What is the Right Dosage of Ritalin

June 20, 2016

We are in the process of determining the right dosage of Ritalin for my kid. We went in for another medication review appointment with a child psychiatrist.  I noted the improvements — there are two. She has been better about taking re-direction and there has been a noticeable decrease in emotional meltdowns at home. However, the non stop chattering, interrupting, and pestering remains the same. Likewise, her teacher noted she still has strong reactions to little things in the classroom to the extent of requiring a school staff person to be called in to help calm her down.  In her defense, the end of the school year can be difficult for a lot of children. It’s emotional.  The psychiatrist discussed things further with me — asking questions, asking for descriptive situations. The doctor recommended a slight increase in the dosage, a slight titration. We would meet for another medication review in a month.Right dosage of Ritalin

The bio-chemistry relationship involved with psychotropic drugs continues to fascinate me.  Could we have a little more of this so that we get a little less of that? A little more chemical input to decrease the behavioral output. I was hoping that once my daughter could pull in the reins on her running thoughts, I would be able to do therapeutic exercises to help her stop, pause, and make a good choice.  Maybe medication is similar to finding a fertilizer that works best on the yard — bringing out the desirable green grass, encouraging new growth, and suppressing the unsightly weeds.

I tried not to examine each blade of her existence. Yet, I wanted to carefully keep note of behaviors improving, antics remaining the same, or difficult ones increasing in frequency. We had a little of each. What a relief to have fewer emotional meltdowns over for example, “Please go play outside, it’s nice and sunny and your brother wants to practice his drums in the playroom.” Still the same ones of non-stop chattering and nonsensical arguing. And then the last one. More stealing and sneaking behaviors– taking notecards from my desk, emptying out brother’s emergency inhaler (placed on his bedside table), and climbing onto the counters to reach an item on a high shelf. I even tried out this one because I doubted her abilities. I climbed up on the countertop. I remained on my knees to account for her 42 inch height and reached my arm up high. Yup, it was doable. It was totally possible to reach the now consumed 8 pack hamburger bun package. Silly me for placing it there, for thinking that our family of five could have Sloppy Joes later this week. Instead we had pasta with meat sauce, a tangy BBQ flavored meat sauce.

Then it just kind of came out of my mouth. We were driving to the gymnastics place that holds summer camps. She loves this place. She was excited to get there. I was looking forward to six hours of her being out of the house, so that I could do things and not have to supervise. I asked if Daddy had given her the pill with her breakfast.

She said, “Yes.” I asked if she really understood what the pill is for…?  

She said in a sing song voice, “It makes me have a good day…?”  

I clarified, “Well, it’s supposed to slow you down so that YOU can make better choices and decisions. And frankly, I don’t think it is working. The sneaking around and stealing this week, I don’t think the medication is helping at all.”  No response from the back seat, just an unusual silence.

That afternoon as well as the following afternoon after camp, and the entire weekend we had delightful times. It’s kind of mind boggling. I wonder how much is in a child’s control and how much is controlled by the medication.  And what is that sweet spot for kids? what’s fair for their age when determining how much control is necessary without completely suppressing the wacky id-driven impulses?

Tomorrow we meet again with the child psychiatrist.  I am actually curious this time around as to what the outcome may be.  When I report on a few pleasant days, will the MD’s answer be to maintain the current dosage. When I tactfully point out her ever present motor mouth, will the MD recommend titrating up a few more milligrams? I am curious to know at what point the medication amount is sufficient in her bloodstream. Maybe my daughter had absorbed what I said in the car. Maybe she was ready, maybe she felt ready to make a shift with her self-perception.

We can all be moved by just a simple statement, a comment, or even a friendly observation. Sometimes just a single sentence can make us self-aware — thoughts can shift, we’re more able to notice our actions. Shifting just slightly until we can see ourselves better. An increased amount in the light– a shift from crescent to gibbous.  

Tonight, the summer solstice and a full moon are to both occur.  It’s a special, rare full moon that Native Americans call a Strawberry Moon. My husband is arranging wood on a fire pit.  I bring out two beers. We clink bottles and share a kiss. Happy Anniversary! Through rough times and fun times, right? I just laugh.  Then, I look up at the moon.

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