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What is attention deficit hyperactivity disorder?

People with ADHD have deficits in their executive functioning, which means their thought processes are less efficient than those without the disorder. If a person with ADHD is going to complete a task, the task either has to be easy, short, or sufficiently interesting or rewarding to fully engage their attention.

Tasks such as studying may require a prolonged and intense period of concentration which a person with ADHD would typically find difficult to maintain.

How does Ritalin work?

Methylphenidate is similar in structure and function to amphetamines, such as dexamphetamine, which is also used to treat ADHD.

These stimulants increase concentrations of the neurotransmitters dopamine and noradrenaline in the brain, which enhances communication between brain cells. Effectively, this makes the mind work more efficiently, requiring less effort to get a task done.

ADHD is not a categorical diagnosis but a continuum. This means although some people clearly have ADHD and some clearly do not, there are many shades of grey between the two extremes.

It is therefore not surprising stimulants also improve mental efficiency in people without ADHD. The main difference is people with ADHD have more concentration problems and therefore show more scope for improvement on stimulants.

How is Ritalin taken?

ADHD is most commonly diagnosed in primary school, and the child is usually started on treatment at this time.

Both methylphenidate and dexamphetamine come in immediate-release tablets which last for around three to six hours; dexamphetamine lasts slightly longer than methylphenidate.

After taking a dose, the drug concentration rises to a maximum and then falls. Everyone has their own therapeutic range, which is the concentration the drug has to be in order to be effective.

The doctor normally establishes the appropriate dose by starting at a low dose and gradually increasing it over several weeks to find the most effective dose. If the person’s optimal dose is exceeded, their functioning becomes less efficient and negative effects increase.

The executive function deficits associated with ADHD are consistent over time, but people change as they go through different stages of development. As children progress through school, the demands on their concentration increase, and untreated ADHD is often associated with declining grades.

How many people use it?

Around 11% of Australian children and adolescents had diagnosable ADHD in 2007 although most were not treated. Between 2002 and 2009, prescriptions for stimulant drugs to treat ADHD among Australians reportedly rose by nearly 90%.

This can be explained by the introduction of newer, sustained-release tablets, which meant doctors could better tailor treatment to the individual – by combining immediate-release and sustained-release formulations for instance. This led to more prescriptions per person per year.

In 2015, around 906,754 scripts were written for methylphenidate and dexamphetamine.

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