    Alternatives to Stimulants
Q:
"My 11-year-old son became withdrawn and fidgety on Ritalin, so I took him off it for the summer. What alternatives will help him focus and follow directions when he returns to school in the fall?" 
A:
Ritalin can cause an increase in obsessive-compulsive type behaviors. If the dose is too high, it can cause the child to act withdrawn or flat. I agree that another medication plan might be tried. The best next step after the stimulant medications would be to try one of the group called "tricyclic antidepressants." These medications, at the low doses used for ADHD, have the same effect on the level of norepinepherine, as do the stimulants. Thus, the child becomes less active or distractible. Talk to your doctor about using Imipramine or another of these tricyclic antidepressants.
Larry Silver, M.D., is the author of Dr. Larry Silver's Advice to Parents on AD/HD and The Misunderstood Child: Understanding and Coping with Your Child's Learning Disabilities. He is also a clinical professor of psychiatry at Georgetown Medical Center in Washington, D.C.
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