'Would Tom Sawyer and Huck Finn be on Ritalin today?” asks child psychiatrist Dr. Lawrence H. Diller in a meeting with the President's Council on Bio-Ethics. 'No doubt in my mind that they would be if they lived in my community. I see Tom Sawyers weekly.”
Dr. Diller isn't the only one. Between 1990 and 2000, there has been a 2,500% increase in the production and use of the prescription drug. Ritalin has become one of the most prescribed drugs in the country.
Ritalin is the brand name for methylphenidate, a central nervous system stimulant that is often prescribed for ADHD (Attention Deficit Hyperactivity Disorder). ADHD is often considered a neurobiological disorder, similar to brain damage or mental retardation, despite the fact that no biological origin for the disorder has ever been discovered. The point, however, would be moot since ADHD is not diagnosed using neurological testing but by using the the criteria listed in the DSM-IV, a reference manual used by mental health professionals .
The criteria used to make the diagnosis of ADHD is established by determining if 'six or more symptoms of inattention have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level.” Since the 'symptoms” include such items as, 'often fails to give close attention to details or makes careless mistakes in schoolwork” it's surprising that every child in the country isn't diagnosed as having the disorder.
Statistics show that we are well on the way to achieving that state. While it's estimated that between 3 -7% of school age children would meet the DSM criteria, in some areas as much as 20% of the schools population takes Ritalin. Not surprisingly, the boys are subject to this 'neurological disorder” at the ratio of 8 or 9 to 1 higher than girls. The disorder also seems to afflict white middle and upper-middle class boys more than other ethnic groups, such as Asian-Americans. Dr. Diller notes that the proximity to Boston is a prime indicator of an ADHD diagnosis.
But couldn't the disparity between socioeconomic and racial backgrounds be attributed to the disparity in access to healthcare? Couldn't it be that wealthy white parents simply have better medical insurance? Perhaps. But when the studies were done in Canada, where all people have equal access to medical coverage, the results were the same.
Ritalin, in my opinion, is a drug that is over prescribed for a very specious 'disorder.” But why is this the case? As Dr. Diller says in this book Running on Ritalin:
The ADD-Ritalin issue reveals something about the kind of society we are at the turn of the millennium -- for no country besides America is experiencing such a rise in Ritalin use. It throws a spotlight on some of our most sensitive issues: what kind of parents we are, what kind of schools we have, what kind of health care is available to us. It brings into question our cultural standards for behavior, performance and punishment; it reaches into the workplace, the courts and the halls of Congress. It highlights the most basic psychological aspects of nature versus nurture, and it raises fundamental philosophical questions about the nature of free will and responsibility.
In upcoming posts I will argue that Ritalin is being used as form of behavior modification in lieu of traditional character development techniques such as reward, punishment, and impulse control. Before we get to that, however, take the test to see if you could be diagnosed as having ADHD.
1
As someone who has ADD, I have to disagree. Ritalin really does make a difference when used properly. It's just a matter of prescribing it to the right people. Also, the disorder is a lot more complicated than common stereotypes would lead you to believe.
I wrote a very detailed post about my personal experiences with ADD on my blog a couple months ago. Let me know if you want to see it.
posted on 02.16.2004 10:21 AM2
Tell me, do you also not believe in seeing doctors for other illnesses, perhaps prefer "positive confessions"?
I would not be at all surprised to find ADHD over-diagnosed in school and ADD under-diagnosed for adults.
But that doesn't excuse your practicing medicine without a license.
posted on 02.16.2004 10:29 AM3
Joe, you're in way over your head on this one. As usual, I don't have the space here nor the time to totally address what you've written but I'll give it the old college try.
First, let's start with your assertion that Ritalin is used as a form of behavior modification in lieu of traditional character development.
It's not used as such because it doesn't work that way. Ritalin doesn't make a kid behave - it only makes it easier for him/her to behave. Ritalin by itself is extremely ineffective. Only when it is used along with techniques such as teaching the child to use various tools to stay organized, stay on-task etc. is it effective. (In short, not too different from what you refer to as reward, punishment, impulse control.) Ritalin alone, in fact, has the potential to make otherwise "naughty" kids even better at misbehaving since they can now concentrate much better!
Now let's go back to Tom Sawyer and Huck Finn. If they were alive today I doubt they'd be wandering the Mississippi getting into little innocent adventures. It's more likely they would be abusing drugs and alcohol and engaging in even worse types of behaviors. I doubt if the idealized agrarian atmosphere that Mark Twain created existed even then, but it certainly doesn't now.
