Adolescent Treatment Unit
How do I help a teenage boy with a mental illness understand how important it is to take his medication?
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Non-adherence to treatment is common in all fields of medicine and can take many forms, including missing follow-up appointments, not following prescribed diets, and noncompliance with medications. Not taking prescribed medications is common and can occur for a variety of reasons. For example, elderly patients may not take their medications because they cannot afford them or have memory impairment that makes it difficult for them to follow instructions. Teenagers pose their own challenges, as they may refuse medications as a means of expressing their independence. Others may refuse because of the discomfort of side effects, believing the medication is not working for them, or just forgetting to take it. People with psychiatric illnesses may become non-compliant for reasons associated with their illness. For example, if a person is experiencing paranoia and is refusing to take medications, it may be because he or she believes the medication is poisonous. A person experiencing mania who is refusing to take medications, may do so because he or she likes the way it feels to be manic. Also, because psychiatric medications often work gradually over time rather than immediately, the person may stop taking their medications because they do not feel they are working fast enough or at all. Understanding why a person refuses to take medication can help you as you encourage compliance. Talk with him and ask him why he is refusing his medication. If side effects are the issue, share this information with the doctor prescribing the medication to see if adjustments can be made to minimize the uncomfortable effects. Sometimes dividing doses, changing dose times or simply taking a medication with food can reduce side effects. Share your concerns and why you believe he should take medications. If you or other family members have taken medications to alleviate similar symptoms, share that information. Seek other opportunities for him to assert his independence, by including him in other family decisions, like where to have dinner, what color to paint his room and what fashion style he prefers. Although rewarding teenagers for medication compliance is sometimes viewed as being controversial, it can be effective, and has been shown to motivate consistency, even with things like diets and work out programs. Consider rewarding him with a CD or video game for a period of medication compliance. Hopefully, the improvement in the way he feels when taking his medication will become reinforcing enough for you to fade the rewards over time.
Do you have group therapy for teens with OCD complicated with anxiety and some trauma induced panic?
Clinically run group therapy, especially for children or adolescents, is often difficult to find. Sometimes therapy groups are put in place when the need arises, but only remain running temporarily. Availability of a therapy group varies based on where you live and may also depend on specific programs such as a hospital, partial hospital, or community mental health center program. These are all good resources for you to contact to learn about groups available within your area. As you may already know, obsessive compulsive disorder (OCD) is characterized by obsessions, which are intrusive and persistent thoughts, images or impulses. It is also characterized by compulsive behaviors, which are repetitive behaviors or actions that the person with this disorder feels driven to perform in response to an obsession. In your question, it is not clear why you specifically ask about group therapy or how the anxiety, panic, and history of trauma relate to the teenager’s OCD. You should know that, although it is not unusual for people with a history of anxiety and trauma induced panic to have OCD like symptoms, OCD can also occur along with other psychiatric disorders. Many symptoms of other disorders overlap and can be similar to OCD; therefore, the disorders can be confused. Because of this and the variety of treatments available, it is important to obtain a comprehensive diagnosis. If that hasn’t already been done, an evaluation can help with a more complete diagnostic understanding and perhaps help prioritize treatment for what could be multiple illnesses. Then, your teenager can be guided in a more focused or individualized therapeutic direction, which may include group therapy and other treatment options. There are also many treatment alternatives that can include individual therapies such as cognitive-behavior therapy (CBT), family therapy, as well as medication management. Although not used for children at this time, newer therapeutic advances for treatment-resistant OCD, such as deep brain stimulation, are also being developed.
My 4 year old daughter started a new school in September and now has developed severe separation anxiety. She is no longer crying or acting out when I leave her at school; it seems to play out more when we are at home and I leave the room or when my husband or another relative cares for her or even more when we are out in public. She was never this way before she started in her new school. Before this school, she had been in a similar structured environment with the same caregiver since she was 3 months old, so I don't know if that is the cause of all the separation anxiety. Her new teacher says that she is well adjusted in school with no social problems. She has become literally a glue stick when I leave her and will have a complete emotional meltdown and works her way up to a severe stress level. How can I help her cope, or is this just a normal stage for her to go through? What can my husband and I do to ease these episodes that she has. My husband says she goes into hyperventilation modes and doesn't know what to do. Any suggestions would be appreciated.
