Last year almost three million prescriptions for Ritalin were written for children. Ritalin is a controversial drug that is used to treat Attention Deficit/Hyperactivity Disorder (ADHD). It appears from the number of children diagnosed with ADHD as well as the number of children receiving Ritalin to "treat," its use is out of control. We do not know what its full action is, what its effects might be years from now, or whether it even treats what it is said to treat. Children are diagnosed as having ADHD so often that it has gained the nickname, "disease of the decade." Ritalin prescriptions are so abundant that the DEA (Drug Enforcement Agency) had to increase the production quota of Ritalin to 8,189 kilograms annually. This is four times what the quota was four years ago (Granat, 60). There is much evidence to suggest that children are too easily labelled as having ADHD and that the use of Ritalin as a medical treatment is not justified.
One of the reasons that children are easily labelled with ADHD is that there is no narrowly-defined certain diagnostic test for ADHD. It is thought that ADHD is the result of a chemical imbalance in the brain, and that this chemical imbalance is the result of the low metabolism of glucose in the parts of the brain responsible for motor activities and attention span. This is a theory and has not been proven to be clearly true (Dayton, 1). A child is said to have ADHD is he or she has six or more of a defined list of symptoms for at least six months. Some of these symptoms include: failing to give close attention to detail or making careless mistakes in school work; difficulty sustaining attention in tasks or play activity; not listening when spoken to directly; easily distracted; forgetful; hyperactive; talking excessively; and fidgeting with hands or squiriming in one's seat (Hallowell, 6-7). Without a diagnostic test, this leaves determining whether children have ADHD up to the opinion of a psychiatrist on what is social behavior. The causes of social behavior are by definition complex. This list of symptoms is highly general and can be summed up as behavior that all children exhibit from time to time while they are growing up. This makes it hard to tell whether a child is in a phase or has some abnormal medical condition.
The overdiagnosing of ADHD may be related to the way health insurance is paid and the self-interest of doctors who gain fees from patients they write such prescriptions for. Health insurance companies are less likely to pay a bill for a child who just goes in for "talk" therapy. There is still a strong tendency only to respect as illness that which is physiological and can be described physiologically. Thus insurance companies almost always pay if the child is diagnosed with some complaint that is called chemical and an abnormality (ADHD) and if the child is then put on medication to "cure" him or her (Granat, 63). A child who has no abnormality or disease can go to a psychiatrist, be said to have ADHD, and be put on Ritalin. The psychiatrist will get his fee, the insurance company will pay the bill. There will of course be a series of visits to the psychiatrists. Drug companies benefit enormously too.
What is ritalin? It is a mild stimulant which works by activating the brain stem arousal system and cortex. Ritalin apparently acts upon the neurotransmitter in the brain called dopamine (dopamine is a chemical that relays nerve impulses from one nerve to another) . Ritalin's stimulant effect has been shown to resemble that of cocaine (Baily, 1). Some scientists believe that Ritalin restores some "chemical imbalance" because a low metabolism of glucose has been connected to the kind of hyperactive behavior which is called ADHD. We do not know that the former is abnormal at all, but we do know that Ritalin will calm people down and allow them to pay attention to something for longer spans of time than is normal for them without Ritalin. In fact, tests have shown that many so-called "normal" chlidren can become calm and concentrate for longer periods when given Ritalin. This is not a theory; it is simply an observation and even this observation has not been proved to be generally true for many people (Dayton, 1; Granat, 111). There is also some evidence that Ritalin does not restore any chemical imbalance having to do with glucose at all. This evidence connects its action to novocaine (injected during small operations).
Not only are there no tests to prove that Ritalin is generally effective for children who are hyperactive, but there is no evidence that the use of Ritalin actually gets rid the problems such children have in school. Consider the following study. A group of children who were taking Ritalin for ADHD were taken off of the drug. It was shown that 64% of the children showed no difference in behavior in school after the drug was taken away (Vatz, 2368). Another study showed that 24 to 35% of the children taking Ritalin in the study still performed well when switched to sugar pills (a placebo). Many of the cases where Ritalin appeared to help could be explained as the child believing in the drug and coming to depend on it.
Even parents who have their children taking Ritalin are not sure whether it is really the cause of their child's improvement. Consider the following example, which is relatively common: Michael, a child, in the second grade, was very high strung and full of energy. This seemed normal for his age. But his parent noticed that Michael was easily distracted, and would have tantrums if things didn't go his way. His parents had him evaluated and Michael was diagnosed with ADHD. The doctor prescribed Ritalin for Michael. Now Michael seems to behave better. He concentrates better, controls his emotions, and he is getting much better grades in school. It looks like Ritalin did the trick. Michael's parents are not so sure. They do not know whether it is the Ritalin that has helped Michael or Michael's improvement is due to a private tutor who they hired at the same time (Granat, 60). Many parents are faced with this dilemma. In another case, a student started taking Ritalin in the fourth garde. He is currently in the seventh grade. His behavior and schoolwork improved after he took Ritalin, but not much. Here is the way his mother talks about his experiences in school:
If you put a boring teacher in front of him . . . he doesn't focus. He has an inability to focus on tasks he finds boring. It helps if the teacher moves around . . . doesn't just and there at the blackboard talking in a monotone. He also has a hard time reading for any long period of time (Granat, 111).
Using Ritalin on a child may also cause them psychological problems of other kinds. By taking Ritalin a child may come to believe he or she needs the drug to get through life, to do well. An example of this may be seen in the case of a boy who was placed on Ritalin in the fourth grade. He was taken off Ritalin for the third grade. Before the start of his fourth grade year, the teacher told his mother he was having trouble concentrating and needed to take Ritalin again (Granat, 112). The young fourth grader came to believe he needed this drug. He and his parents felt he had to resume the drug. Using Ritalin can also hurt a child socially if others find out about it. A child may resist because he fears his peers will find out; if he takes it, he may not be able to stop for fear he is not as able as they. Many children, when asked, will admit they do not like the idea of having to take something to control themselves (Lavin, 15-16).
One might conclude Ritalin has begun to be used because people feel socially pressured into it. It is being used to cover social difficulties and not as a medication for a real disorder. Recently a report was issued which recommended that Ritalin not be given children at least until they are six (Baily, 2). Ritalin is a powerful drug whose full operation no one understands and the evidence suggests that its effectiveness in helping children deal with social pressures is not proved.
This internet article listed many facts about the drug Ritalin. It was informative and had good statistics. There was not much discussion of these facts.
This essay reviewed many of the arguments for and against the use of Ritalin. It was useful because it had examples to back up each side. There was also much technical information about ADHD and Ritalin.
This book provides an overview and history of the disorder called ADHD. It addressed many of the most frequently asked questions about the disorder. It had some drawbacks. There was no index. It is also mostly in the form of questions and answers and that made it simplistic.
The book was another overview and history of the disorder, but it was written from the point of view of a child psychiatrist. Lavin was frank about the motives among doctors and insurance and drug companies for prescribing drugs. Another advantage of the book is that the writer lists other ways to help a child who is overactive or not doing well in school..
This newspaper article was useful because it stated many of the problems people encounter who use Ritalin (children and adults). It has many statistics. Its drawback is that the writer does not include evidence for use of calming drugs like Ritalin.