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Rising
Ritalin Use |
What is Behind
the Alarming Increase in Ritalin Use Among US Children?
By Phyllis Gray, 1994
“Ritalin is the most often prescribed medication for ADHD. It is a
stimulant that is closely related to amphetamine. Over 70 percent of all
children diagnosed with ADHD are prescribed Ritalin. Another 20 percent
are prescribed its generic equivalent, Methylphenidate (MPH), and another
stimulant similar to Ritalin, Dexedrine.
It is not known exactly how Ritalin works on a child with ADHD or why a
stimulant would help a hyperactive child have better concentration. What
is known is that Ritalin is not a cure in the sense that an antibiotic might
cure an ear infection. While Ritalin is in the blood stream it helps the
child, but once blood levels of the drug are reduced the child's behavior
returns to its previous state. Also, the use of Ritalin in children diagnosed
with ADHD is not diagnostic. While other medications treat specific symptoms
of the distinct disorder for which they are prescribed, Ritalin has the
same effect on all people with or without ADHD. In other words, everyone
who takes Ritalin is able to concentrate better, is less fidgety, is better
able to focus, etc.
Many unknowns
ADHD has been perhaps the most studied of all childhood psychiatric conditions,
and Ritalin is the most studied childhood psychotropic medication. However
there is still much that is not known about ADHD and Ritalin.
There are no firm figures on how many children are taking the drug. In the
1980s it was estimated that between 200,000 and 500,000 children were receiving
stimulants. In 1987 750,000 children were believed to be on the medication.
Both of these figures were the result of extrapolation from regional studies.
A study done by the University of California, Irvine, Child Development
Center estimated that in 1993 3 million children were diagnosed with ADHD.
Ninety percent of these children were on medication; 1.3 million receiving
Ritalin. Researchers believe that the number of children on Ritalin has
grown to 3.5 million with another 1.4 million taking other medications,
most likely Dexedrine.
Production and use of Ritalin is expected to double by the year 2000, which
would bring the number of children taking the medication to 7 million. Some
estimate that ADHD affects 10 percent of all children. If this is so, it
would mean that within a few years fully 10 million children could be on
the drug.
No other nation comes close to the US in the production and use of Ritalin.
Ninety percent of all Ritalin is produced and used in the United States.
Only Australia is close to the US in per capita use. Canada has seen a comparable
rise, although it is still at about one-fourth of per capita use as compared
to the United States. Britain has had a policy of intervening with social
support for children with ADHD and using Ritalin only as a last resort,
although these measures are being attacked because of budget cuts. Sweden
prohibits use of the drug.
There is a wide disparity in the prescription and use of Ritalin in the
US. Virginia has the highest per capita use of the drug. It is six times
higher than the state with the lowest usage, Hawaii. Within some states
there is a 20-fold difference among communities. In Michigan 5 percent of
pediatricians were prescribing 50 percent of the Ritalin. In Delaware, 9
of 135 providers (7 percent) wrote 26 percent of Ritalin prescriptions.
These disparities imply that there are developing Ritalin mills, medical
practices that become known for quickly diagnosing ADHD and prescribing
Ritalin. Doctors and parents have reported that some school districts regularly
inform parents that their child is possibly afflicted with ADHD and tell
them which doctor to see.
Ritalin produces quick and noticeable changes in the child in reducing many
of the symptoms associated with ADHD. In the short term it does, while in
the blood stream, improve concentration. It will improve a child's test
scores and make a child less combative and decrease aggression. However
it cannot resolve more complex problems such as low reading comprehension,
nor can it help children with learning disabilities, such as dyslexia.
Little is known about whether the temporary improvements continue once the
child is removed from treatment. According to Dr. Diller Lawrence in his
book Running on Ritalin, studies conducted in the 1960s show that drug treatment,
isolated from behavioral modification and talk therapy, produces no long-term
benefits for the child. In these studies researchers found that children
treated only with Ritalin were just as likely as the ADHD population as
a whole to suffer problems of unfinished education, drug addiction and problems
with the law…
Social issues behind the use of Ritalin
Since 1960 the number of children in families where both parents are working
has gone up from 30 percent to 70 percent. Sixty percent of preschool children
are now in some form of daycare. The number of children growing up in single
parent households, mostly headed by women, has also gone up dramatically.
The vast majority of these parents have to work. Parents from varied economic
backgrounds--from poor single parents forced to enter the work force because
of changes in welfare laws, to white collar and professional workers putting
in a 50- or 60-hour workweek--have less and less time to spend with their
children.
Moreover, because of the added pressure for academic achievement children
are being forced to compete in school at younger and younger ages. There
is very little time for evaluation and patient work to overcome learning
problems. It is not uncommon now to find three and four year olds being
brought in for ADHD evaluation and being prescribed Ritalin.
The educational crisis has exacerbated the problem. Schools are under greater
pressure to have students diagnosed with ADHD and placed on Ritalin. Budget
cuts have led to a dramatic increase class sizes. Classes of 30, 35 children
and more preclude one-on-one treatment of behavioral problems and lead administrators
and teachers to seek quick solutions. Furthermore, cuts in special education
programs have reduced the amount of resources available for classroom aides,
specialists, counselors and teachers to help troubled students. The full
inclusion of special education students in regular classes has placed even
greater responsibility on already over-taxed teachers.
There are many alternative treatments for ADHD that prove effective. Many
educators, psychologists and psychiatrists point to how behavior management
and changing the child's structure and environment can alleviate symptoms
of ADHD. But such approaches and changes cost far more than the cost of
a Ritalin prescription, and schools already dealing with massive budget
cuts do not have the resources to develop additional programs.
Obvious measures to alleviate some of the factors that may lead to ADHD--such
as better daycare provision, smaller classrooms, individual consistent attention
and discussions with counselors and social workers--are precluded in an
atmosphere of constant budget-cutting and belt-tightening.
Under these conditions many children who have symptoms similar to ADHD have
been misdiagnosed and given Ritalin. One study found that when children
diagnosed with ADHD were reevaluated with a standard test more than 25 percent
were learning disabled and not ADHD.
In addition, the market-driven restructuring of the health care industry
has also contributed to the increase in Ritalin usage. It is much cheaper
for Health Maintenance Organizations (HMOs) to treat ADHD with drugs rather
than psychiatric analysis and other behavioral therapies. A typical month-long
prescription of Ritalin is $30 to $60. A typical psychiatric analysis is
$1,500, or at least twice as much as the cost of Ritalin for a year. Most
managed care plans limit psychiatric treatment or behavioral therapies to
a time much too short to have any effect on ADHD.
In addition, HMO's, managed care and health insurance companies all pressure
doctors to spend less time with patients. Few doctors have the time for
the type of evaluation required to diagnose a child with ADHD: observing
the child, discussing with the parents, teachers and other caregivers. Routine
appointments in a clinic are placed 15 minutes apart and most doctors do
not even spend that much time with the patient. Furthermore, the changes
in diagnostic standards have meant that physicians are no longer required
to witness symptoms, but can rely on reports from untrained school authorities
and parents." Ritalin: What it is, what it actually does…
Articles and Information
Behavioral Communication of Children
Rising Ritalin Use by Phyllis Gray
A Perspective on ADHD, ADD, and ODD
What Doctors Know, The Pharmacology of Ritalin
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