Does Ritalin really add up?

NEA Today, Apr 1999 by Jardin, Robert

More than four million.schoolchildren take the prescription drug Ritalin to combat attention deficit/ hyperactivity disorder (ADHD). Dr. Lawrence Diller, a behavioral pediatrician and author of Running on Ritalin: A Physician Reflects on Children, Society, and Performance in a Pill (Bantam) discussed the ethics and effectiveness of such widespread Ritalin use with Robert Jardin of the NEA Health Information Network.

What is attention deficit/ hyperactivity disorderand how common is it?

Attention deficit/hyperactivity disorder-informally known as ADD--defies a concrete definition. There are no blood tests, brain scans, or psychological tests that definitively diagnose it. For practical purposes, a person struggling with performance or behavior problems that include high degrees of inattention, impulsivity, or hyperactivity may be said to have ADD.

Because there are no specific markers for ADD, estimates of its prevalence in the United States vary widely, from 1 to 20 percent.

How is ADD diagnosed?

Evaluating for ADD includes assessing a child's personality, intelligence profile, learning skills, emotional status, and family dynamics, to name a few.

Ultimately, the ADD diagnosis is an opinion. Some doctors diagnose ADD in virtually every child they evaluate as a way of codifying certain behavioral tendencies. Other doctors don't even believe that ADD exists.

Educators should be aware of their own biases and those of parents and doctors. For example, studies have shown that when special education teachers and general education teachers observe the same children, special ed teachers rate the students as having less intense or frequent problems with attention, impulsivity, or hyperactivity.

How does Ritalin work-and is it "the" answer?

Ritalin-the trade name for methylphenidate-is a stimulant, and it helps people focus on tasks they find difficult or boring.

A major misconception about Ritalin is that it has a paradoxical effect, calming children rather than stimulating them. This misleads parents into believing that somehow their children's brains are different from those of "normal" children. In fact, the effects of low-dose stimulants, including Ritalin, are the same on children and adults, ADD or not.

But the fact that Ritalin works for ADD children does not mean that it can be considered the moral equivalent to or replacement for better parenting and schools for American children. The best that can be said for Ritalin is that it offers symptomatic relief that may help both children and caregivers cope more effectively.

Do you prescribe Ritalin?

My role as a physician is to ease suffering. After evaluation of family and school factors, I will prescribe Ritalin to allow "round and octagonal" children to fit more easily into those square educational holes.

But my role as a citizen pushes me to alert others about the huge increase in Ritalin use in our country. Otherwise, I'd be silently "complicitous" with values and forces I believe are harmful to children and families.

Educators likewise have a duty to help a child seek a medical evaluation for ADD and Ritalin, if they think that will help. But, at the same time, they should alert families to others factors that we must all work toward changing.

What would be an ideal learning envi. ronment for ADD students?

The most successful programs have been those where the children spend time in a specialized, highly structured classroom.

Also, classrooms should be geared toward close monitoring, with more immediate and tangible rewards and consequences for behavior.

Two researchers, have developed special classrooms where behavioral techniques, such as token contingency awards. are as successful as Ritalin in improving children's performance and behavior.

But they also found that unless the regular teacher adopted some of these techniques during the ADD student's transition period back into the mainstream classroom, the gains the child made were quickly lost.

Resources

CHADD (Children with Attention Deficit Disorders) sponsors support groups and publishes two newsletters on attention disorders for parents and professionals. For more information, contact the organization at 8181 Professional PI., Suite 201, Landover, MD 20785, 301/306-7070. Or visit the Web at www.chadd.org.

The National Mental Health Association provides a variety of free materials on mental health, including a fact sheet on attention-deficit/hyperactivity disorder. For a list of materials, contact the NMHA at 1021 Prince St, Alexandria, VA 33314, 800/969-6642, TTY 800/433-5959. Or visit the Web at www.nmha.org.

The National Association of School Psychologists offers free information on promoting educationally and psychologically healthy environments for all students, including those suffering from ADD. Contact NASP at 4340 East West Hwy., Suite 402, Bethesda, MD 20814, 301/657-0270. Or visit the Web at www.naspweb.org/.