Expert: Dr Billy Levin - 7/16/2007

Question
Hello Dr. Levin,

Please help.  My son just turned 5.  He has been on 18mg Concerta for about 6 months without issue.  Prior to that, he was on 10mg of Metadate for about two months.  I am seeing very aggressive and abusive behavior over the past few weeks with his 2 year old brother, and even with adults.  He was kicked out of camp last week, also for aggressive behavior.  He can be a very sweet, mindful boy, so these outbursts are heartbreaking to me.  He has been diagnosed by a Psychiatrist with ADHD and has been placed in an inclusion program for September Kindergarten.  Cognitively he is above average.  I am trying to figure out if he needs more Ritalin, behavior modification, or both.  Please give me some advice.  I am tired of feeling sad, worrying whether or not he will ever be able to socialize properly.


Answer
As Concerta comes in 18,36 and 54mg doses it is not possible to guess the right dose. The optimal dose is essential for a good response and is unrelated to age or weight. Without using rating scales it is impossible to decide on  an optimal dose. While using a short acting stimulant given 3 times a day at 4 hourly intervals the dose is increased until just right. Then the total dose can be converted to the correct Concerta equivalent. I think his dose is too little.