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The Family                          

Group issues guidelines for monitoring Ritalin in children

NEW YORK (CNN) -- Reports of sudden death in children and teen-agers treated with psychotropic drugs such as Ritalin have prompted the American Heart Association to issue guidelines for proper drug monitoring.

Drugs like the popular Ritalin and other psychostimulant medications, which are often used to treat children or adolescents with attention deficit hyperactivity disorder or ADHD, have been associated with increased cardiovascular risks.

Doctors say while some psychotropic medications may cause sudden death, in general, Ritalin taken alone is very safe.

"There's no clear evidence in the literature that Ritalin is associated with a higher incidence of sudden death in children," said Dr. Michael Artman of New York University Medical Center.

According to guidelines, before a child starts treatment, careful medical and family histories should be obtained to screen for heart palpitations, heart conduction problems or fainting spells. If there are any such concerns, the child should be referred to a cardiologist before starting medication.

Once a patient starts medication, he should discuss any new symptoms that develop with a doctor, and a complete physical examination should be performed with special attention paid to heart rate and blood pressure.

Also, physicians should ask patients if they are taking other medications that might adversely affect the breakdown of Ritalin in the body.

The guidelines were released one week before the National Institutes of Health Consensus Development Conference on diagnosis and treatment of Attention Deficit Hyperactivity Disorder.

Medical Correspondent Dr. Steve Salvatore contributed to this report.

Diagnosing hyperactive children is tricky

Some are merely inattentive                September 15, 1997

BIRMINGHAM, Alabama (CNN) -- Children who had the symptoms were once considered "bad." Then scientists identified a behavior pattern they named Attention Deficit Hyperactivity Disorder, and drug treatments were prescribed. Thousands of children benefited from therapies that relied on stimulants.

Now some researchers say ADHD can easily be misdiagnosed -- and that some children who don't do well in school may have other problems, and be unnecessarily taking drugs.  Such was the case with 9-year-old Eric Courington.

When Eric had problems concentrating, his parents were concerned. A teacher mentioned the possibility that he might have ADHD. When his parents told a pediatrician what the teacher said, Eric was prescribed amphetamines, or stimulants.

Amphetamines are the most common drug used to treat hyperactive children, and Ritalin is among the most heavily prescribed. It is estimated that as many as 3 million U.S. children have been diagnosed with ADHD.

Parents sought a second opinion

Eric's parents said his grades were generally good -- mostly A's and B's -- so they sought a second opinion.

"ADHD is a relatively rare disorder," explained child psychologist Bart Hodgens of the University of Alabama at Birmingham. "There are many children experiencing school problems and behavior problems, and there are multiple reasons why that is happening."

Social problems, learning difficulties and medical conditions also can affect the way a child performs in school.

Hodgens and pediatrician Dr. Ditza Zachor examined Eric, after his mother described the boy's problems and why he was given Ritalin.

"There are children who are not carefully evaluated, probably misdiagnosed and taking stimulant medications," Hodgens said.

Conclusion: Original diagnosis wrong

After Eric underwent a series of tests -- neurological, educational and behavioral -- the doctors concluded he had been wrongly diagnosed.

His problem, they said, was simply inattention. And that was "related to his learning style and his ability to process and use language," Hodgens said.

It is not uncommon, he said, for children with Eric's symptoms to be misdiagnosed with ADHD and given drugs. And he and Zachor offered a different prescription: a little extra help from his teachers.

For more information on this and other subjects go to Interventions Archive.  The EFAP assists you and your family resolve personal problems and maintain healthy and productive lives. 

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