FDA WARNING RE: RITALIN AND HEART ATTACK

At my children's school, it seems as if more and more kids are being put on methylphenidate (Ritalin) for so-called behavioral disorders. But in a dramatic reminder that Ritalin and related attention deficit hyperactivity disorder (ADHD) medications are potent drugs with dangerous side effects, a US Food and Drug Administration (FDA) advisory panel has recommended that they carry a "black box warning" -- the FDA's highest level warning -- that they may increase the risk of death from heart attack and other cardiovascular problems. This advice came after 25 deaths and 54 serious cases of cardiovascular problems among children and adults taking these stimulants (methylphenidate or amphetamines) between 1999 and 2003. Pick your poison, eh?

TOO MANY DRUGS FOR TOO MANY CHILDREN

In recent years, there has been growing concern that too many children are being put on ADHD medications. Once reserved for kids with obvious and major symptoms (hyperactivity, impulsivity and inattention), there seems to have been a kind of trickle-down effect. Now children who would formerly have been considered merely fidgety, impatient or inattentive are being pumped full of powerful drugs.

Is it just my perception or are parents using drugs to medicate behavioral and discipline issues? To learn more about this dilemma, I consulted advisory panel member Steven E. Nissen, MD, interim chairman of the Department of Cardiovascular Medicine at The Cleveland Clinic and president of the American College of Cardiology. He told me that he hopes the new awareness of the risks will slow down the escalating number of prescriptions for ADHD.

All drugs have side effects, and should be prescribed only when absolutely necessary. This is especially true when it comes to powerful stimulants like Ritalin, which can cause adverse cardiovascular effects including high blood pressure, a racing heart, abnormal heartbeat or stroke.

TRY NONDRUG APPROACHES FIRST

In Dr. Nissen's opinion, while there are still some children who need and benefit from Ritalin, this drug should be prescribed only after other approaches have been exhausted. Be certain that it truly is profound ADHD and not just a child overwhelmed by his/her overscheduled world or in desperate need of parental attention. Psychotherapy, behavior modification, social skills training and nutritional guidance have all met with some degree of success in controlling ADHD symptoms.

Often a combination of strategies is best, along with a team approach ensuring that parents, physicians, therapists and teachers are all on the same page.

The bottom line: If you're the parent of a child with behavioral difficulties, rest assured that you're not alone, and there are many helpful treatment options. Don't let yourself be talked into giving your child powerful drugs with powerful side effects until you explore more healthful alternatives.