Ritalin? Just Say No
On any given day in North America, almost five million kids will take a powerful psychostimulant drug. The geographical caveat is important: more kids in North America are diagnosed with attention deficit disorder (ADD) and given drugs like Ritalin to "help" them behave than in the rest of the world combined. In fact, the US and Canada account for a startling 95 percent of worldwide Ritalin consumption.
In the midst of this drug epidemic, April 2001 appeared to signal a backlash. Two television magazines, PBS's Frontline and A&E's Investigative Reports, pondered the massive increase in use, as did a five-part series in Canada's National Post newspaper. Still, of all the critical reports in recent months, none has come any closer to facing the hard facts about Ritalin than have the hundreds that came before.
Fact one: While medical "experts" and the media persistently deny it, developmental studies have now established that certain differences in caregiving and family structure cause some children to become impulsive and hyperactive. In a recent example, a ten-year, federally funded study in the US, reported at the April meeting of the Society for Research in Child Development, found that the more time children spent in daycare the more unmanageable they became. Kids who spent more than 30 hours a week in daycare scored significantly higher on such things as "explosive behavior," "talking too much," "argues a lot," and "demands a lot of attention" -- the very behaviors that so often lead to stimulant treatment.
Fact two: Ritalin is little more than coke for kids. "Cocaine, which is one of the most reinforcing and addictive of the abused drugs, has pharmacological actions that are very similar to those of methylphenidate [Ritalin], which is the most commonly prescribed psycho-tropic medication for children in the United States." This conclusion, reported by Nora Volkow and colleagues at Brookhaven National Laboratory, appeared in the Archives of General Psychiatry in 1995. A follow-up study, published in the American Journal of Psychiatry in 1998, found that the pharmacological actions produced by oral, therapeutic doses of Ritalin were comparable to those produced by recreational doses of intranasal cocaine. Researchers are quick to point out that children prescribed Ritalin do not (usually) snort or inject it, which alters the drug-taking experience. But do we really believe parents would give their kids cocaine, even if it was only in pill form?
Fact three: Ideology is driving the science. Fighting the drug war, researchers like Volkow have demonstrated that continued use of cocaine and other stimulants causes brain changes. Yet never have these researchers investigated whether chronic stimulant use might produce the same effects in kids. Meanwhile, other researchers have pointed to subtle differences in certain areas of the brain to suggest that ADD is a biological disease -- a claim repeated in the recent Frontline episode. The truth is that all these studies have looked only at hyperactive individuals who have been taking stimulants for years. At least one study, published in Psychiatry Research in 1986, was honest in its findings: "since all of the [ADD] patient had been treated with stimulants, cortical atrophy [i.e., brain deterioration] may be a long-term adverse effect of this treatment."
Fact four: The US Drug Enforcement Administration has long known that massive amounts of Ritalin are being diverted by adolescents and adults into recreational use, where it's often crushed up and snorted, or even injected. The DEA reported that Ritalin misuse in high schools increased from three to 16 percent from 1992 to 1995. Similarly, it found that while children between the ages of ten and 14 were involved in about 25 emergency-room visits connected with Ritalin misuse in 1991, this number had jumped to 1,725 by 1998.
Fact five: Stimulants are no cure. Perhaps all this hypocrisy could be excused if stimulant "treatment" somehow worked, but it doesn't - at least not for the children themselves. Parents have been encouraged to believe that pharmacological control will boost their child's learning and social skills, but this rarely happens. Dozens of objective studies have assessed the long-term effectiveness of stimulants on children's academic performance, social development and self control. None has shown them to be effective for anything but controlling kids' behavior -- an effect that vanishes once the drug wears off. Such studies rarely make the headlines, however. Instead, we hear about recent research from the US -- "the MTA study" -- that relied heavily on subjective reports from teachers and parents while ignoring its own objective findings, which showed little promise for drug treatment. Reporting on this research, the media, too, has found a cure where there isn't one.
So where does the cure lie? It lies in prevention. This means getting back to basics as a culture, with parents who have and take the time to truly matter in the lives of children.
Richard DeGrandpre is the author of Ritalin Nation: Rapid-fire Culture and the Transformation of Human Consciousness (Norton, 1999), and Digitopia: The Look of the New Digital You (Random House, 2001).