Childhood Diseases

Question
Posted by: BMJ | 2010-05-30

Q.

ADHD

Dear Doc

My 8y 11m old son has adhd. We are sure of the diagnoses and have had good results with Ritalin. He was daignosed 1 month before he started gr1.

He started on 5mg Ritalin in the morning. Then we asked our dr about the afternoon as he battled with homework, so he was on 5mg in the morning and 5mg in the afternoon. As he grew both older and bigger his dose was adjusted to 10mg in the morning, 5mg in the afternoon.

In the middle of 2009 we moved him to Ritalin LA 20mg to avoid the repeat dose and also because the first dose wore off before the end of the school day and I did not feel comfortable with him carrying this kind of meds in his school bag.

After another 6 months or so we found his hyperactive side very problematic in the late afternoons and our dr suggested we try Concerta as it releases slowly and you avoid the up and down behaviour. It certainly evened out the day but we found the morning release not sufficient for school concentration. Our dr then said we can give him a 5mg booster (Ritalin) in the morning. This worked extremely well and he has been on Concerta 36mg and a 5mg booster for almost a year now. He does not take the booster over weekends or holidays.

In the last 6 weeks we have noticed that the Concerta seems to be out of his system by 4pm and it seems to just not work the way it did before. He is eating huge amounts at the moment and he has obviously had a growth spurt as he grew 4cm in one month alone. He is involved in sport and has some remedial class to help him with reading, so 3 days a week he only gets to homework at about 4pm and he has really been batteling to keep focussed.

I can only see his dr again on the 9th June. I did speak to his dr telephonically. We both feel that the next dose of 72mg Concerta is to big a jump. My dr suggested we give him Ritalin 20mg LA with a 5mg booster in the morning and 10mg Ritalin in the afternoon at about 3pm.

I am ok with that dosage but I am concerned that we will have the up and down again. I do not want to over medicate him, but at the same time, Ritalin has been a lifesaver both scholastically and socially. He is such a lovely son and I want to do what is best for him. I just dont know what is - one dose of 72mg or the various doses. Can you please give me your opinion.

Kind regards

Expert's Reply

A.

Paediatrician

Your son has effectively done very well on the Concerta plus a 5mg Ritalin booster in the afternoon. The Concerta seems to be wearing off by 4pm. Why not just increase the Ritalin in the afternoon to 10mg. He does not have tha main side effect of Ritalin which is appetite suppression,so he should be OK on a bigger afternoon dose. It would be better to do this than to double the dose of Concerta.

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