Advanced Search

The American Journal of Psychiatry, VOL. 158, No. 4

Book Forum: Somatic Therapies | April 01, 2001

Ritalin: Theory and Practice, 2nd ed.

RACHEL KLEIN, PH.D.

Am J Psychiatry 2001;158:668-668. 10.1176/appi.ajp.158.4.668

View Article Information

Edited by Laurence L. Greenhill, M.D., and Betty B. Osman, Ph.D. Larchmont, N.Y., Mary Ann Liebert, 2000, 443 pp., $90.00.

Article

References

text A A A

I approached this book with some misgivings because its title connotes a promotional text about a brand drug. Since Ritalin is one of five marketed stimulants with few clinical distinctions, why focus exclusively on one? Perhaps because Ritalin, and its generic methylphenidate, are commonly prescribed in attention deficit hyperactivity disorder (ADHD) and have borne the greatest public outcry concerning alleged misuse and abuse. Therefore, a summary of current knowledge serves a useful purpose.

The book is scholarly and interesting. It does an excellent job of reviewing important, timely topics. The chapter on pharmacoepidemiology by Safer and Zito is especially informative in describing secular patterns of use. Staff from the Drug Enforcement Administration report a fivefold increase in methylphenidate "emergency room mentions" and conclude that its abuse is similar to that observed with other psychostimulants, including cocaine. This thought-provoking review would be more informative if it explained the meaning of the "mentions" in emergency room records. Could these reflect the increased use of stimulants in accident-prone children with ADHD rather than medical emergencies linked to the medication? Although cocaine and methylphenidate are mentioned with equivalent frequency in emergency room records, these figures are not interpretable because the rate of exposure for each compound is not given.

It is often assumed that adjusting methylphenidate dose to body weight equates drug exposure across individuals of differing sizes. Rapport and Denney describe empirical strategies that refute the idea that body weight is a guide to dose. Such studies are important to clinicians and parents as well as researchers who often struggle to standardize doses across individuals. This goal may well be an elusive one.

Other clinically relevant topics include the effect of anxiety disorders on methylphenidate response in children with ADHD. The jury is still out, but it seems possible that children with ADHD and anxiety disorders may differ in pharmacological sensitivity. The book serves clinicians well by also including thoughtful discussions of the effects of methylphenidate on learning and cognition, aggression, and tics as well as side effects and long-term treatment.

There is limited attention to other treatments for ADHD, except for parent training in a chapter by Schachar and Sugarman, who note a dilemma in interpreting seemingly contradictory findings. Thus, parent training alone is reported to be effective, but it offers no incremental advantage when added to methylphenidate. This conclusion is not trivial because it should guide practice. The reader would have been better served by being informed that efficacy for parent training is found on parent reports exclusively. Since parents are active treatment participants, they are likely to report improvement. Due to its timing, the text does not include the large National Institute of Mental Health study of intense psychosocial treatment and medication used alone and in combination (1), which failed to reveal superiority for combination treatment over solo medication.

The stated mission of the text is to set the record straight—a worthwhile goal given public controversies that have plagued patients and professionals. However, the examination of Ritalin focuses exclusively on ADHD, but methylphenidate has wider clinical applications. Since these are omitted, a full appreciation of methylphenidate is not part of the package. It may be time to rethink the title.

References

The Multimodal Treatment Study of Children With ADHD Cooperative Group: A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Arch Gen Psychiatry1999; 56:1073– 1086

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.

Submit a Comments

Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of JBJS editorial staff.

* = Required Field

Comment Author(s)*(if multiple authors, separate names by comma)

Example: John Doe

Affiliation & Institution*

Comment Title*

Comment*

Cancel

Print
E-mail

Recipient(s) will receive an email with a link (good for 72 hours) to 'Ritalin: Theory and Practice, 2nd ed.' and do not need to have American Journal of Psychiatry account to access the content.
Your Name:*
Example: John Doe

Email Address:* CC Me:
Enter your valid email address. Example: jdoe@example.com

Recipient's Email Address:*
Separate multiple email address with semi-colons (up to 5).

Subject:* 's American Journal of Psychiatry: 'Ritalin: Theory and Practice, 2nd ed.'
Subject for your email.

Message:
(Optional, message will truncate at 1000 characters)

Processing your request... Please Wait...

Copyright © in the material you requested is held by The American Psychiatric Association (unless otherwise noted). This email ability is provided as a courtesy, and by using it you agree that you are requesting the material solely for personal, non-commercial use, and that it is subject to The American Psychiatric Association's Terms of Use. The information provided in order to email this topic will not be used to send unsolicited email, nor will it be furnished to third parties. Please refer to The American Psychiatric Association's Privacy Policy for further information.

Copyright © American Psychiatric Association. All rights reserved.
Share
Get Citation

RACHEL KLEIN; Ritalin: Theory and Practice, 2nd ed.. American Journal of Psychiatry. 2001 Apr;158(4):668-668.

Download citation file:

RIS (Zotero)

EndNote

BibTex

Medlars

ProCite

RefWorks

Reference Manager

Copyright © American Psychiatric Association. All rights reserved.
Reprints