Focus on Ritalin, Part II
Is Ritalin Over-Prescribed?
Children do require a letter from a psychiatrist to get the prescription, but many doctors do not hesitate to give their patients a prescription for it. According to the DEA, prescriptions are up more than 600 percent. The question of whether or not it is over-prescribed adds to the controversy of this drug.
The issue of over-prescription, says Dr. Fay, is "very controversial. Studies seem to indicate that 3 to 5 percent of school-age children have ADHD; studies of Ritalin usage show that between 5 and 15 percent of school-age children are taking medication for the disorder. That would seem to indicate that it is being over-prescribed. Busy parents and physicians, coupled with an understaffed and overworked educational system, frequently make the decision to medicate a child too quickly." In other words, it's easier to medicate a child than to try various behavior modification techniques.
Elizabeth Pantley, author of Kid Cooperation and Perfect Parenting , gets the opportunity to talk candidly with many parents and professionals about many topics. "Over the years, the word 'Ritalin' pops into conversations more and more often," she says. "I've uncovered some pretty scary numbers. John Breeding, Ph.D., author of The Wildest Colts Make the Best Horses , cites an increase of 700 percent in the production of Ritalin between 1990 and 1997." Breeding believes that the number of children on Ritalin today in the United States is around 5,000,000. "Have children changed so much over the years?" asks Pantley, whose own children span more than a decade. "I don't believe they have."
Why the Increase?
Are we medicating our children as an "easy way out?" Are doctors too quick to diagnosis children with ADHD? These questions are at the hearts of many people, even those who say Ritalin was a lifesaver for their child.
Jody's son began taking Ritalin at the age of 5. "My overall opinion of Ritalin is that it is way over-prescribed as an 'answer' to what could be a normal, but highly energetic, child. Oftentimes, doctors are just too lazy to delve further into the child's past to discover why they might be exhibiting certain behaviors," says Jody.
Though Jody thinks it is prescribed too often, she still feels it was right for her son. "For those children who truly have ADD or ADHD, my opinion is that it is a Godsend -- an absolute necessity in order for them to function and concentrate."
"Most parents in my experience are quite resistant to having their children on Ritalin and do it in response to school pressure," says Dr. Lewis. "Many parents are greatly helped by sitting down with a professional who can help them with their parenting skills. These children would be a challenge for any parents and often make their parents feel like failures."
"I believe that the real issue here is that children, in vast numbers, are being misdiagnosed as having ADD/ADHD and that Ritalin has become a convenient solution to behavior issues," says Pantley. "In the A.D.D. Book , Dr. William Sears says that Attention Deficit disorder has become a 'fashionable diagnosis,' and I have certainly wondered about this as I see a wide assortment of my children's friends arrive at our home for a playdate with the day's medication on hand."
Pantley does believe that ADD and ADHD are real disorders for some children, and that Ritalin can be helpful for them. "However, by teaching even these children to rely on medication to fit into society is, I fear, sending the wrong message. We are teaching them that for the rest of their lives that they must use medication as a crutch, and basically telling them that they do not have within them the ability to handle life on their own."
What Are The Alternatives?
Could diet, environment and discipline play a roll in dealing with hard-to-handle children? "I do believe that the vast majority of children's behavioral problems can be resolved by improving on the child's diet, environment and, most of all, by implementing thoughtful, consistent and positive discipline in the home and at school," says Pantley. "In this way the child can learn how to develop self-control and self-discipline that he can rely on for the rest of his life."
When Ritalin made Joyce's son act like a "zombie," she and her husband started searching for alternatives. They discovered that excess sugar could cause some behavior problems.
"We knew that Stephen consumed lots of soda and candy," says Joyce. "Whenever we'd move the couch to clean, there would be dozens and dozens of candy wrappers and soda cans. I remember once at a football game Stephen was in a relatively calm mood, but then after he drank a soda, he became extremely hyper." Joyce put her whole family on a low-sugar, low-fat diet to try to help her son. "Of all the attempted cures, this one seemed to work the best."
Jenny Lewis believes a careful assessment of the school and class environment should be made before putting a child on any medication. She also encourages counseling for the child and the family. "Even when Ritalin is used, it should never be used without educational intervention and counseling alongside," she says.
Dr. Fay believes other alternatives can be tried, but feels a child with ADHD will also need medication. "There are some behavioral techniques which can be tried, but in a child who truly has ADHD, they are unlikely to be effective without medication. Such things as a structured environment, clear but obtainable goals, and positive reinforcement can help. There are other medications -- Dextramphetamine, Pemoline (Cylert), Clonidine (Catapres), and the tricyclic antidepressants -- which are effective, but none are as safe as Ritalin."
New Age Treatment?
Didier Combatalade, Research Manager at Thought Technology Ltd., believes that EEG biofeedback, sometimes called neurofeedback, is a viable alternative to Ritalin. "EEG biofeedback, by monitoring and feeding back brainwave activity, offers the child a controllable handle over his/her ability to pay attention," says Combatalade.
The child is treated in a series of "training sessions." During these sessions the child is taught to produce a specific type of brainwave frequency -- the frequency that is associated with paying attention. "There is actually no clinical intervention, per se," says Combatalade. "The child is simply placed in an environment where his/her own system can teach itself how to produce the proper behavior. Audio or visual feedback provides an immediate indication of success and learning occurs naturally."
Combatalade compares EEG biofeedback to riding a bike. "Once you know, it's difficult to forget! Actually there might be a need for an occasional remedial session after the treatment period is over, but a lot of kids just get it the first time and keep on going!"
Biofeedback has no known adverse side effects. In a worst-case scenario, the treatment is simply not effective. "Occasionally, there are cases where biofeedback does not work. Since biofeedback is a tool for teaching self-regulation, some people just never manage to get control over the handle, so they never learn."
Before the treatment, parents are given an idea of how many sessions will be required for improvement to be noticed. The parent should then decide whether it is financially viable for them to continue with this type of treatment. "The clinician will know when to stop from the fact that there is not improvement," says Combatalade.
Dr. William Sears reminds us that many famous people had ADD: Thomas Edison, Winston Churchill and Mozart. What would our world today be without the creativity of these people? "In some ways, parenting the child with ADD is like being a gardener," says Dr. Sears. "You can't change the color of the flower or the time of the year it blooms, yet you can prune the plants and pick the weeds to help the flower blossom more beautifully."
Remember, while Ritalin may be the right answer for one child, it may be the wrong choice for another. Parents should explore every option before agreeing to any treatment.