Warnings due for Ritalin

Ventura County Star, March 7, 2006

"Parents tell of ADHD concerns", by Marjorie Hernandez.

When doctors diagnosed Todd Bullis' 11-year-old son with attention deficit disorder about two years ago, the boy was placed on Ritalin. The drug, however, didn't help much and, in some ways, made things worse.

A 13-year-old patient of Dr. Barbara Paul-Blume undergoes a 15-minute treatment to help stimulate the math center of the brain. The patient had been on ritalin and was ADD diagnosed. Different behavioral subtypes of ADD include slow activity, hyperactivity and depression.
Bullis and his ex-wife decided after four months to take their son, whose name is being withheld, off the stimulant.

"He was on Ritalin, but he wasn't doing any better in school," Bullis said. "In fact, he became moody. He did have more energy, but he also had more ups and downs. He felt worse about himself, but he just wanted to get off the meds."

Some adults and parents whose children are on Ritalin and other stimulants used to treat attention deficit hyperactivity disorder are thinking twice before taking the prescription drugs. An advisory committee to the Food and Drug Administration recently voted to place a "black box" warning label on the stimulants, citing that the drugs may be linked to heart problems and "serious adverse events," including death.

After more than 50 years on the market, reports of sudden deaths, strokes, heart attacks and hypertension in children and adults taking Ritalin and other stimulants spurred new government studies into the medications' safety. The committee vote led some people to look for alternatives to Ritalin. Doctors nationwide received calls from patients and worried parents who heard about the study and wanted to know what to do. Some call for patients to stick with the medication. "I don't think the side effects or warning are valid because the medicine has been proven to be safe for a vast majority of people," said Dr. Joel Young, medical director and founder of the Rochester Center for Behavioral Medicine in Michigan. "Medication has a long track of recorded safety and effectiveness. I'm more concerned about the effect of not treating ADHD than treating it with medication."

According to the National Institute of Mental Health, about 2 million children in the United States have ADHD. Its principal characteristics are inattention, hyperactivity and impulsivity. Stimulants such as Ritalin, Conserta, Adderall and Dexedrine help increase the level of chemicals to the brain, which helps regulate behavior.

Sales of drugs to treat ADHD have increased sharply in recent years, with use growing at a faster rate among adults than children. According to a survey cited by the FDA, about 2.5 million children ages 4 to 17 take ADHD drugs. About 7 million adults have been diagnosed with the disorder, according to David Giwerc, Attention Deficit Disorder Association president.
Spending on ADHD drugs soared from $759 million in 2000 to $3.1 billion in 2004, according to IMS Health, a pharmaceutical information and consulting firm.

Although there is no data on how many students in the county have ADHD, each school does keep track of the students who use Ritalin and other drugs, said Patti Contini, director of the Ventura County Superintendent of Schools health and early childhood program. Students are allowed to take their medication during school with physician and parental consent. A nurse or health technician must be present when the child takes the medication, she said.
Parents say their children need the drugs to function daily.

"I had discussions with a few parents, and most of them recognized the benefits of the medication for their children," said Dr. Donn Browne, pediatrician at Buenaventura Medical Group in Oxnard. "They realized there isn't a whole lot of options that work."
Young noted that patients and parents do have the option of using nonstimulants like Strattera.
Bullis said he was initially hesitant to put his son on Ritalin because he read about the possible health complications. Bullis and his ex-wife decided to take their son off the drug and try a different approach. That's when they contacted Barbara Paul-Blume, a licensed clinical psychologist. Paul-Blume and her business partner, psychologist Dan Staso, use neurofeedback to treat various disorders, including ADD, phobias and depression.

At their office in Ventura, Paul-Blume and Staso treat ADHD patients by teaching them to control their brain wave activities. ADHD patients usually have slow brain wave activities, which cause problems like inattention, hyperactivity, memory loss and fidgeting, Paul-Blume said.
"A lot of people diagnosed with ADHD don't respond to medications," Paul-Blume said. "Here, we train the brain to correct itself through repetition. A lot of patients even see their memories improving and their IQ increase by 10 to 27 points."
Although that might seem appealing to some patients, Young and Browne say more research needs to be done.

To conduct neurofeedback, about 20 small electrodes are placed in a snug cap on the patient's scalp. Brain waves are then read and analyzed. No electric currents are used on the brain, Paul-Blume said. Once the brain mapping is complete, ADHD patients go through 30-minute treatments at least twice a week depending on the severity. Using the map, Paul-Blume and Staso place electrodes on the areas to be treated. Paul-Blume and Staso said alternative forms of treatment like neurofeedback provide a longer-lasting effect than using drugs.
Bullis' son, now 13, said he is much more focused at home and school. Before neurofeedback treatment, he said he was getting C's, D's and F's. A few months after treatment, his grades have catapulted to A's, B's and C's.

"I'm just thinking of making it smaller," the teen said as he stared at the bottom, or theta, brain wave, which was tracked on a laptop screen. Electrodes connected in areas of his head were linked to the computer, which read his brain waves. "I didn't like being on the drug. I couldn't sleep ... and I didn't have an appetite. Doing this is much better."
Bullis said he recommends that other parents look at neurofeedback as a valid and lasting alternative to stimulants. "I'm so happy, it brings tears to my eyes," Bullis said. "He is just doing so much better."

— The Associated Press contributed to this report.