The facts that you cite as an attempt to imply that Ritalin is over-used don't really mean too much -- The fact that there has been a 2500% increase is only an indicator that a great deal more study has gone into this syndrome and it is therefore diagnosed more. (Is it over-diagnosed sometimes? - probably.)
--The fact that there isn't any single neurological test doesn't mean that ADHD doesn't exist. There are a lot of syndromes where there is no single neurological test - yet they all exist.
--As far as taking the ADHD "Test". It isn't meant to take the place of a full-evaluation and is only useful for someone to determine if they should go get a full evaluation.
A few things that you might want to be aware of. Ritalin has received a bum rap ever since the Church of Scientology waged a campaign against it in the 80's. Much of the negative hysteria, even today, can be traced back to a systematic attempt to smear the drug.
Ritalin isn't that widely used anymore. Many advances in medication have pushed it to the back of the shelf for a vast majority of ADHD sufferers. (You might want to look for some statistics on Ritalin done in the last two years.)
The biggest problem with Ritalin comes from people thinking it (or any other type of medication) is some kind of cure all when it is far from it. (Kids still need "character building") Also, those who've had their own issues of feeling "different" when they were kids ironically get real weird when their own children are given the opportunity to have a different kind of childhood than they had. I guess it stems from the fear that they'll be even more stigmatized when actually the opposite is true.
Your contention about Ritalin and ADHD reminds me of similar problems that people had with treating depression with medication back in the 70's. They originally equated depression with some sort of moral failure or the person not trying hard enough or they weren't breast fed as a child or some other nonsense. Eventually, the medical community and the public came to realize that there's a huge biological component to it. (There was even the same concern about it being over-diagnosed etc.)
When you find yourself in the same company as Scientologists and anti-drug whackos trying to sell books to anxious parents it's time to get off the bus.
I'll agree that Ritalin might be over-used but that in no way invalidates ADHD or the need for medication to treat this problem. It and other drugs just need to be used the way they were intended.
-Jim.
4
CD's post about his experiences with ADD are here:
http://sithoughts.mu.nu/archives/009426.html
It's pretty typical of most adults who experience this problem.
6
JD:
Ritalin is a drug, which purportedly treats a physiological condition (chemical imbalance, perhaps?). What condition does it treat, and how can we measure, physically, the before-and-after affects of Ritalin? Presumably, if there's a chemical imbalance of some sort, we ought to be able to detect that even without subjective Yes/No questions.
posted on 02.16.2004 3:16 PM7
I've posted a response to Parts I & II at Infinite Monkeys.
posted on 02.16.2004 3:25 PM8
tgirsh,
The very sort of objective measurable "before and after" results are visible through the S.P.E.C.T. scans I've written about in the response I mentioned just above. I don't think I mentioned that specifically in my post, but I have books and brochures that show the impacts of the medications very clearly.
But the physical manifestations of mental disordes have long been very elusive. Some types of depression, for example, can be detected/confirmed through blood tests. Some can't.
Just because we can't see or haven't yet found something's physiological origin doesn't mean it's not real. Several psychological conditions are treated successfully or partially through methods that work, though no one can explain exactly why or how. Sorry, but it's not always a black and white field.
posted on 02.16.2004 6:57 PM9
InfMonkBrad:
It's entirely possible that ADHD is "real," but it's almost certainly overdiagnosed and Ritalin is certainly overprescribed. Joe's "supply side" complaint hits the mark perfectly, I think. The drug is effective, no doubt, but it's being "pushed" way beyond its intended use.
posted on 02.16.2004 10:13 PM10
Joe, I'm with you 100% so far. My own son was a perfect candidate for an ADHD diagnosis at the age of 6. Instead of drugs I taught (and am continuing to teach) him to control his own actions. I don't doubt that ADHD exists. I also don't doubt that it is far over-diagnosed and that parents are using drugs instead of parenting to control their children. When we give children an 'out' by drugging them instead of teaching them responsibility for their own actions we do them a great dis-service.
posted on 02.17.2004 9:08 AM11
Personal experience:
I was diagnosed with ADHD at the age of 14. Very little was known about this disorder at the time. The Dr. that diagnosed me felt that behavioral modification, not drugs, was the answer. Under his care for a year, I rapidly improved.
