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The Ritalin Debate

Understanding When To Treat ADHD With Medication

It's a common scenario for children all over the country: starting the day with a dose of Ritalin or a similar drug. In the year 2000, about 20 million prescriptions were written for drugs like Ritalin, even though it's estimated that only about four million children suffer from attention deficit hyperactivity disorder, or ADHD. This discrepancy has resulted in a closer look at the diagnoses of ADHD, Ritalin as a solution to the problem and the process used in prescribing psychiatric drugs to children.

The Medication Backlash

During the early 1990s, various factors combined to cause a precipitous increase in the use of drugs such as Ritalin to treat ADHD. While too numerous for the purposes of this article, there's no doubt that the increase was there and was causing great concern in a variety of quarters.

In 1996 and 1997, the United Nations' International Narcotics Control Board issued warnings about the dramatically increasing use of methylphenidate (primarily Ritalin), in the Unites States. The board cited concerns about the possibility of over-diagnosis of ADHD, consequent overuse of the drug and the potential for abuse. This report resulted in a serious backlash against the use of psychotropic drugs to treat children.

When Michael Weathers was in third grade, his mother, Patricia, was charged with neglect, and a caseworker from the local child welfare office showed up at her door with authorization to take Michael from her. Weathers' "crime" was her refusal to continue medicating her son. Michael had been on Ritalin and other psychiatric drugs since he was 6 years old. Increasingly alarmed by the disturbing side effects, she had informed Michael's school that she was going to explore alternative treatments. The school's response was to terminate Michael's enrollment and report Weathers to child welfare.

It is this type of action that has sparked the parental activist movement against Ritalin and other psychotropic drugs. In addition, a number of children whose parents were coerced into giving their children psychotropic drugs have died as a result.

In 1999, an article published in the International Journal of Risk & Safety in Medicine by Dr. Peter Breggin, author of Reclaiming Our Children: A Healing Solution for a Nation in Crisis (Perseus Publishing, 2001), referred to a number of disturbing reports filed over a 12-year period with the FDA's Spontaneous Reporting System. Of the 121 cardiovascular problems associated with Ritalin use, there were nine cardiac arrests and four heart failures in addition to numerous lesser, but still serious, problems.

Weathers is in the forefront of the anti-drug movement. She has testified about her experiences before Congress and has appeared on a variety of national television shows. She is also a co-founder of the National Coalition of Parents for Label and Drug Free Education.

"I believe families throughout this country need protection," says Weathers. "They need factual information about ADHD and the effects and side effects of the drugs used to treat it. No parent should be pressured into medicating their child by a school system as I was."

Efforts of Weathers and like-minded people have born fruit. Currently, nearly every state has passed legislation protecting children and their parents from being coerced into administering psychotropic medication in order to attend school.

Finding Solutions

While there's well-documented evidence that drugs such as Ritalin and other stimulant medications do control the symptoms associated with ADHD, there's also a growing body of evidence that it has been over-prescribed and that the diagnoses of ADHD relies too much on the observations of teachers and not enough on thorough physical and psychological examinations.

In addition, there are alternatives to drug therapy that are very effective in treating children with ADHD, but do not give the immediate results that Ritalin does and so are often balked at by school officials.

One popular program, which Weathers took her son to, is operated by Dr. Mary Ann Block, founder of The Block Center and author of No More Ritalin: Treating ADHD Without Drugs (Kensington Pub Corp., 1996). Although she takes the radical view that ADHD is not a "real" disorder, a point that is constantly debated on both sides of the ADHD camp, she also is a good example of why a thorough physical evaluation is important prior to the diagnosis of ADHD.

"There are often underlying causes that can cause the same types of symptoms as those seen with ADHD," says Dr. Block. "I have often seen these symptoms resolved after treating the health issues, whether it's undiagnosed allergies, nutritional deficiencies, low blood sugar, other chronic health problems or even learning differences."

Dr. Block's attention to what she calls "learning differences" is one that is receiving an increased amount of attention from unbiased researchers. The idea is that some children merely learn differently and use acting out behaviors when their unique learning needs are not addressed. It's the same principle that is shaping research into learning disorders such as dyslexia, and it's a legitimate concern.

However, the idea that Ritalin and similar drugs should never be used to treat a child with ADHD symptoms is probably not legitimate simply because there are many children who have been helped by medication.

The Other Side of the Story

Teressa Colclasure, of Orangevale, Calif., tried everything to control her son's impulsive, destructive behavior. By age 5, Trystan had been kicked out of daycare and was nearly kicked out of preschool as well because of his poor impulse control and inability to sit still for even a moment. She says that in November of 2001, she was "strong-armed" into putting him on Ritalin by the principal of Trystan's school when the boy was in kindergarten. And, at first, her fears seemed to be justified because Trystan seemed so doped up. However, once his dose was adjusted, it was as if a miracle had occurred.

"For the first time in five years Trystan would sit and let me read a whole book to him," says Colclasure. "I could take him out and he would stay with me and not run off. He could complete a thought without babbling off on some other topic and sit in class and actually learn. He was not going to the office every day or getting sent home or suspended. He went from November to May without getting sent to the office one time; before that, he was sent up every day. He even came to me after being on Ritalin for a month or so and told me he was learning in school and he finally understood the things the teacher was telling him. This all helped me to be OK with Ritalin."

According to the National Institutes of Health, current medical opinion acknowledges that ADHD is a very real condition with long-term adverse effects on academic performance, vocational success and social-emotional development. However, the controversy over what it is, whether it can be reliably diagnosed, and, if treated, what interventions are the most effective, continues to rage. At this point, there are no clear answers, but it is clear that no parent should be forced to give their child psychotropic drugs against their will. On the other hand, stories like Trystan Colclasure's make it impossible to rule out Ritalin as a partner in a successful course of treatment.

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