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| |  Ritalin Improves ADHD At School, Not At Home WASHINGTON, MD -- June 16, 1997 -- Standard Ritalin treatment improves classroom behavior in children with attention deficit/ hyperactivity disorder (ADHD). However, it may not improve the children's behavior at home, according to a study in the Journal of the American Academy of Child and Adolescent Psychiatry. This discrepancy may lead parents and teachers to differing opinions about the effectiveness of Ritalin treatment. Other steps may be needed to improve hyperactivity and behavior problems at home, the results suggest. The research was led by Dr. Russell J. Schachar, a child and adolescent psychiatrist at The Hospital for Sick Children in Toronto. Dr. Schachar and colleagues compared the effects of four months of twice-daily Ritalin therapy with an inactive placebo in 91 children with ADHD. Teachers reported significant reductions in the major symptoms of ADHD -- including inactiveness, hyperactivity, and impulsive behavior -- in children who were taking Ritalin. The teachers also noticed less "oppositional defiant" behavior and other problem behaviors with Ritalin. In contrast, parents saw no significant improvement in problem behaviors at home in children taking Ritalin. Neither was there any drop in the frequency of parent-child conflicts. The most likely explanation is that the Ritalin the children took earlier in the day simply wore off by the time they got home after school. Most previous studies of Ritalin have failed to separate out the effects of treatment on school versus home behavior. Ritalin is a brand name for the drug methylphenidate, a stimulant that has a paradoxical calming effect in patients with ADHD. The children taking Ritalin received the standard twice-daily dosage -- once at breakfast and once at lunch. The dose was specifically adjusted to the children's body weight. Whereas teachers were more likely to notice the positive effects of Ritalin than parents, the parents were more likely to notice side effects. This could lead to differences of opinion as to whether the treatment is working. If parents see only the side effects but not the benefits, they may be more likely to take the child off Ritalin, even if it is helping his or her behavior in school. The results suggest more study of the home behavior of children being treated for ADHD is needed. Experience has shown that giving a third dose of Ritalin in the late afternoon can further improve behavior of the ADHD kids at home. As part of the current study, Dr. Schachar and colleagues are analyzing the results of programs designed to improve the parents' child management skills and knowledge about ADHD. Future reports will tell whether these programs have any impact on ADHD symptoms or behavior problems.
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