Frequently Asked Questions About Methylphenidate, ADHD Diagnosis

FAQs regarding Methylphenidate (Ritalin), an ADHD stimulant medication, plus answers to questions on diagnosing ADHD in children. (Note - this is a UK-based site.)

Q. What is the clasification for the medication Methylphenidate?

A. We have been sent the following by the company that makes Equasym, which is a brand name for Methylphenidate. From this, we can therefore see that the clasification for other brands (Ritalin, Concerta and also Equasym) of Methylphenidate are:

Equasym is the brand of methylphenidate hydrochloride supplied by Medeva Pharma Limited, and is available in tablet strengths of 5 mg, 10 mg and 20 mg. It is a class B drug, and this relates to the levels of penalties for offences under the Misuse of Drugs Act 1971.

Q. What are the differences between cocaine and methylphenidate?

A. Methylphenidate is chemically similar to cocaine and other stimulants but presents a pragmatic paradox in that it decreases activity and increases the ability to concentrate in people with ADHD. It has its effect in ADHD, by blocking the activity of dopamine transporters (which usually remove dopamine once it has been released), thus increasing levels of dopamine.^a Some people with ADHD may have too many dopamine transporters^b, which results in low levels of dopamine in the brain.

Many addictive drugs, including cocaine, alcohol and amphetamines also increase dopamine levels. The key difference between methylphenidate and addictive drugs is the length of time which it takes for the drug to reach the brain. Methylphenidate takes about an hour to raise dopamine levels whereas inhaled or injected cocaine hits the brain in seconds.

^a N J of Neuroscience 2001; 21 121 ^b Lancet 1999; 354 2132 2133

Q. What are the most common Generic (Brand Names) for Methylphenidate?

A. Some of the most common Generic (Brand Names) used in the UK are: Ritalin, Ritalin SR, Equasym, Equasym CD, and Concerta XL. There are various other Generic (brand names) in the USA and other countries, if in doubt please contact a local Support Group via our Support Group Pages.

Q. Can I crush the fast acting Ritalin tablet if my child won't swallow it?

A. Crushing is not a good idea as the Ritalin/Equasym is bitter and swollowing is quicker as a tablet, than a powder or pieces. Try giving a quarter which is easier to swallow, placed far back on his tongue, where the bitterness is less obvious with his favourite drink. It should just wash down. When used to a quarter, try a two quarters (half) and eventually a full half and if required a whole eventually. Also compliment him when he manages to succeed. A sip of the drink before you start also helps. However crushed and mixed with something they like may be alright providing the bitter taste does not come through!

The Slow Release tablets such as Concerta XL and Equasym XL should not be crushed or opened in any way as this will make them ineffective.

^a From a question posted on adders.org forum and answered by Dr Billy Levin from South Africa

The following FAQs are reproduced with the kind permission of the stated publications:

Taken from Booklet: Expert Opinions in ADHD Issue 1 Dosing

Authors: Professor Peter Hill, Professor of Child Psychiatry, Great Ormond Street Hospital Dr Daphne Keen, consultant Paediatrician, Great George's Hospital Published by AC publications Ltd Dec 2001

Q. How much methylphenidate or dexamphetamine will a child with ADHD normally need to take?

A. There is no set dose that will suit all children of one age or size or even type of problem, one child may need a higher or lower dose than another similar child. The important thing is to start with a low dose and gradually increase it until the pre-agreed aims of treatment (e.g.: better concentration at school, improved behaviour at home) are achieved. The optimum dose will need to balance effectiveness and any unwanted effects that appear.

Q. How often does a child with ADHD need to take methylphenidate or dexamphetamine?

A. The spacing of doses will also depend on the child. Most children take two or three doses a day at mealtimes. If a child wakes up with severe behavioural problems and need to take a dose straight away and a second dose a couple of hours later for the start of the school day. Further doses may then be more widely spaced during the day. As a general rule, three doses a day is often more effective than two.

Q. Does a child need to take more methylphenidate as he/she gets bigger?

A. This varies. Some children need higher doses when they reach secondary school but this is more to do with the fact that their schooling is more structured and requires greater concentration rather than that they are bigger.

Q. Do children with ADHD need to take methylphenidate during the school holidays?

A. This will depend on the aims of treatment. If the aim is to improve concentration in school, then a child may be less in need of treatment during the holidays. But if the aim is to help impulsive behaviour and social relationships then the treatment will need to be continuous so the child feels consistently successful during week ends and holidays as well. It is important for the child to discuss these issues with parents and doctors. Whereas some children can discuss this maturely, others do not have a good insight into the impact of their difficulties.

Q. Is methylphenidate addictive?

A.No. You only have to see how easily children stop and start treatment to realise that they are not addicted in any way. Indeed, the usual problem is getting children to take their medication.

Q. What about suggestions that children taking drugs for ADHD become zombies?

A. If a child loses their spark or personality on ADHD stimulant medication treatment they are receiving the wrong treatment. The medication is either unsuitable for them or they are receiving too high a dose for their needs.

Taken from Booklet: Expert Opinions in ADHD Issue 2 Assessment

Authors: Professor Peter Hill, Professor of Child Psychiatry, Great Ormond Street Hospital Jane Gilmour PhD DclinPsy, Lecturer in Clinical Psychology, Great Ormond Street Hospital, London Published by AC publications Ltd Dec 2002

Q. How long does an ADHD assessment take?

A. A complete assessment for ADHD by a child psychiatrist or paediatrician is likely to take about 1.5 hours or more and is quite likely to require more than one appointment if the school is to be contacted.

Q. Are GPs; the only people who can make referrals by assessment?

A. Most referrals for assessment are made by GPs in response to requests by parents, though teachers, educational psychologists or community paediatricians may set the ball rolling. A referral cannot normally take place without the knowledge and cooperation of the parents and the child.

Q. Will the child psychiatrist, paediatrician or child psychologist visit the child's school?

A. This is most likely if there is conflicting information from the parental and school reports. Such visits are an opportunity to see the child in class and in social situations. The child will be told about the visit but can choose whether or not to tell other pupils.

Q. Which questionnaires are recommended for ADHD assessment?

A. The revised Conners Rating Scales (CRS-R) are widely used for parent and teachers assessments as they are reliable and sensitive to changes in behaviour in response to treatment.

Q. Will the child be asked to complete a questionnaire as part of the assessment?

A. Children with attention problems find it hard to complete questionnaires, so assessment is carried out through verbal questioning and practical tests.

Q. Should children be tested for food intolerance?

A. Some children with ADHD may be sensitive to certain foods and many parents will report this accurately. Patch testing for food intolerance or hair analysis for mineral deficiencies are not advisable as results are inconclusive and may suggest such wide ranging dietary changes that they are impractical for the child and his family.

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