Ritalin: Miracle Cure or Mind Control?

The Ledger, Lakeland, Florida, Published August 18, 1996

 

Lakeland, Florida—Devin, 8, takes his first pill before he gets out of bed in the morning, in a spoonful of applesauce. Samantha, 15, takes one of her pills if she can’t concentrate at her part-time job. And Scott, 16, takes a pill before his mom will get in the car with him to practice his driving.

These Polk County children have been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), the most common psychiatric disorder among children under 18 in the nation, and are taking the stimulant Ritalin, the most common medication used to treat it.

ADHD has permeated Florida, from the lunch lines that form at nearly every elementary school to the office in Plantation that serves as headquarters for the national Attention Deficit Disorder (ADD) support group.

An estimated 135,000 children in Florida have ADD, a disorder whose main symptom is an inability to focus, usually accompanied by hyperactivity. Locally:

■ More than 1,600 Polk Elementary students—about 4 percent—take Ritalin at school each day.

■ The first charter school in Polk County, and the fifth to open in the state, is for students with ADD. The Apple School was approved unanimously last week by the Polk County School Board.

■ Psychologists and psychiatrists say up to 70 percent of the children they see are being treated for ADD.

The rapid increase in Ritalin use in the past few years has given rise to a debate: Do this many children have Attention Deficit Disorder?

Is Ritalin being used to unlock the potential of students who can’t focus, or as the drug of choice to control unruly kids?

“We’re very medically- and drug-oriented in this country. There’s no question in my mind that we probably use too much Ritalin,” said Dr. John J. Ross, professor of pediatric neurology at the University of Florida.

But educators, parents, and doctors say they have seen the medication work miracles with children—curbing impulsive behavior, improving concentration.

“I treat 300 patients a year with ADHD,” said Dr. J. David Moore, a Tallahassee psychiatrist. “I’ve also lived with the disorder. There’s no controversy, in my mind, that this is real. I know kids who will tell you in a heartbeat that (Ritalin) has changed their lives.”

Local success stories abound: an elementary-school boy whose reading went up by two grade levels a few months after taking Ritalin; a middle-school girl in danger of being suspended who is now in the gifted program; a toddler who couldn’t sleep at night or sit still during the day who now bird-watches with his grandfather.

Ritalin has been used for 40 years with children, and there are several hundred studies that show it to be a safe drug with minimal side effects.

Yet many parents and professionals feel torn, worried about the implications of giving medications that influence brain chemistry and behavior to so many young children.

“I prescribe a lot of Ritalin but am still in amazement,” said Dr. Robert Eanett, a pediatrician at Watson Clinic South in Lakeland. “I have self-doubts. I can’t resolve it, even though I know science.”

“There’s not a parent who comes in here who begs for it—most want me to say their child doesn’t need it. But once they see the results, they won’t accept a lower level of performance.”

 

A National Trend

The state is mirroring a national trend toward more children being diagnosed and medicated for Attention Deficit Disorder.

Levels of methylphenidate consumptions in Florida have more than doubled in the past 10 years, going from 0.41 grams per 100 residents in 1985 to 1.09 grams per 100 residents in 1994.

Florida’s annual consumption of Ritalin is mid-range for the country, according to the U.S. Drug Enforcement Administration. In 1994, Florida ranked 36th in the nation in Ritalin use, up from a ranking of 43 in 1992.

Georgia, Michigan and Ohio used the most Ritalin, while Hawaii, Guam and Puerto Rico used the least.

The increase in Ritalin production corresponds to the increase in diagnosed cases of ADHD in children.

Since ADHD was recognized by the American Psychiatric Association in 1980, it has been the primary childhood psychiatric disorder in America.

Three million school-age children—about 5 percent—are estimated to have ADD; that’s at least one in every classroom. The vast majority of cases—about 80 percent—are thought to have the form that includes hyperactivity: Attention Deficit Hyperactivity Disorder.

The main symptoms: an inability to concentrate, complete a task or follow instructions; a tendency to fidget, squirm and interrupt; impulsiveness.

Most children who are being treated medically for ADD/ADHD take doses of Ritalin, or its generic, methylphenidate, several times a day. Since 1990, the use of Ritalin in this country has increased six-fold. Sales of Ritalin and methylphenidate in 1995-96 topped $350 million.

Ritalin works, doctors believe, by elevating levels of the chemical dopamine, which transmits messages in the brain. When most children concentrate, their brains release extra dopamine to block out competing sounds or sights. Children with ADHD seem to have a shortage of this chemical.

 

Public Concern

There is, however, evidence of significant public and scientific concern about the widespread use of Ritalin:

■ Use dropped in 1987 due to well-publicized claims—some say started by the Church of Scientology, which is anti-psychiatry—that the drug has dangerous side effects and was prescribed indiscriminately to uncooperative students.

