Expert: Dr Billy Levin - 8/18/2006

Question
Hi Dr. Levin,

Thankyou so very much for your time. I truly appreciate it.

My son is 2.5 yrs old and has just been prescribed Ritalin. He has not had a diagnosis for ADHD. He is majorly speech delayed with no known causes as of yet and we see his paediatrician regularly to track progress. He just had an MRI brain scan which came back normal. He noticed my son is quite hyper. Always on the go. He does lash out at times and hit and has very poor concentration. So after he has observed Blake's behaviour a couple of times, he has prescribed Ritalin for him, for him to take a quarter of a tablet twice a day.
He is to be assessed for autism and ADHD and behaviours in 2 months time with a psychiatrist because of his speech delays.
I am very concerned with giving my son medication at such a young age. My paediatrician says there are no long term effects and may be only minor short term side effects. Everything I have read about Ritalin says it shouldnt be given to toddlers which makes me even more uneasy about it. Could you please give me some advice as I'm not sure what to do.

Thankyou so very much once again.

Kellie

Answer
It is a little difficult to provide you with answers because of a special situation. Many doctors do not put children on Ritalin if under 6 years of age, I do not agree with this and have treated hundreds of under 6 year old successfully. But no treatment should be started until a final diagnosis is made. Hyperactive, temper outbursts, speech delays and poor consentration are all certainly part of ADHD.Speech delay is typical of ADHD. There is no separate assessment for ADHD and Autism, it is all part of the same examination. A MRI plays no part in the assessment. As Ritalin only works for 4 hours,two doses a day even if the dose is right, will not work. If rating scales are used for diagnosis,they can also be used to reevaluate and  monitor till the optimal dose is  being given. The dose is determined by response, not by age or weight! Very few will respond to such a small dose. There are no long term side effects but young children do not always take to the medication and the dose has to be increased very gradually till optimum. Usually 3 doses a day are needed.  Even the "terrible" two's may need treatment!