The epidemic of ritalin: A cure for brattiness?

The Argument

This kin of cocaine and speed is being prescribed at an ever-increasing, ever more irresponsible rate

January 17, 1999|By Judith Schlesinger | Judith Schlesinger,Special to the Sun

The Office of Drug Enforcement estimates that by 2000, fully 15 percent of school-age children will be taking ritalin for something. The question remains, "for what?" -- brattiness, boredom, reluctance, defiance? Whose attention is truly deficient -- kids' or parents'? (Or both?) Lately more adults are appropriating the diagnosis, using it to retroactively explain their own disappointments in life.

Few people familiar with ritalin are neutral about it. A milder form of speed and structurally kin to cocaine, ritalin is used to treat attention deficit disorder, a grab bag of unruly behaviors that interfere with some children's ability to learn and obey.

Once called ADD and now ADHD to include hyperactivity, the disorder is fully as controversial as its treatment. At one extreme are exhausted parents who believe family life would be unlivable without ritalin; their enthusiasm is shared by those who profit from the 700 percent increase in sales since 1991, including its manufacturer, which quietly contributed nearly $1 million dollars to ADHD support groups. Critics fear a generation of kids drugged into compliance instead of developing internal resources; they blame the psycho-medical establishment for pathologizing yet another human problem, and point to the lack of clear biological evidence that ADHD exists at all.

Between the opposing shores is a roiling sea of confusion. There's little doubt that ritalin works -- it is a powerful drug, after all -- but no one knows why. How can a stimulant calm a "hyperactive" child, anyway?

Advocates claim it's "paradoxical," that ritalin "activates the inhibitor," a vague calming mechanism presumed to reign in the seat of volition, the frontal cortex.

Detractors note that since ritalin increases focus in all kids, it's not treating any special disorder. The official psychiatric diagnosis requires a behavior checklist, including "not remaining seated when expected to do so" (Criterion A2b) and "having difficulty awaiting one's turn" (A2h).

Since the verdict turns on the perceived frequency of transgressions, it's easy for frazzled caretakers and sympathetic helpers to confer the subjective diagnosis -- and no laboratory tests to prove them wrong.

One thing is irrefutable: the suffering of families wrestling with their kids' maddening behavior. Many devoted, careful parents struggle for years to differentiate "can't" from "won't"; finally baffled by the self-defeating behavior of their otherwise good and intelligent kids, they're relieved to blame a neurological glitch.

In this they get passionate support from "Understanding ADHD" by Christopher Green and Kit Chee (Ballantine, 320 pages, $12.95), which claims to be "The Definitive Guide" but is packed with muddy assertions: "There is controversy only in the media, not in reputable professional circles," and "academics ... only see what they read in books, while we have to cope with the variables of real life." (One breezy heading is "Reality before Science.")

Stretching the loose diagnostic net to include "behavior out of step with parenting," the authors warn that, without ritalin, ADHD "can drag clever parents and children down the social and financial scale."

Such achievement concerns are indicted in the thoughtful "Running on Ritalin" (Bantam, 386 pages, $25.95), where pediatrician Lawrence Diller worries that ritalin is being cynically prescribed to narrow the gap between IQ and performance in a kind of "cosmetic psychopharmacology." Alarmed by the increasing demand for a drug whose long-term effects remain unknown, he demonstrates how contributing psychosocial factors -- family dynamics, attitudes toward free will and responsibility, marital dysfunction -- are trampled down in the stampede to make kids successful: "Should we, even with the best intentions, force kids into academic and career paths not well-suited to their personalities and abilities, and then medicate them to raise their motivation?"

It's true that, for a supposed medical entity, ADHD has curious demographics: largely a white, middle- or upper-class phenomenon, it's most prevalent in the South and rare among children of Asian immigrants (Virginia has the highest per capita ritalin use, Hawaii the lowest).

Moreover, it seems that a few doctors are doing most of the prescribing (in Michigan, 5 percent of the doctors write 50 percent of the scrips). Diller compares ritalin to "the canary in the coal mine," reflecting society's toxic obsession with achievement.

Pace, not pride, is the true architect of "Generation Rx" in the provocative "Ritalin Nation: Rapid-fire Culture and the Transformation of Human Consciousness" by Richard DeGrandpre (Norton, 284 pages, $23.95), where ADHD results "from our growing addiction to speed and excitement."

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