mood and thoughts. Mania is the opposite. Mania is characterized by hyperactivity, rapid thoughts and speech, jitters, irritability, euphoria and sometimes hallucinations. A lighter version of mania is known as hyper-mania and seldom involves irritability or hallucinations.

There is such a medical program as a combination of methylphenidate and various medications to control bipolar disorder. This is usually the case when a child has been diagnosed as Bipolar/ADHD. Sometimes there is justification for placing an individual with this condition on a stimulant drug. If symptoms improve over time then there is probably no concern with using Ritalin for someone with a Bipolar condition.

The concern about using a stimulant with bipolar disorder is that the patient might develop severe mania as a result. The individual’s behavior and state of mind needs to be constantly monitored should that be the case and even subtle changes in behavior and mood should be reported to the treating physician.

Tourette’s Syndrome and Ritalin

Children and youth with Tourette’s syndrome and/or tics should avoid methylphenidate since it can worsen the symptoms of these disorders. If Ritalin is found to be the best medication for children with these disorders, lower dosages may prove to be successful. Discuss all options thoroughly with your physician and monitor consistently for any problems.

Heart Conditions and Ritalin

Perhaps the most serious conditions that warrant avoiding the use of any stimulants are heart conditions, including a congenital heart defect, heart rhythm disorder or a recent heart attack. Children with these conditions have died suddenly without warning from using methylphenidate and other stimulants.

Epilepsy and Ritalin

Epilepsy and other seizure disorders also place children at serious risk when combined with methylphenidate absorption. While it is risky, there has been some success administering Ritalin when the Epilepsy is well-controlled. It is imperative to always discuss a full, detailed medical history with a physician before placing your child or teen on Ritalin.

Pregnancy and Ritalin

Any women who are planning to become pregnant, pregnant or nursing should refrain from using Ritalin. It is not known if the drug is dangerous for an unborn baby or can pass through breastmilk to the infant. Any woman planning on becoming pregnant while using methylphenidate needs to discuss her plans with her physician ahead of time.

Addictions and Ritalin

Persons addicted to alcohol or other drugs also need to be especially careful about methylphenidate use. Methylphenidate can interact in a harmful or even lethal manner with illicit drugs or with alcohol abuse. If you are suffering from an addiction, it is best to treat the addiction prior to beginning the use of Ritalin.

Young Children and Ritalin

Children under the age of six should only receive Ritalin under the direct supervision and recommendation of a physician. There are more pronounced side effects for this age group, requiring extra monitoring.