The Ritalin Debate Rolls On

Too Much or Too Little? It Depends on Whom You Ask

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WASHINGTON, D.C., APR. 21, 2001 ( Should schoolchildren be given drugs to help them pay attention in class?

An increasing number of children — 2 million in America alone, by one estimate — are being given Ritalin daily. Ritalin is a medicine given to treat attention-deficit (hyperactivity) disorder, or ADHD. Some experts and parents argue that the drug is being overprescribed.

Parents are sometimes obliged to submit their children to Ritalin. Last year the New York State government threatened to take Michael Carroll´s 7-year-old son, Kyle, away from him, the Sydney Morning Herald noted in a Feb. 21 article. Carroll´s “crime” was having taken Kyle off Ritalin because it had turned his once-active, inquisitive son into an idle and brooding insomniac and done little, if anything, for the reading problem it was supposed to address. The boy´s school doctor reported Carroll to the authorities and asked the Child Protective Services to intervene and force Kyle back onto the medication.

Opponents claim a conspiracy between the drug´s manufacturer, psychiatrists and ADHD support groups has led to Ritalin becoming widely and routinely overprescribed in a way that unnecessarily changes children´s characters and places them at risk of potentially damaging side effects.

Although the manufacturer, Novartis, recommends that the drug not be administered to children younger than 6, recent U.S. newspaper reports claim it is being routinely prescribed to toddlers as young as 2.

Yet, some researchers think that ADHD is greatly underdiagnosed. One of them is Russell Barkley, director of psychology at the University of Massachusetts Medical Center and author of 14 books on behavioral disorders. “We´re not even reaching half the people,” he said. “The fact that we´re seeing a rise is not bad news, it´s good news. Twenty to 30 years ago we didn´t pay attention.”

The origins of ADHD

In 1972, Virginia Douglas, a Canadian researcher, provided the definition of what is known as attention deficit disorder, the Washington Post said in a March 18 report. Her diagnosis was part of a turning point in child psychiatry toward defining mental illnesses more on the basis of observable behaviors and less on a patient´s life history. The Post explained that this approach located the problem in the child´s brain and separated it from the child´s character. That opened the way for large-scale use of medication to change the behaviors.

In 1980 the American Psychiatric Association´s Diagnostic and Statistical Manual of Mental Disorders divided ADD into two main categories — attention deficit with or without hyperactivity. By the 1994 edition, the disorder was called attention-deficit (hyperactivity) disorder. By some estimates, 10% of school-age boys in the country, and a much smaller percentage of girls, could fall within the definition used to describe ADHD.

One of the problems underlying the debate over Ritalin is the question of what constitutes “normal” behavior. The psychiatric association´s diagnostic manual says ADHD can be diagnosed if a child displays a persistent pattern of inattention or hyperactivity in two settings — typically, school and home — and if that behavior interferes with social and academic performance.

The scientists who study ADHD believe these children are predisposed to it by particular patterns of brain chemistry, with most cases having some sort of genetic basis, others possibly the result of environmental factors during pregnancy or after birth.

The diagnosis of ADHD remains controversial in society at large, even as the number of children who are treated for it is skyrocketing. The Post noted that an estimated 3 million children in the United States have been diagnosed with ADHD, including perhaps 200,000 between ages 2 and 4.

Critics charge that it´s wrong to view these kids´ behavior as pathological in the first place; the fault lies with overcrowded schools, stressed-out parents with little time for the children, and a society that wants to dull its rough edges and is intolerant of anything but success.

Another problem is that at least half of the children diagnosed with ADHD also suffer from complex mixtures of other problems — learning disabilities, anxiety, depression — that can require a complex mixture of other drugs. Theoretically, one can find a drug to treat each symptom. But the relationship between behavior and the underlying biological facts isn´t cut and dried, particularly in children.

Experts in disagreement

Last September the Cybercast News Service ran a three-part series on Ritalin. It quoted one of the best-known critics of Ritalin, Dr. Peter Breggin, the author of several books and publications outlining the risks associated with adolescents´ use of stimulant drugs, and the director of the International Center for the Study of Psychiatry and Psychology in Bethesda, Maryland.

“Ritalin is harmful to the brain, and to overall growth,” Breggin said. “Ritalin addiction is becoming increasingly problematic … and ADHD is a completely fabricated diagnosis with no medical or psychological basis to it.”

But Dr. Bruce Meyer, a pediatrician with 30 years of experience who works with the Columbus Children´s Hospital in Ohio, does not agree. “For the child who is defined by the criteria as having [an attention deficit disorder], there´s a tremendous and remarkable success, so the child is able to function in school and function with peers.”

But Meyer also admitted that between one and three of every 10 children referred to him for additional analysis and possible treatment are improperly suspected of having ADHD.

It´s a difficult disorder to identify, according to Meyer, so some children are erroneously referred for Ritalin treatment. With proper testing, he said, children can be accurately diagnosed.

Meyer acknowledged that some critics of Ritalin have a basis for argument; ADHD is “overdiagnosed,” he admitted, with an estimated “5 to 10% of kids in any school” branded with the attention disorder.

Kiddie cocaine

Another problem with Ritalin is its abuse by those who use it for stimulation, as an alternative to cocaine. The Globe and Mail newspaper reported April 7 that doctors in Canada prescribed almost 78 million doses of Ritalin and its more potent cousin, Dexedrine. For people who are not hyperactive or do not have trouble paying attention, these drugs produce an immediate, euphoric and addictive high.

The Globe and Mail reported that Ritalin tablets can be picked up in the schoolyard or shopping mall for a few dollars apiece; Dexedrine goes for $5 or more. In the United States a 1999 survey of 6,000 Massachusetts children found that almost 13% of secondary-school students had taken Ritalin even though they did not have a prescription for it.

William Frankenberger, a psychology professor at the University of Wisconsin-Eau Claire who has studied the issue for 14 years, has found, in a survey of 651 students ages 11 to 18, that more than one-third of those given prescriptions have been asked to sell or trade their medication. With prescription rates in both countries about the same, Frankenberger says, it is likely that the experience of Canadian students is not much different.

Debate will continue on the benefits and drawbacks of using pharmaceuticals to modify behavior. In this age of instant solutions, popping pills is an attractive way to solve problems. Yet, more care needs to be taken before putting children on drugs that are anything but kids´ play.

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