■ Last year, a critical PBS documentary, Attention Deficit Disorder: A Dubious Diagnosis? concluded that the dramatic growth in the number of children labeled as ADD have been “largely man-made.” It also claimed the CHADD (Children and Adults with Attention Deficits Disorder) support group had been propped up by $1 million unpublicized donations from Ciba-Geigy, Ritalin’s manufacturer, which used the group to distribute information exaggerating the benefits of drug therapy.

■ The deaths of two young men in 1995, in Virginia and Mississippi, were attributed to the abuse of Ritalin combined with other drugs. The DEA cited reports of abuse of Ritalin by adolescents, who discovered they could get a rush by crushing the tablets and snorting the powder, sometimes called “Vitamin R,” “R-Ball,” or “the smart drug.”

■ In February of this year, the International Narcotics Control Board released a report saying that methylphenidate and Ritalin could pose dangers to children’s well-being over the long term and lead to adolescent addiction when improperly used. In response, Ciba-Geigy launched a national campaign called “The 3R’s of Ritalin: Read, Respect, Responsibility.” The company sent out educational pamphlets to more than 100,000 pharmacists and 110,000 doctors to pass on.

The message: Make sure Ritalin is taken only by the child for whom it’s prescribed, in the appropriate dose.

“We’re essentially encouraging parents and school nurses to eliminate any opportunity for diversion of the medication,” Ciba’s spokesman Todd Forte said.

 

Schools Respond

But schools, already charged by law with recognizing and responding to ADHD students in the classrooms and making special accommodations for them, are hard-pressed to keep up with regulating and dispensing the medication.

Since most schools lack full-time nurses, Ritalin and other medications are often given out by part-time clinic aides, secretaries or principals who have had minimal training on medical procedures.

“The biggest thing that would help is a full-time clinic aide in every school. That would be an absolute blessing to the health and welfare of our kids,” said Christina Landeck, a health services specialist with Polk County Schools.

The schools also have been called upon to educate teachers and principals about ADHD.

Teachers may be the first to call a parent’s attention to a child who is disruptive, not performing at grade level, or unable to complete in-class tasks or homework. They may recommend to the parents that a school psychologist or a pediatrician examine the child.

“The two most common times for ADHD to be discovered are when students are entering the first grade and the third grade,” said psychiatrist Moore. “That’s academically when they start tightening the screws.”

The Polk County School has an ADD/ADHD liaison who works with parents, teachers, and the medical or mental health community, with the goal of helping these students to succeed in school.

But public schools just aren’t able to do enough, says Dr. Brenda Harris, a Lakeland mother who is opening a charter school for ADHD students in Polk County.

“These kids are getting lost in the school system,” said Harris whose 4-year-old son has ADHD. The Apple School will include kindergarten to fifth grade. There will be no more than 12 students per class, and teachers will use techniques that help ADHD students stay focused and motivated.

“They won’t be marked as the bad kids in the class anymore,” Harris said.

 

The ADD Industry

As ADD numbers in Florida grow, so does the support system and industry surrounding it.

CHADD, the national support group founded in Plantation in 1987, now has 2,000 members and 37 chapters statewide, and a national budget of $2.2 million.

The ADD Warehouse, also in Plantation, is a for-profit business run by the cofounder of CHADD, Harvey Parker. It stocks hundreds of books, videos and other ADD resources, most of which are sold by mail order.

Ritalin and other medications used to treat ADD are purchased by thousands of families each month. At Walgreens, a monthly dose of 40 milligrams a day, totaling 120 tablets, is $66 for Ritalin and $37 for the generic, methalphenidate. Many insurance policies cover at least a portion of the cost.

Pediatricians must review dosages and update prescriptions of Ritalin monthly, which may involve frequent office visits.

And a psychological work-up for an ADHD diagnosis can range from $400 to $600.

Alternative treatments for ADHD—including special diets, vitamins, chiropractics, biofeedback, or massage—have proven not to be effective in treating the disorder. And yet, they are touted everywhere from the Internet’s World Wide Web to nutritional catalogs.

“ORDER NOW—Pycnogenol, a patented extract from the bark of the French Maritime Pine Tree, has been shown to effectively and naturally control symptoms of ADD,” flashes continually on one ADD Web site.

“As long as there are no satisfactory answers—and stimulants are terrific, but they only control the symptoms—people become sitting ducks for all kinds of claims,” said Rapport, from the National Institute for Mental Health. “With ADHD, they are legion: repatterning, eye movement therapy, diet. People should definitely check out the treatment before investing in it, and make sure there are controlled studies supporting its results.

“The ones that are cheap and harmless don’t bother me as much,” she said. “Drinking herbal tea is one thing, but spending $500 to $1,000 on something that is unproved, most families can’t afford that.”

ADHD is considered by most researchers, doctors and psychologists to be a legitimate, clinical and treatable disorder. But as awareness has increased, some say the rapid rise in diagnosis might be more indicative of the lens through which a child’s behavior is viewed.

One Lakeland mother said she took her son to see a psychiatrist to deal with grief, and the first thing the doctor told her was: “Well, he doesn’t have ADD.”

“It has become presumed,” she said, “that you are taking your child in to be screened for ADD.”