-Books: No More Ritalin: Treating ADHD Without Drugs, by Mary
Ann Block, D.O.
-books-"Natural Treatment for ADD and Hyperactivity" by Dr. Skye Weintraub, N.D.
-"Driven to distraction" by ed Hollowell, MD. good book from what one friend told me. 12/99
I have just joined your list and am looking forward to being
part of your group.
I am 34 years old, have suffered with ADHD all of my life,
as have my father and grandfather. My father is on Ritalin,
but for the past two years I have been treating mine naturally,
primarily through a low carb, high protien, no sugar or wheat,
all natural diet, but I have also been using an ephedra/caffiene
combination as this acts like natural Ritalin for me. I would not
recommend this to others as different people have different
reactions to ephedra and I have recently learned that continued
use of ephedra may burn out my adrenal glands (I've been on it
two years already), so I am looking for natural alternatives. I
have recently ordered and am waiting for a delivery of DMAE,
Magnesium and Grapeseed Extract as I have read much about
thier positive effect on ADHD.
I would be very interested in this Restores product that your
intro mentions. I already take Evening Primrose Oil, Flaxseed
and an essential oils blend and various other vitamins, but if they
were all combined into one formula it would be great. Please tell
me more about the ingredients and amounts and let me know what
it costs and what the normal adult dosage would be.
I am doing so much better since changing my diet to low carb,
no sugar (even lost 42 pounds and am keeping it off effortlessly).
My increased focus and calmness has enabled me to take on a
challenging and rewarding job a year ago as well as pursue several
home based businesses in creative areas that I have always been
passionate about. While I have come a long ways, I am still very
disorganized, especially with paperwork (my desk at home is a
nightmare, never mind my bookkeeping!) and it frustrates me. I
have so much talent and creativity (I am very musical (guitar, voice,
saxophone, songwriting) make jewellery and paint) and could
do so much with it if I could get more on top of things (the usual
ADHD situation). So any info you could give me on products or
things that can help me would be most appreciate
The Healing Connection
91 McGill Avenue
Concord, NC 28025
Owner: Liz Singing Butterfly , Herbalist
The Hypnosis Center
129 S. Long Street
Salisbury, NC 28144
Tom Hartman, A.C.H., R. H./ Owner
Also, there would possibly be someone through Simply Good / Health Food
Store in Salisbury that could help too.
There is also a Doctor in Kannapolis: Dr. Castiglia
, he does not
recommend medication, but uses alternative methods and diet. He is an
Why are millions of children taking a drug that looks like,
acts like and is abused like an amphetamine?
By MARY EBERSTADT
With the number of children enrolled in the nation's
elementary schools hitting record levels this fall, parents
can expect to see something else: more kids taking Ritalin, a
drug so similar to cocaine ``it takes a chemist to tell the
difference,'' as one journalist summarized the science.
Ritalin, consumed by more than 3 million American children
diagnosed with attention deficit disorder, is probably the
most widely misunderstood drug in America. Many people
believe that methylphenidate, to use Ritalin's generic name,
is a sedative. Others believe it is a mild stimulant that helps
distractible and hyperactive children. Both
characterizations are wrong.
``Methylphenidate is a central nervous system stimulant and
shares many of the pharmacological effects of amphetamine,
methamphetamine and cocaine,'' according to a 1995 Drug
Enforcement Administration background paper.
It ``produces behavioral, psychological, subjective and
reinforcing effects similar to those of d-amphetamine,
including increases in rating of euphoria, drug liking and
activity, and decreases in sedation.''
That same DEA report includes a table listing the potential
adverse physiological effects of both methylphenidate and
the stimulant dextroamphetamine; they are nearly identical.
And Richard DeGrandpre, in his new book ``Ritalin Nation,''
quotes a 1995 report in the Archives of General Psychiatry:
``Cocaine, which is one of the most reinforcing and addicting
of the abused drugs, has pharmacological actions that are
very similar to those of methylphenidate, which is now the
most commonly prescribed psychotropic medicine for
children in the U.S.''
Ritalin ``works'' on children in the same way that related
stimulants work on adults -- sharpening the short-term
attention span when the drug kicks in and producing
equally predictable valleys when the effect wears off. Just as
predictably, children suffer the same adverse effects as
adults who imbibe such drugs, with the two most common --
appetite suppression and insomnia -- being of particular
So why are millions of children taking a drug that looks like
an amphetamine, acts like an amphetamine and is abused like
an amphetamine? Partly because of the protean nature of
ADD itself, which ``has gone through at least 25 different
name changes in the past century,'' writes Thomas
Armstrong in his book ``The Myth of the ADD Child.''
The question of what ADD really is remains passionately
disputed. Research on the neurological side of ADD has
become a quest for something, anything, that can be said to
set the ADD brain apart -- genes, imbalances of brain
chemicals like dopamine and serotonin, neurological damage,
lead poisoning, thyroid problems and more.