Many young children experience some separation anxiety when they start school for the first time. It is positive to hear that your daughter has adjusted to her new school routine. Separation anxiety is typically temporary and will fade over time. Several factors can contribute to how quickly a child moves past their separation anxiety, e.g., a child's temperament, how a parent responds to the child's anxiety, the child and parent's prior experiences with separation and reunification, and the child's development of coping skills. At this point, you can try a few proactive strategies: Come up with a plan of what your daughter can do during separations from you or her father, for example, play with preferred toys, do a craft with the other parent or caregiver, listen to music or watch a video. Practice separation for brief periods of time and praise her for any successes. The idea is to build upon her success over time. While it can be helpful to provide her an opportunity to have practice sessions you do not want to significantly alter your routine. Keep a calm, positive attitude as young children are sensitive to your mood and may pick up on your frustration or anxiety whether it be in your voice, face or gestures. Another thing to try is to develop a goodbye ritual, for example, a special wave through a window or a brief goodbye song along with a hug or kiss. It's important to tell your child when you are leaving and that you will return and then follow through - don't stall or make repeated goodbyes. Young children can also learn some basic relaxation techniques such as counting, imagining pleasant thoughts and taking deep breaths to be used when they are experiencing anxiety. There are also some children's books that can help; you can do a Google search on the topic of “children's books and separation anxiety.” If the problems persist, the next step would be to consult with a clinician that works with young children, such as a therapist, psychologist or psychiatrist. Your health insurance company can provide you with a list of people who are local. Your pediatrician may also have referral sources for you.
I am a single mom with three children. My son is 16 and my daughters (twins) are 12. I'm having an extremely difficult time with them lately. Despite the fact that I tell them repeatedly, they still talk to me in a very disrespectful way. They "tell" me what to do and deliberately disobey what they're told. I realize this probably sounds like a typical situation for kids their age, but I think it's way past typical. Can you point me in the right direction on how to handle this and set things right going forward? I appreciate any assistance you can provide.
Differentiating between “typical” teenage disrespect versus disrespect above the age-expected norm can be difficult. Some testing of limits or authority is developmentally normal for teenagers and can represent their attempts to individuate or form a separate identity from their parents. Generally, this can be managed by setting age appropriate expectations and consistently enforcing reasonable consequences for non-compliance.You describe your children as being disrespectful to you, but you don’t mention their behavior with other authority figures, such as teachers or coaches. Often, disrespectful behaviors are not limited to the home setting and might include defiance in the classroom, refusal to do work or truancy. Oppositional defiant behaviors can present for a number of different reasons, can be associated with numerous conditions like ADHD, anxiety, or a learning disorder, and can significantly impact family, educational and social functioning. A thorough evaluation from a mental health specialist will help to determine if your children'shavior is more severe than expected for their age. Since you identify disrespect from all of your children, it might be helpful to see a therapist who specializes in treating families. Work with a family therapist can help you to set expectations together, which might improve your children's compliance while addressing underlying conflicts within the family that may be contributing to their disrespect.
I have an 11 year old male who is self-absorbed and does not understand empathy unless it is directly communicated to him. He has friends but is not as social as his younger brother. Should that be of concern and is that normal for that age group?
As children move into late childhood, peer relationships continue to grow in importance and complexity. There is certainly some normal variation among children and youth as to how social they are with other children and adults. The fact that your son has some friends is a positive sign. In regards to his ability to be empathetic, please know that a well-developed capacity for empathy typically emerges in most children as they enter late childhood (approximately 10-12 years of age). Studies suggest that there are many factors which can impact the development and display of empathy in youth. At this point, you may want to monitor the situation and seek feedback from school personnel and his pediatrician about how they see his progress in this area. If you or school personnel have ongoing concerns, then seek further advice from your pediatrician or a clinician familiar with child development.
What information has been gathered by your organization regarding the drug Resperidal? How long does a person have to remain on this medication? Do the side effects described in the brochure occur in the majority of people on this medicine? Are the long-term effects from this medicine known at this time?