Then my family moved. We sought out a new Dr. This one decided to try me on Ritalin. I turn out to be one of the many (we later found out) that react badly and, in my case, violently. I went from moderately distractable (thanks to Dr. T's help), to completely unmanageable in about 2 weeks. I, not my parents, determined what the cause was, dropped the drugs in the toilet, and found a new Dr (who confirmed my suspicion).
Amazingly enough, this third Dr. proscribed... behavioral modification. She assisted me with literally retraining my brain in order to help me focus and concentrate. These techniques have helped me through my entire life.
There are some disoders that require medication. I do not believe that ADHD is one that does not. Parents need to use a loving hand and provide a firm, structed, discplined environment. Behavioral modification techniques should be used to "train" a child to focus.
Throwing drugs at the problem won't make it go away.
posted on 02.19.2004 11:11 PM12
My Nephew recently was put on ritalin. I don't feel it was a good choice on my brother's behalf. I feel he is simply giving up because the school tells him that it is a need. The funny thing I disslike the school and I took my niece out of the school two years ago. I am helping my brother,because he is alone. I pulled her out of the school, because at age 14 she couldn't tell time or any of her times tables. She was getting suspended every second week and getting in detention on the other weeks The thing is since I have taken her out two years ago and in another school, she can tell time she knows her times tables and she has never been suspended since! Yes get that she has never been in trouble since or suspended. I have tried to make my brother see this, but for some STRANGE reason he doesn't he is working with the school on this one........I am at a lost, but I fear for my nephew I truly do fear for his safety and his learning and his future caree plans......The thing is my brother hasn't mentioned the ritalin to me yet.......my 15 yr old niece mentioned it, because she is concerned ......It makes me so upset the schools today are making me want to take legal action on them. I am from Canada Ontario and I swear every child I know lately is suppositly A.D.D or A.D.H.D! I think plain in simple that teachers are lazy and see no room in class room for individuality anymore! I am terrified when my daughter will be starting school in a year and half, I mean it will only be getting worse. She is very smart in fact her peditrician say's she is about a year a head of herself. I mean I am sure they will see her progress as A.D.D or A.D.H.D or this new one they have now authority dissorder. Apparently if a teenager is rebelous or never wants to listen to authority they may have a more serious condition, yes it might be an actual emmotional/mental dissorder! I MEAN COME ON DR'S and TEACHER'S I am 29 and I still have a problem with authority telling me what to do! Please any information and web sites any advice would be apperciated, sorry for the long e-letter I just wrote....... just that I am at a lost with the education and medical community.........
posted on 05.13.2004 9:57 AM13
My Nephew recently was put on ritalin. I don't feel it was a good choice on my brother's behalf. I feel he is simply giving up because the school tells him that it is a need. The funny thing I disslike the school and I took my niece out of the school two years ago. I am helping my brother,because he is alone. I pulled her out of the school, because at age 14 she couldn't tell time or any of her times tables. She was getting suspended every second week and getting in detention on the other weeks The thing is since I have taken her out two years ago and in another school, she can tell time she knows her times tables and she has never been suspended since! Yes get that she has never been in trouble since or suspended. I have tried to make my brother see this, but for some STRANGE reason he doesn't he is working with the school on this one........I am at a lost, but I fear for my nephew I truly do fear for his safety and his learning and his future caree plans......The thing is my brother hasn't mentioned the ritalin to me yet.......my 15 yr old niece mentioned it, because she is concerned ......It makes me so upset the schools today are making me want to take legal action on them. I am from Canada Ontario and I swear every child I know lately is suppositly A.D.D or A.D.H.D! I think plain in simple that teachers are lazy and see no room in class room for individuality anymore! I am terrified when my daughter will be starting school in a year and half, I mean it will only be getting worse. She is very smart in fact her peditrician say's she is about a year a head of herself. I mean I am sure they will see her progress as A.D.D or A.D.H.D or this new one they have now authority dissorder. Apparently if a teenager is rebelous or never wants to listen to authority they may have a more serious condition, yes it might be an actual emmotional/mental dissorder! I MEAN COME ON DR'S and TEACHER'S I am 29 and I still have a problem with authority telling me what to do! Please any information and web sites any advice would be apperciated, sorry for the long e-letter I just wrote....... just that I am at a lost with the education and medical community.........janz_faith@hotmail.com e-mail just subject it ritalin information please, thank-you
posted on 05.13.2004 9:58 AM