The most famous study was reported in The New England
Journal of Medicine in 1990. Researchers used positron
emission tomography to measure differences in glucose
metabolism between hyperactive adults and a control group.
What emerged was a statistically significant difference in
the rates of glucose metabolism, a difference hailed by many
observers as the first medical ``proof'' of a biological basis
for ADD. The study has long been controversial, however --
not least because a series of follow-up studies failed to
confirm the original result.
ADD remains an elusive disorder. The diagnosis still depends
almost exclusively on behavioral criteria. The criteria for
children, according to the latest Diagnostic and Statistics
Manual, include six or more months' worth of some 14
activities such as fidgeting, squirming, distraction by
extraneous stimuli, difficulty waiting turns, blurting out
answers, losing things, interrupting and ignoring adults.
Some children, of course, have problems so severe that drugs
like Ritalin are a godsend. But that has little to do with the
most obvious reason millions of American children are
taking Ritalin: compliance. One day at a time, the drug
continues to make children do what their parents and
teachers either will not or cannot get them to do without it:
Sit down, shut up, keep still, pay attention. In short, Ritalin
is a cure for childhood.
Mary Eberstadt is consulting editor to Policy Review, the
journal of The Heritage Foundation, 214 Massachusetts Ave.
NE, Washington, DC 20002.
What if Albert Einstein had been on Ritalin?
by Eric Plasker, D.C.
Did you know that Albert Einstein, one of the greatest geniuses
of the last
century, did not speak until he was four years-old and didn't read until he
was seven? His teacher described him as "mentally slow, unsociable and
adrift in his foolish dreams." He was expelled and refused admittance to
the Zurich Polytech Institute.
Today, he would have been put on Ritalin.
Thomas Edison's teachers said he was too stupid to learn anything.
Newton did very poorly in grade school. Opera singer Enrico Caruso's
teacher said he had no voice at all and could not sing. Winston Churchill
failed sixth grade. Beethoven handled the violin awkwardly and preferred
playing his own compositions. His teacher called him hopeless as a
composer. Would these geniuses have been Ritalin candidates also?
What are we doing to our children? How did we allow our country
jokingly referred to as the "Ritalin capital" of the world?
Ritalin is a very dangerous and highly addictive drug. Under Federal
it is classified as a "schedule II controlled substance," the same rating
given to cocaine, opium and morphine. Withdrawal symptoms can be severe and
include depression, fatigue, paranoia, increased dreaming, irritability,
bedwetting and suicide.
At my "Chiropractic Mother's Morning Out" program on The Ritalin
Controversy, one of the mothers stood up and told her son's story. He had
tried Ritalin for a very short time and hated the way it made him feel, so
he stopped taking it on his own (hurray for him!). What's scary is that
seven years later, he still suffers from the side effects -- including
Can you really try it just once? Think long and hard about the
Ritalin's side effects are numerous and severe. According to the
"Diagnostic and Statistical Manual Of Mental Disorders," the side effects
include stunting of growth, depression, insomnia, nervousness, skin rash,
anorexia, nausea, dizziness, headaches, abdominal pain, blood pressure and
pulse changes, and Tourette's Syndrome (a permanent and irreversible
condition characterized by body ticks, spasms, screaming obscenities, and
The physiological changes that cause these side effects are occurring
whether there is an outward manifestation of symptoms or not. This is
How far will we go to control, mold, and conform our children
made up normal? Are we turning our geniuses of tomorrow into drug addicts?
According to a Canadian report, Ritalin is responsible for more
crime than any other drug. Kids are selling their Ritalin to other kids. A
USA Today report indicated that some kids crush Ritalin into a powder and
snort it like cocaine, while others cook it and inject it into their
"My child wouldn't do that," you might say. How do you know? This
highly addictive drug we are talking about here. Remember the 15 year-old
who is still suffering from withdrawal seven years later. He no longer owns
his life and his consciousness. He now has a lifelong battle for his will.
Well known criminal defense attorney Melvin Nash, from Marietta,
who receives chiropractic wellness care with his family, indicated that
approximately 60% of the people he defends for everything from DUI to armed
robbery have been on Ritalin at some point in their lives. He stated: "I
would home school my kids before I put them on Ritalin!" That's a powerful
The United States is number one in Ritalin consumption in the
far. How did we let this happen? Have we bought into the multimillion
dollar marketing strategies of the drug manufacturer? You decide.
One person who just started teaching in a middle school was asked
if a lot
of her kids were on Ritalin. Her reply: "Yes, but not enough." This gives
me a pain in my heart.
Another person was discussing her friends who became parents late
They said they couldn't deal with their son because they had forgotten what
it was like to be a child. Their child is on Ritalin. I cry for him.