Risperdal is the brand name for risperidone. Risperdal was originally used as an antipsychotic drug, a medicine to help improve reality testing and decrease unrealistic, delusional beliefs or hallucinations. You may sometimes hear Risperdal referred to as a “second generation” or “atypical” antipsychotic drug. In other words, Risperdal, is one of a newer group of medications that also includes Zyprexa, Seroquel, Geodon, Abilify, and Clozaril, all of which have been considered to have less severe side effects than older antipsychotic medications, such as Thorazine, Mellaril and Haldol. Therefore, the use of “second generation” drugs like Risperdal has increased dramatically over the last several years, as they have more benefits. Risperdal is approved by the FDA for the treatment of schizophrenia in adults and adolescents, acute manic or mixed episodes associated with bipolar disorder in adults and children ten years and older, and behaviors such as aggression, self injury, and sudden mood changes associated with children ages five to 16 who have an autistic disorder. As these medications have been used, physicians and researchers have found further benefits than the original indications. For example, in addition to the reality testing benefit for schizophrenia, Risperdal and similar medications have shown benefits for such difficulties as mood stabilization, as an adjunct medicine for some antidepressants, and aggressive and otherwise out-of-control or dangerous behaviors for younger children. As we use newer medicines, we learn not only about new benefits or indications for these medications, but also new problems. The brochures that come with prescribed medications can be frightening, as they often include even rare side effects. Many side effects are mild, temporary, or dose dependant, and even placebo medicines or inactive pills can cause some of the same symptoms. Also, sometimes symptoms are associated with, but not necessarily caused by, the medication. In most medicines, including Risperidal, there are very few serious or dangerous side effects that occur in the majority of people. If these types of side effects develop in most people taking a medicine, the medicine would likely never have been approved by the FDA in the first place, or it would be taken off the market when these difficulties were realized. Some medicine’s benefits are so important or life saving, and there are no other reasonable alternatives that even serious side effects are tolerated. However, despite safeguards, some side effects can be relatively common and have to be taken seriously. With risperidone, for example, sedation and weight gain may occur. Blood tests to monitor cholesterol levels and glucose is important, too, but more immediately dangerous side effects are actually quite rare. In addition, there are also longer-term side effects that need to be considered if one stays on this medication for months or years. How long someone, particularly a child, needs to stay on Risperdal varies and depends on the individual circumstances. The treatment of some disorders such as schizophrenia depend on medications like Risperdal on an ongoing basis to prevent the return or increase of debilitating symptoms, at least until newer, hopefully better medicines are developed. For some children, with growth and development, and possibly with therapy to help build age-appropriate coping and safety skills, attempts to come off Risperdal can be successful with careful monitoring. Additionally, especially with younger children, the diagnosis may not be clear, however, the medication helps to control behaviors which may place a child or others at risk for their safety. As the child grows, their own controls may improve and their actual diagnosis clarified, which then can help to guide the decision about the safety of stopping or finding a more appropriate medicine. It is important that these decisions are not made alone, but made with a physician you trust and, ideally, one with experience working with brain-based disorders in children and who understands these medications. There are certainly side effects and risks, but if prescribed and given appropriately with careful consideration of the anticipated benefits versus the potential risks and alternative treatments, medications such as Risperdal can be of immense help. You can also look at web sites that provide useful information for patients and their families. Medlineplus.gov is a service of the National Library of Medicine and the National Institutes of Health and can provide further details you may find helpful.
My granddaughter is 5 years old, her mother is bipolar, and her father is undiagnosed. She has anger and aggression issues and difficulty focusing for any length of time. What or where do you suggest I turn?
Given your granddaughter’s family history, your concern is understandable. As we learn more about psychiatric disorders, we increasingly recognize the biological and genetic contributions to brain-based illnesses. However, along with the possible inherited aspects of psychiatric illnesses there are also strong contributions from a child’s environment and what he or she picks up and learns from those who are most likely to influence them, especially parents, and also other relatives, teachers and role models. Although a parent’s psychiatric disorder may increase a child’s likelihood of having a similar disorder, it may only increase the risk. It does not cause the disorder, nor does it mean that their child will develop that disorder. In your granddaughter’s situation, there may be many causes of her anger, aggression, and difficulty focusing, including possible psychiatric disorders. Other reasons may be reactions to environmental or even developmental crises, such as starting school or being away from home for the first time. Even a non brain-based physical illness may relate to childhood anger or difficulty focusing. Therefore, getting a better diagnostic understanding of her difficulties is the first step to help her out. Assuming that your granddaughter is in the care of her parents, they should be encouraged to start the process of addressing her symptoms with her pediatrician. That is a good place to begin.
Information from other sources such as school or day care can provide helpful insights and observations that can also aid in understanding her difficulties. At that point, her pediatrician can determine if further diagnostic evaluation or treatment is needed, which may include counseling, family therapy, and /or a psychiatric consultation. Often, many of these resources can be obtained by contacting your insurance company or through a local community mental health center.
