How much Ritalin is enough?

Have you, like me, ever pondered the Great Conundra of Life?

I refer, of course, not to the common ones: Which came first, the chicken or the egg? Does a bear poopie in the woods? Is the Pope truly Catholic? How many roads must a man walk down before he finally admits he is lost and asks for directions?

No, none of those. I am pondering the fact that ever-higher proportions of America's children and even adults are being diagnosed with some disorder and given some pill as a magic cure-all elixir. There's Paxil for social anxiety. There's Wellbutrin for depression, or, if that drug paradoxically make you more depressed, there's Zoloft or Prozac or Celexa.

For Attention Deficit Hyperactivity Disorder, there's Ritalin or Adderall or Strattera. Up to one in ten boys between the ages of 3 and 17 are diagnosed as having ADHD, and then there's this problem:

Recent research investigations confirm what school administrators and teachers have realized for many years: The number of kids taking psychotropic medication has increased substantially in recent years. That increase is consistent with the rising number of kids diagnosed with ADHD.

Psychotropic medications treat a variety of behavior, emotional, and mental disorders, including ADHD.
Highlights of Research on Increases in Drug Treatment for Childhood ADHD

The following are statistics detailed in the story.
*The number of preschool children being treated with medication for ADHD tripled between 1990 and 1995.

*The number of children ages 15 to 19 taking medication for ADHD has increased by 311 percent over 15 years.

*The use of medication to treat children between the ages of 5 and 14 also increased by approximately 170 percent.

*White, suburban elementary children are given medication to treat ADHD at more than twice the rate of African American students.

*Methylphenidate (commonly known as Ritalin) is manufactured at two and a half times the rate of a decade ago.

*The majority of children and adolescents who receive stimulants for ADHD do not fully meet the criteria for ADHD.

*Many children who do meet the criteria for ADHD are not being treated.

*About 80 percent of the 11 million prescriptions written for methylphenidate (Ritalin is the brand name) each year are written for children.

...The increase in the number of prescriptions doctors write for treating ADHD is staggering. According to the Congressional Testimony of Terrance Woodworth, a deputy director of the Drug Enforcement Administration, the number of prescriptions written for methylphenidate has increased by a factor of five since 1991. About 80 percent of the 11 million prescriptions doctors write for that medication each year treat childhood ADHD, he said. In addition, production of Adderall and Dexedrine, also used to treat ADHD, has risen 2,000 percent in nine years.

The increasing use of stimulant medication to treat ADHD in the United States differs significantly from practices in the rest of the world, according to United Nations data, Woodworth said. The U.S. produces and consumes about 85 percent of the world's production of methylphenidate.

The significant increase in stimulant medication prescribed to children has raised concerns that our society is choosing quick-fix remedies to treat ADHD. "How we deal with our kids' problems reflects our thinking and a much larger problem in our culture," said Lawrence H. Diller, who practices behavioral pediatrics in California and is author of Running on Ritalin: A Physician Reflects on Children, Society and Performance in a Pill (Bantam Books, 1998).

Although Diller prescribes stimulant medication for children with ADHD, he questions the large number of children currently on the medication in the United States.

The number of students I have seen on Ritalin and other psychotropic medications has definitely exploded during my teaching career. I have to wonder: is this really necessary? How many students could be treated without resort to potent medications with all kinds of side effects? In some troubling cases, Ritalin has been a substitute for giving children the attention and discipline that they need-- in a way, Ritalin can be described as a prescription for the attention deficit of the PARENTS, not the child.

I have already told you of parents I have met who have acknowledged "doctor-shopping" until they finally got a diagnosis for their children so that they could get 504s or IEPs that allow them longer time on standardized tests or the like.

While that is appalling, there's another question that is also important: when kids "act out," is Ritalin always the answer? I am NOT saying that Ritalin is unnecessary in every case. Oh no-- I have seen many students whose lives have been transformed by the use of these drugs. But I don't think the drastic increase in these prescriptions is based solely on better methods of diagnosis.

Now there's THIS interesting article:

Children from broken marriages are twice as likely to be prescribed attention-deficit drugs as children whose parents stay together, a Canadian researcher said on Monday, and she said the reasons should be investigated.

More than 6 percent of 633 children from divorced families were prescribed Ritalin, compared with 3.3 percent of children whose parents stayed together, University of Alberta professor Lisa Strohschein reported in the Canadian Medical Association Journal.

The study of more than 4,700 children started in 1994, while all the families were intact, Strohschein said. They followed the children's progress to see what happened to their families and to see what drugs were prescribed.

"It shows clearly that divorce is a risk factor for kids to be prescribed Ritalin," Strohschein said.

Other studies have shown that children of single parents are more likely to get prescribed drugs such as Ritalin. But is the problem caused by being born to a never-married mother, or some other factor?

"So the question was, 'is it possible that divorce acts a stressful life event that creates adjustment problems for children, which might increase acting out behavior, leading to a prescription for Ritalin?"' Strohschein said in a statement.

"On the other hand, there is also the very public perception that divorce is always bad for kids and so when children of divorce come to the attention of the health-care system -- possibly because parents anticipate their child must be going through adjustment problems -- doctors may be more likely to diagnose a problem and prescribe Ritalin."

Ritalin, known generically as methylphenidate, is a psychostimulant drug most commonly prescribed for the treatment of attention-deficit hyperactivity disorder in children.

There is a big debate in much of the developed world over whether it may be over-prescribed -- given to children who do not really need it. In March, a University of California, Berkeley study found that the use of drugs to treat ADHD has more than tripled worldwide since 1993.

Strohschein said it is possible that some mental health problems pre-date the divorce, so "it is possible that these kids had these problems before, but are only being identified afterward."

Her study was not designed to find out why the children were prescribed the drug.

"I might be finished with the survey, but I am not necessarily finished with the question," she said in a telephone interview.

Of course, there are many conclusions one can draw from this survey. Were the kids already having trouble, but the problem came to the fore when there is suddenly only ONE parent as caretaker? Is it that the parents' recognition of the stress of divorce makes it more likely that they will be evaluated, and the ADHD is then discovered? Is this yet another bit of guilt to heap upon the heads of divorced parents?