For most of his life, 14-year-old Kyle Gilson has struggled with attention problems and hyperactivity. "All kids have energy, but it's different when they're going Mach 2 with their hair on fire," says his mother, Jeanua, of Gilbert, Ariz. After third grade, Kyle was put on Ritalin, and then a series of other medications to modify his behavior. But there were drawbacks to all of them: the drugs worked only for four or five hours, and Kyle had to make an embarrassing trip to the school nurses' office to get a midday dose. He was also subject to terrible mood swings as the effects wore off, which his mother called the "afternoon nasties." "And he had a really poor appetite," Jeanua Gilson says.
But this fall, Kyle and hundreds of thousands of other kids are switching to a new time-release version of methylphenidate, the main ingredient in Ritalin. The new drug, Concerta, approved by the FDA in August, can be taken before school; the effects last 12 to 14 hours. "Longer-acting drugs that avoid school administration are the wave of the future," says Harvard child- psychiatrist Timothy Wilens, who has studied Concerta. Indeed, in its first two months on the market, sales of Concerta soared to $24.4 million, according to Alza Corp., the company that markets the drug. Ritalin, meanwhile, was flat at $103 million for the first nine months of 2000, says its manufacturer, Novartis. "Our market share has been eroding for the last 20 years," says a Novartis spokeswoman, saying generic drugs are taking over. Now, Novartis and other drug companies are also working on new time-release versions of methylphenidate.
The diagnosis of attention-deficit disorder is controversial, as is medicating children with psychotropic drugs. But the National Institutes of Health recently concluded that a combination of behavior programs and medications, such as methylphenidate, is the most effective way to help the estimated 3 to 5 percent of school-age children whose inattention threatens their success at school.
Still, taking Ritalin can be tough on kids. "When a child's in middle school, they think their life depends on what other people think of them," says Beth Kaplanek, president of the advocacy group CHADD. "When they have to go to the nurses' lounge every day, they think everyone notices." Some kids deal with it by skipping their midday dose. "But that doesn't make that child's life any easier at school," she says. "It just adds to the stress."
The traditional formula also seems to wear off abruptly for many children, making it difficult for some to maintain an even emotional keel during the day. The new drug delivers more like a "nonstop flight," said Wilens. "If you're flying to California, and you have to make two or three stops on the way there, you still get there. But most people would prefer a nonstop flight without all that up and down."
The new formulation also reduces chances of abuse, the experts say. Methylphenidate, a stimulant and controlled substance, has the paradoxical effect of calming and focusing children who are chronically inattentive. But for those without the disorder, it can create a high when crushed and snorted. A recent survey in Massachusetts public schools found that almost 13 percent of high-school students said they had experimented recreationally with Ritalin or an equivalent, even though they didn't have a prescription for it. Concerta reduces chances of abuse because it is made from a paste. "You can't grind it up and snort it," says Peter Jensen, director of the Center for the Advancement of Children's Mental Health at Columbia University. "It doesn't need to come into the school, and that reduces the likelihood that it will get into the wrong hands."
Children taking Concerta, like Ritalin and its generic equivalents, may experience side effects, including headaches, loss of sleep, stomachaches and a slowdown of growth. And some parents say that kids who need to stay focused longer than 12 hours--for example, to do homework or participate in a school play--have problems using Concerta since a second dose in a day could keep them from sleeping. But it's working for Kyle Gilson. Now, his mother says, he can get on with the business of being a kid.