My nephew is very sad. Turning eleven 11 ½. His parents are no longer together, and his mom is due to have another baby soon. He has had problems with bed wetting for most of his life and says there isn't anything that makes him happy. His father is also very sad. It has been about a year since his parents separated, which I am sure is affecting my nephew. I worry about both of them. My nephew's mom sees him very little, even though he has expressed wanting to see her more. I am supportive and see my nephew more. We don’t talk negative about his mom. His maternal grandparents are involved in his life, which I think is important, but they can be defensive about the situation. What should I be doing? My heart breaks for him.
Providing your support is a great thing, as both your nephew and his father need it. Under the circumstances you describe, when a child says that nothing makes him happy, additional help may be needed. Although your nephew is going though some significant stress in his life now, it can be easy to think he will get better with time. However, sometimes life stresses bring about depression or other psychiatric disorders that can persist even after the stress subsides. In addition, as it appears the current circumstances have gone on for about a year, your nephew may already be feeling he is not at his best in school, forming friendships, or meeting other developmentally appropriate and important elements of growing up.Your nephew, therefore, should be seen by a professional who can assess how sad he is and determine how best to help him. Ideally, his mother and father can talk with him together, despite their own separation, to work out a plan for him to be seen. Knowing that his parents can work together in his best interests can be an important message that can also decrease any feelings of abandonment he may have. Often a child’s pediatrician can be the first professional with whom to consult and who can direct any further care that your nephew needs. Schools can provide some important observations of how a child is functioning, in addition to possibly providing some supportive services, especially if his performance or behavior in school is suffering. Finally, if your nephew’s father is also very sad, he should seek help, as his needs are important to address, not only for his own sake, but also for his son’s. When a parent is dealing with any kind of illness of their own, they may not be as helpful to their children as they could be if they were feeling well. Knowing that his father is taking care of himself will likely be very reassuring to your nephew and good role modeling. My 10 yr old son was diagnosed with ADHD inattentive last year. He is taking Adderall 10mg. Last year he was on Focalin and it really made him feel lethargic and unable to eat...but he seemed more focused. Adderall doesn't upset his appetite as much, but I feel he is less attentive on it. He also seems crabby and is extremely shy at school. I took him to counseling last year, but neither he nor I noticed a difference. I guess my question is...I need help helping my son and I do not know what my next step should be.
Medications for ADHD can be very helpful, however, as with many disorders or conditions, it can be a challenge to find the right medication and dose that is effective and has minimal or no side effects. Several questions could be asked of the child’s provider to help determine further medication directions. For example: What were the doses of the Focalin last year? Has your son been tried on higher doses of the Adderall? Have there been other medications trials? There are still several medication options available, including alternate doses of the medicine he has already tried, other stimulant preparations, or non-stimulant medicines, such as clonidine, or guanfesine (Tenex) or Strattera.What is especially important, however, is having a doctor with whom you trust and work well with. The role of your son's doctor should be more than just prescribing medication; it should also be to help diagnostically ensure that ADHD is the correct diagnosis and to better understand why your son is crabby and so shy at school. For example, if there is an underlying condition like depression or anxiety, or even a learning disability, these difficulties could complicate the ADHD treatment and success of the above medications. It is also important to know if the crabbiness and shyness developed with the medications or were also sometimes present before your son started his treatments. Similar to finding the most effective medications, it can also be a challenge to find the right therapist, but don’t give up because there are many fine therapists in this area. If you see things are not changing with his current counselor, consider starting a discussion with his counselor to see if there are things that could be done which can improve therapy. Sometimes switching to a therapist that you and your child better connect with and trust is necessary. Some child and adolescent psychiatrists do provide therapy, and a psychiatrist can also make recommendations for a therapist and the type of therapy that might be most helpful for your son. In general, it is the integration of diagnostic understanding, medications if indicated, therapy, and working with your son’s school system that will give him the best opportunity to benefit from treatment.
My daughter is addicted to pain killers, attempted suicide and is now in inpatient care. She has very young children, 1 ½ and 3 ½ . I will be their care giver while my son-in-law works. I am concerned how the 3 ½ year old will react once he realizes his mother is not coming home. What are some behavior issues or other signs I should be looking for to avoid any long-term affects, since I am not sure the circumstances will change anytime soon. I don't want my grandsons to suffer in any way.
