Time to unscramble the Ritalin riddle

Guidelines: Pediatric association takes a needed first step in diagnosing hyperactivity.

May 29, 2000

THERE's a lot of controversy surrounding the use of Ritalin to treat attention-deficit hyperactivity disorders in children.

That's why the American Pediatric Association's recent guidelines on diagnosing ADHD are such a needed step in better evaluating school-age children with this problem.

ADHD itself is controversial. The diagnosis is derived from observations, not blood or brain-imaging tests. About 2.5 million American kids, mostly boys, have been diagnosed with the disorder -- and many doctors prescribe Ritalin to relieve symptoms that include extreme restlessness, an inability to concentrate, impulsive behavior and difficulty sitting still.

Yet ADHD's symptoms describe most young children at one time or another and can also be caused by other problems, including lead poisoning, depression, abuse, poor nutrition, infections or sleep disturbances.

And although Ritalin is often used as a quick-fix over long-term behavior therapies, no one knows how the drug affects early childhood brain development.

The APA guidelines seek to make sense of disparate methods used in diagnosing this disorder. Recommendations include consulting physicians, teachers and parents; evaluating behavior in more settings for a longer period; and looking for other conditions -- a trait common in as many as one-third of ADHD children.

The guidelines come just months after a much-publicized study in the Journal of the American Medical Association found that during the 1990s, the number of young children -- including preschoolers -- receiving mood-altering drugs such as Prozac, Zoloft and Paxil leaped nearly 50 percent. And much like Ritalin's, these drugs' effects on early brain development are unknown.

One thing health professionals agree on: A good diagnosis of behavioral disorders is essential. No one wants children suffering unnecessarily or parents turning away from proven treatments out of fear. But misdiagnosing children and overmedicating them with drugs that haven't been adequately tested is unacceptable.

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