....that need to be performed. While ADHD is believed to result from some imbalance involving dopamine levels in several parts of the brain combined with behavior problems it isn’t determined by lab tests, but rather by a series of psychological assessments. A PET scan of the brain could establish whether a child shows typical ADHD type functioning patterns as compared to non-ADHD children (my son does indeed show problems in those parts of the brain), but in most cases doctors rely on various psychological tools.
Ritalin itself is rapidly cleared from the body and so does not build up in any harmful way and does not seem to affect liver function at all, unlike Pemoline (Cylert®), a less commonly used drug. As a result, lab tests don’t need to be run at regular intervals once Ritalin therapy has begun.
Some antipsychotics *can* cause liver damage and lithium (an excellent drug for treating otherwise intractable bipolar or schizophrenic symptoms) can build up to toxic levels and so regular testing is vital for these. But Ritalin is a short acting drug and is gone from the body relatively quickly, generally in about 4 hours. The longer acting versions such as Metadate and Concerta are actually mechanical methods of releasing small amounts of Ritalin steadily over a longer time period (8 to 12 hours).
There are certain situations where someone should *not* take Ritalin. According to Drugs.com, these include if the patient has used an MAO inhibitor such as isocarboxazid (Marplan), tranylcypromine (Parnate), phenelzine (Nardil), rasagiline (Azilect), or selegiline (Eldepryl, Emsam) within the past 14 days. Serious, life-threatening side effects can occur if one uses Ritalin before the MAO inhibitor has cleared from the body.
Also, do not use Ritalin if the patient is allergic to methylphenidate or if he/she has glaucoma, overactive thyroid, severe high blood pressure, tics or Tourette’s syndrome, angina, heart failure, heart rhythm disorder, recent heart attack, a hereditary condition such as fructose intolerance, glucose-galactose malabsorption, or sucrase-isomaltase deficiency, or severe anxiety, tension, or agitation.
In addition, *always* tell the prescribing physician if the child has a congenital heart defect, a personal or family history of mental illness, psychotic disorder, bipolar illness, depression, or suicide attempt, epilepsy or other seizure disorder; or a history of drug or alcohol addiction.
There are some side effects of taking Ritalin that need to be monitored. It depresses appetite and so can affect body weight and growth rate unless you carefully time meals for non-Ritalin periods of the day. It can cause problems in going to sleep, jitteriness, stomach pain, tics and other things, and it can interact with a variety of medications (for a listing see http://www.drugs.com/ritalin.html).
In general, I would talk to your doctor, but I suspect that just a general physical done by a physician that knows the child’s health history would be enough in most cases.
There is one thing, however, and that is sometimes children with sleep disorders can show ADHD-like symptoms. If you watch your child sleeping and notice excessive snoring, cessation of breathing for brief periods, or more than normal nightmares or sleepwalking for the child’s developmental stage, then a sleep study might be suggested.
Be aware, however, that Ritalin used in the absence of behavioral therapy is not the best alternative. Ritalin does not cure ADHD. Instead it lessens symptoms so a patient can function. ADHD doesn’t necessarily "go away" as a child grows to adulthood either, but as the patient matures their ability to cope with their differences by developing tools that aid them in functioning in daily life can make it become a non-issue and mean they can stop taking the drug. There can also be self-esteem issues in ADHD children because for too long they have been the "bad kid" in the class or unable to complete tasks that other kids their age can do easily.
If someone in your household is prescribed Ritalin, it is very important that they take it exactly as the doctor prescribes it. It is a potentially addictive drug with a strong possibility for abuse and has a healthy street value. It is sometimes known as "Poor Man’s Cocaine."
This is how one web site puts (that goes along with what I have learned by having a son with ADHD):
"Like many complex syndromes, ADHD is probably due to more than one problem. It is thought to be a neurobiological and behavioral disorder involving areas of attention, activity level, impulse control, distractibility, and concentration.
Since several parts of the brain are responsible for these functions, delayed maturation or dysfunction in any or all of these areas could result in ADHD symptoms. Brain imaging using scans, like the PET scan, show areas of the brain that function differently in ADHD kids when compared to controls.
It is felt that the greatest area of brain involvement in this disorder is the cerebral cortex in the prefrontal area (responsible for things like inhibitions and fine judgment) with several other brain areas also involved. The brain dysfunction at least partly involves insufficient dopamine activity in these areas.
Dopamine is a neurotransmitter responsible for communication between nerve cells. Dopamine problems can result in anything from Parkinson’s disease and schizophrenia to drug addiction, depending upon the part of the brain with too much or too little dopamine activity.
The diagnosis of ADHD requires a great deal of clinical skill, since the diagnostic criteria are taken from a range of common behaviors that fall along a continuum from normal to problematic.
Deciding where to draw the line between a slow-to-mature, healthy, extremely active boy and an ADHD boy can be difficult. It is essential to gather collateral information from people who see the child at school, at play, and at home.
There is no definitive diagnostic lab test to establish the diagnosis. Other conditions causing similar symptoms must be ruled out. Even performing a trial of psychostimulant medication, like Ritalin®, and watching for improvement in performance or behavior isn’t foolproof, since these medications also improve performance in non-ADHD kids (hence the Olympic ban on performance-enhancing stimulant drugs). The bottom line is to focus on function: do the child’s symptoms (attention, activity, concentration, impulsivity, distractibility) significantly interfere with social, school, or recreational functioning? Does the emotional harm resulting from the child’s continued failures outweigh the potential risks of labeling them with a pathological diagnosis and treating with medications with potential adverse effects? If so, then treatment is indicated....
...Psychostimulants are relatively safe, and some of the newer formulations allow once-daily dosing of the child in the morning. There is a risk if psychostimulants are given concurrently with one of the older types of antidepressants.
Pemoline (Cylert®), an effective, longer duration psychostimulant is to be used only after a trial of other medications, as there is a small but real risk of liver problems or even liver failure with this medication. Other medications, such as SSRIs of the Prozac® family or other antidepressants, such as bupropion (Wellbutrin®, Zyban®) or venlafaxine (Effexor®) have reported effectiveness without the addictive potential of psychostimulants."
( http://health.myfoxtwincities.com/TextItem.aspx?id=2099 )