This is obviously a very difficult situation for the entire family. At these young ages, children are naturally focused on having their immediate needs met. It sounds like you and your son-in-law have addressed this concern with your plan to be their primary care giver in their mother’s absence and while their father works. Consistency in your presence and your expectations and limits will help to alleviate their anxiety. Sticking with familiar routines, foods and toys is also likely to be helpful.Your grandsons may experience anxiety or sadness that can be expressed as changes in sleep, changes in appetite, increased aggression, social withdrawal or regression in developmental gains, such as wetting the bed once they have been toilet trained. These are likely to be temporary and are likely to respond to your encouragement and consistency with routines. If these do happen and persist, consider first seeking help from the children’s pediatrician or a mental health provider.
How early can ADD/ADHD be diagnosed and how can you tell the difference between a child's normal inability to focus and something more serious that may need to be treated?
Attention-deficit hyperactivity disorder, or ADD/ADHD, occurs in about three to five percent of all children and can be accurately diagnosed in children as young as three or four years of age, although the diagnosis in this age group is more difficult and more controversial than in older children. The controversy in diagnosing very young children with ADD/ADHD arises because all children can have difficulties with attention span, hyperactivity and impulsivity, the three areas clinicians closely assess when diagnosing ADD/ADHD. Kids can have difficulties in those three areas in response to things that are going on in their lives or a particular crisis, and sometimes, struggles in these areas are developmentally appropriate. However, in order to diagnose ADD/ADHD, a comprehensive evaluation is necessary. Symptoms typically start at a very young age and occur persistently. They will also occur in more than one setting, like home and school. Finally, to be considered a disorder, there must be some impairment, for example in school or socially. Not all children or adults with ADD/ADHD have difficulties in all three areas either, some, for example, just have difficulty with concentration or inattentiveness. The evaluation of a child with severe or persistent symptoms typically includes a pediatric evaluation, psychiatric interview, parent or teacher rating scales or observational history, and may include psychological testing. As part of the evaluation, a child’s behaviors will be compared to the behaviors of children in the same age group or the same developmental age. It is important to have a good evaluation to rule out undetected learning disabilities, depression, anxiety, or history of trauma, which may be associated with the behaviors typical of ADD/ADHD. An evaluation will help rule out other causes including environmental, psychological, biological, or a combination of these causes. Treatment is most successful when any underlying conditions are recognized and treated. If you have concerns, the first place to start is with a child’s pediatrician. This is generally the first clinician a parent can express their concerns to. A child’s pediatrician already knows the child and can provide further direction. A specialty evaluation by a child psychiatrist is likely to be recommended to ensure accurate diagnosis and treatment of ADD/ADHD, particularly in young children.
My 16 year old has been smoking pot almost every day for the past few months. He participated in an outpatient substance abuse program and was tested weekly until recently - he continues to smoke. He has rebelled against all the rules of our house and is sneaking out and not coming home at night. He has ADHD and has been medicated for many years (Concerta). I don't know what steps to take next, should we put him in an impatient situation?
You are right to be concerned. Daily marijuana abuse is a serious problem that can have immediate or short range effects, and long range harmful effects. Intoxication for example, can cause distorted perceptions, impaired coordination, cause difficulty in thinking, problem solving, learning and memory, which can last for days or weeks after the acute effects of the drug wear off. While drug abuse is often associated with adolescents with attention-deficit hyperactivity disorder, marijuana typically interferes with the adjustment and treatment of ADHD. In addition, chronic marijuana abuse is also often associated with psychiatric difficulties. It is not certain, however, whether marijuana use causes mental health problems, makes them worse, or is used as an attempt to self medicate symptoms already present. In your son’s situation, he is not cooperating in any of your efforts to provide him help. Although the drug use and defiance may be the problems seen, this behavior may actually be hiding other less obvious problems. Despite these difficulties, help is available. The challenge is getting your son to accept help. If your son is attempting to self medicate, he may be frightened, and what appears to be oppositional behavior, may be the only way he knows how to find some relief. Therefore, if someone he trusts can talk to him, encourage and provide support for treatment, he may be more willing to accept it to relieve not only the drug use, but also any underlying mental health problem, which can’t be adequately treated while he is using marijuana, as you describe. Some people find voluntary support groups or 12-step programs, such as Alateen or Narcotics Anonymous more acceptable and may be more acceptable to your son rather than feeling forced by others to get into treatment. Failing that, obtaining treatment may depend upon the circumstances. For example, if he has had legal difficulties connected with using drugs, the court