My son is on Ritalin LA now. He used to be on Concerta. If your child has a problem with pills, you cannot cut or crush Concerta; however, the 18 mg pills are fairly small, the 36 mg ones are not. As most people report, the worst side effects occur in the first two weeks. Lack of appetite, very quiet, just overall kind of grumpy. Then they sort of magically disappear. The only one that didn't really disappear was the lack of appetite with the Concerta. Because Concerta has quite a sophisticated delivery mechanism, the shell of pill doesn't really disintegrate and will usually pass in the child's stool. I think, to a degree it bothered DS's stomach. Also, we didn't get the best response with Concerta (18 mg) and the 36 mg was too high. The higher dose caused him to chew his fingernails and nibble on his lips causing severe chapping. Adderall was just horrible for him, although it worked!
Last year, Ritalin LA came out. It is a regular capsule with spanules in it. Thirty percent of the spanules release immediately and 70% of the spanules release 3-4 hours later. They can be opened over applesauce or other cool food. He has MUCH fewer side effects and seems to do very well in school. In fact, just yesterday I got my first report back. My doctor has a "scales" form that he asks to send to the teachers. It asks them to rate certain behaviors (fidgeting, disruptiveness, work completion) on a scale of 1 to 3. One being "not at all" to three being "all the time." I was thrilled to see that he got mostly all ones. He did get two "2s" which means "sometimes" for fidgeting and talking out loud occasionally. But the teacher said that many of the non-ADHD kids would get this too. So, I'm real pleased with the Ritalin LA. If you have a problem with Concerta you may want to try this. Same drug, different delivery system. Metadate is also just like Ritalin LA except that it has a 50/50 time release versus 30/70 time release. My doctor explained why a 30/70 was better but I think it is more technical than I can explain here.
Anyway, as far as telling the school, if you can get away with not telling them, that is fine. My son's school has known from the beginning because they were so instrumental in the initial feedback of his behavior. I mean, in first grade, let's face it they don't have much homework and you don't really know what they do from day to day. There was no way I could know that he was not finishing his classwork and was belting out "This Land is Your Land" in the middle of working on his assignments if she had never told me and suspected that he had a problem. The teacher never said the word "ADHD" to me, as so many seem to do. But she did indicate that the things he was doing, while not bad, were outside the range of what the other kids were doing. So, during my conference I had to tell her that I was going to try to find out the answers to his behavior. I guess what really got me was a tape she had made of the first few weeks of school. She videotaped several of the activities that the kids do during their day and she showed this video to the parents at back to school night. It was a great video, until I saw them having "story time". There were all of the kids listening intently to the story. There was my son, listening to the story yet scooting around the classroom looking at the various toys and pictures around the class. He was laying around, rolling around, walking, tapping, etc. I was mortified. What I thought was "normal boy" behavior was obviously NOT!! The teacher's feedback in the classroom has always been key to adjusting his medication also. There is just so much that I cannot see at home. While one medication dose may make him seem *fine* at home, it may not be enough to work in the classroom. The classroom atmosphere is very different. I've also never felt that labeling him was a problem. It may have been 10 years ago, but not anymore. The school system, at least large school systems, have become very aware and there are many children with it.
On another tangent, but same topic, my 12 year old daughter was diagnosed with very mild ADHD when she was about 8. As with most girls, her problem is excessive daydreaming. Again, I would never have known without the teacher's input. She was tested and I was told that she was very borderline and that I could use behavior modification on this or I could use meds, which they thought meds got the best result. I went with the meds--I mean how do you modify a daydreaming behavior or inattentiveness that only happens in the classroom. Her teacher noticed a huge difference and all was well. Over the years, my daughter has resisted taking the meds from time to time and we have gone on and off them (Concerta for her). I don't know why she doesn't want to take them because she says she cannot "feel" them. Maybe it is a stigma for her. Anyway, we did go through some of 5th grade and some of 6th grade without the medication. But it is a struggle for her. She has been in 7th grade for a little over a month now and has brought home about 8 homework notices for not completing her homework properly. She has received 2 demerits, and one detention. All for not doing her assignments properly because she is not paying attention. In fact, her teacher called me the other day because she is not paying attention. The teacher had a big, long talk with her and my DD managed to do very well in 6th period--enough to really impress the teacher, but we both know that she cannot sustain this. The teacher did tell me that she is not the "only one" in the class with this problem but it is bad enough that there is a problem. This particular school, which is private, did not know about her ADHD. I did elect to tell the teacher at this point because there was really nothing that we could do to fix this with behavior mod. So, on Thursday DD and I will be back at the pediatrician looking for our new ADHD med. For me, this thread has been VERY timely.
What a difference a day makes!! 
) We just don't want anyone to know about our DS's problem at school so I was less than honest.
(this little guy is called "hyper"...I think I'll start using him instead of saying DS)
We're very pleased because in the last 2 weeks he hasn't gotten even 1 sticker. He is also on a "point sheet" which is marked Y or N in different categories. It's been full of N's lately but today was all Y's! So, we don't see much change but apparently it's enough to allow him to settle down and stay on task. This was only one day so we'll see how it goes but so far, so good!
Good Luck!
