Ritalin - Beneficial or Dangerous

Ritalin: Beneficial or Dangerous

Methylphenidate, also known by the brand name Ritalin, is a mild Central Nervous System (CNS) stimulant. This paper will explore the use of Ritalin in terms of its biological, cognitive, social and physical developmental effects on the children that use it in the treatment of Attention Deficit Hyperactive Disorder. The impact the drug has on the user, the family of the user and on their education will also be addressed.

Ritalin is the primary drug of choice in the treatment of Attention Deficit Disorder and Attention Deficit Hyperactive Disorder in children. Attention Deficit Hyperactive Disorder (ADHD) is a condition characterized by elevated levels of inattention, motor activity, and impulsive behaviour and affects almost 5% of school-age children and can reach as high as 12% (Klein, Abikoff, Hechtman, Weiss, 2004). Because it affects many children in all parts of society, from upper class to lower class, from learning disabled to gifted, researchers have devoted a lot of time to study the condition and its treatment. The condition affects not only the child at home with his family but in the school classroom environment as well as his relationships with his peers.

Ritalin increases extracellular dopamine in the brain by blocking dopamine transporters. It also increases dopamine in the nucleus accumbens, which may reinforce the effects of drugs of abuse. Stimulant induced dopamine increases are thought to be responsible for improving attention and performance (Volkow, Swanson, 2003). Research shows that the time it takes for Ritalin to reach peak brain concentration when taken intravenously, is less than ten minutes and orally, about one and one half hours. When taken by prescribed doses, it is a mild stimulant and should not lead to increases of dopamine sufficient to bring about reinforcing effects like those of cocaine and methamphetamine. In conclusion, the reinforcing effects of the drug depend on the speed at which it is capable of increasing extracellular dopamine, whereas its therapeutic effects are connected to a slower increase in dopamine over a period of time (Volkow, Swanson, 2003).

After ingesting the recommended dose of Ritalin, the maximum behavioural benefit begins when the serum concentration level reaches its maximum, and then declines about 2 -3 hours later. To achieve the optimum results, another dose must be taken to raise the serum concentration level to its maximum again. This can prove to be an administrative nightmare and be costly for a child in the school system both from time lost in the classroom while they wait for the school administrator to distribute the medication, to the financial cost for the parent who may not have a drug plan. What became evident, was an increasing need to develop a sustained-release formulation, which could be administered once a day. In the last seven years, there have been several formulations of Ritalin developed that allow for a pill to be taken once a day. The second generation of these once a day formulations are now being used in over 75% of cases in the U.S.A for the treatment of ADHD (Volkow, Swanson, 2003). This shows that Ritalin is beneficial under these conditions.

Addiction is possible if a child takes more than the recommended dosage over a long period of time. Therefore, it is essential that an adult monitor the administration of the drug to the child. Ritalin is usually administered orally in pill form and it is rarely abused when taken this way, but can also be taken intranasally by grinding the pill into a powder and snorting it or injecting it intravenously when it is being abused. This method is used mostly by teenagers who use it to stay up late to complete essays or study for exams. Often they have obtained it from a friend who has been prescribed the drug for treatment of ADHD or by theft from another student (Levinthal, 2005). This shows that the drug can be dangerous when it is not taken as prescribed.

According to a study done on the academic achievement of children being treated with Ritalin over a two year period, children using the stimulant showed a significant improvement in reading and mathematical skills (Abikoff, Hechtman, et al, 2004). It was easier for them to handle the academic demands but it was noted that the drug had limited effects on their cognitive abilities and intensive remediation, such as a reading recovery program, was required. Other studies have reported an optimum response when medium to high doses of Ritalin were administered (Scheres, Oosterlaan, et al, 2002). Several studies on cognitive functions, such as inhibition, working memory, and vigilance where Ritalin was taken, have been inconclusive. Some showed improved attention, working memory and inhibition, where others showed reduced performance when higher doses of Ritalin were taken (Konrad, Gunther, et al, 2004). The importance of being prescribed the dosage that works best for each child is paramount and would obviously; take time and patience on the part of the child, his family and his teacher. In the meantime, the child copes with the day-to-day struggles of dealing with this disorder. To fully comprehend how the drug affects the child’s behaviour, involves considerations as to what is happening in the environment that would typically affect the behaviour, i.e. reinforcement processes, after the drug has been administered. The behaviour pharmacology of Ritalin shows that it makes it easier for the child to display self control and less impulsivity. However, according to a study done on four students using placebo and medication conditions, it was found that the medication may have little effect on impulsivity (Neef, Bicard, et al, 2005). Therefore Ritalin would not be considered beneficial in this study.

Social effects of children with the ADHD disorder include, but are not limited to, low self-esteem, behaving more intrusively, being bossy, negativity, oppositional behaviour and the inability to perceive social cues (Klein, Abikoff, et al, 2004). According to the results of a study in New York and Montreal of children with ADHD, even when the children were given the stimulant, Ritalin, it had little impact over the long term. It seems as though the benefit of the stimulant Ritalin within the social context, reaches its peak performance early on, and that continuing to take the medication did not result in further improvement of social skills (Abikoff, Hechtman, et al, 2004). There was a concern raised as to the long-term side effects of using the medication and what affect it would have on this small group of children later in their life. They wondered if the children, who did not show a significant improvement in social skills, could justify their use of the Ritalin. The study also showed that when