system may be able to mandate treatment. Many states have provisions for parents to request court or state involvement for their child or adolescent out of their control, and again, the court can mandate some type of care. Because your son has already started treatment for two disorders, the marijuana abuse and ADHD, a place for you to start can be with his current treatment providers. Assuming they are not the same individual provider or organization, they should communicate with each other to make sure their treatment and understanding of your son are compatible and supportive of each other so that, together, they can make a coordinated recommendation. Your son’s pediatrician should also be involved in these recommendations. In addition, attempting to diagnostically determine any underlying mental health or physical disorder that may contribute to the drug abuse and his behavior should be one of the recommendations. Specifically for the drug use, there are many options that can be considered when outpatient treatment is not sufficient to alleviate the problem. Some of these programs are dependent on where you live, but in Rhode Island, for example, there are intensive outpatient programs that are programmed for approximately ten hours a week, often providing group treatment, usually with an educational and skill building emphasis, as well as family involvement and education. Other programs that are often available include day treatment programs, or if these are not successful, inpatient treatment may be necessary. Inpatient programs could be primarily rehab, emphasizing drug treatment, or they could be residential or hospital based psychiatric facilities, like Butler, that can address the drug use in the context of any underlying psychiatric difficulty. Drug screening is typically part of any of these programs.In addition, family involvement, education, and support are essential. Raising children, even in the best of circumstances, is a challenging endeavor and parents should not have to feel they are alone in making difficult decisions. The complications of drug use as well as ADHD, and a refusal to follow parent’s directions makes a parent’s need for support and direction even more vital, although by asking this question, you must already realize this. Twelve-step programs for families such as Alanon can provide a great deal of help and support for families. Alanon support groups take place all over Rhode Island, including on the Butler campus (for more information on the support group meetings held on Butler’s campus, visit our support groups page.). Alternately, the same providers mentioned above should also be able to provide or recommend appropriate support for family members.
What’s the difference between Asperger’s syndrome and autism?
Good question. The terms "Asperger's" and "autism" are often easily confused. In order to understand what Asperger’s syndrome is, it’s important to first understand what autism spectrum disorders are, since Asperger’s syndrome is one of them. Autism spectrum disorders are complex neurobiological disorders of development that are present throughout a person’s life. Often, they are referred to as a developmental disability because they usually appear during the first few years of life, while a child is developing and can cause delays or problems in different skills that arise from infancy to adulthood. Autism spectrum disorders typically cause problems in the areas of social interaction and communication skills. Children with an autism spectrum disorder show difficulties in verbal and non-verbal communication, social interaction, and leisure or play activities. What makes Asperger’s different from other autism spectrum disorders, like autistic disorder, is that people with Asperger's typically don't have the significant communication delays and cognitive delays as people with autism experience. Asperger's syndrome is characterized by difficulty with social communication. A person with Asperger’s sometimes uses advanced and overly-formal language when talking with others and they may have an extensive, pervasive interest in a specific subject. People with Asperger's function relatively well in terms of intelligence and basic social functions. They often go to school, graduate from colleges, and live independently. With all autism spectrum disorders, including Asperger's, different people can have varying degrees of impairment. One person may have mild symptoms, while another may have much more serious symptoms.
With Ritalin receiving bad reviews regarding mood swings and behavioral issues, why is it still being prescribed?
Ritalin was the first stimulant medication to be used in the treatment of attention-deficit hyperactivity disorder (ADHD), beginning in the early 1960’s. It is the most widely prescribed stimulant and its active ingredient, methylphenidate, is the active ingredient for many other prescriptions, including Ritalin LA, Concerta and Metadate CD. Ritalin, like all medications, can cause side effects. Although commonly cited, the side effects of mood swings and behavioral issues related to Ritalin may be exaggerated. In the MTA study (Multimodal Treatment Study of Children with ADHD), which was the largest multisite study of children with ADHD, 85 percent of children showed no or mild side effects. Review of the literature notes increased irritability in 5.8 percent of patients, increased anxiety in 8.2 percent of patients and aggressive behaviors in only 1.7 percent of patients. Interestingly, measures of aggression were noted to decline in treatment in most of the MTA study patients. As with all medications, accurate diagnosis and careful medication monitoring, with dose adjustment when needed, is crucial to obtaining the greatest possible benefit with minimal side effects. Although Ritalin may not be the appropriate medication for every patient with ADHD, it continues to be a useful medication for many.