It has always puzzled me why in some schools up to 50% of the
kids are on
Ritalin and in other schools very close by, only five percent are on the
drug. This variation can be seen from class to class as well. How do we let
Where is the responsibility going that we entrust our child's
mind to a
highly addictive and dangerous drug such as Ritalin? What price are we
willing to pay to maintain our high tech lifestyles and busy schedules or
to have our kids be "perfect"?
What if Albert Einstein had been on Ritalin?
There is a genius in all of us that is just trying to get out.
all the ideas, talent, strength and creativity we keep stored inside
because we worry about what other people would say or think. They would put
us down, call us unruly and tell us to grow up. They would put us on
Ritalin to get us to conform to the norm that is mediocrity and maintain
our drug dependent world.
As a chiropractor, I get to experience this genius every day in
I see the healing and regenerative powers of the human body and spirit at
work every day. People who were on drugs get off them. So-called "hyper"
children calm down and parents who are hypoactive get increased energy. I
have seen people's own bodies begin to work correctly because of
chiropractic and heal themselves from just about every malady you can name.
I have also seen what the continuous expression of this genius
in families that under chiropractic wellness care. Wellness care keeps the
expression of this genius uninterferred with so people can express all of
their genetic potential on a moment-to-moment basis, every minute they're
All children, especially the ones who aren't "perfect" or "normal"
their senses clear. They need their adaptation capacity at 100%. They need
their nerve system free from interference. Do they really need artificial
stimulation or sedation?
Could you imagine if Helen Keller had been on Ritalin? Would it
her the best opportunity to thrive in the world and express her innate
potential? I doubt it. We would have been robbed of a wonderful gift.
Is Ritalin the drug industry's version of a Joe Camel cigarette
Is Ritalin the drug companies' insurance policy to big business down the
road? Is it any wonder our country can spend close to $80 million a year on
drug abuse awareness and the problem continues to get worse?
Please parents, open up and take these insights to heart. I am
a parent and
I know that all parents make the best decisions they are capable of for
their children, given the knowledge they had at the time of their decision.
You now have more knowledge. Let's take a stand for our next generation.
American Psychiatric Association (1987). "Diagnostic and Statistical
of Mental Disorders" (3rd ed. Revised). Washington, D.C.: Author.
Citizens Commission on Human Rights (1993). "Psychiatric
Multibillion-Dollar Fraud A Common Sense Appraisal of Psychiatry and Your
Tax Dollars," Los Angeles.
Medical Economics Co. Inc., (1985). "Physicians Desk Reference,"
Roane, Marilyn Miller (March 7, 1988). "Rx Drug Abused Targeted,"
Beacon Journal, Akron, Ohio.
Whyte, K.; Gallagher, Tim; Koch, George; Powell, David; Cole,
Caimey, Richard; Lequine, Stephen; West, Laurie. (Feb. 2, 1987). "A
Prescribed Urban Nightmare" Western Report.
Seventeen magazine, February 1996, "Ritalin Alert."
Newsweek magazine, March 18, 1996, "Mothers Little Helper."
(Eric Plasker, D.C. practices in Marietta, Georgia. To discuss
raised in this month's "Viewpoint" column about Ritalin, or to obtain
information about Dr. Plasker's "Chiropractic Mothers Morning Out"
programs, call him at 770-509-3400.)
By MARILYN CHASE
Last Halloween, a San Francisco first-grader with behavior problems in
school began to suffer night terrors. Eight months of insomnia later, his
parents turned to an unconventional but increasingly popular therapy
-- "sensory integration."
Restless and bright, seven-year-old Henry Matarozzi could never sit
still. In kindergarten, he knocked down other kids' blocks and launched
objects from the classroom loft. Now that he's in second grade, he
shouts answers in class and runs down the hall, bowling over
classmates. His intellect has never been in doubt: Henry relishes word
play and religious discussion (he erected a Buddhist shrine in his
bedroom at age four). But his behavior was disrupting his school life,
and the sleepless nights had to be treated.
Henry underwent a battery of neuropsychiatric assessments: hearing
discrimination, visual perception and IQ tests. "They kept sending us
away. He would test so high," says his mother, Sharon Hawley. In June,
she turned to San Francisco occupational therapists Alanna Freeman
and Kristi Harris to calm and focus his senses.
Certain children, the theory goes, have problems registering and
interpreting the sensory information -- tactile, auditory and visual -- that
bombards them. This, in turn, disrupts their ability to plan and execute
appropriate responses. Kids can appear clumsy or impulsive, zippy or
indolent, hypersensitive or insensitive to social cues. Hypersensitive
youngsters develop "sensory defensiveness," in which a shirt tag or
wrinkled sock become intolerable irritants, and everyday playground
encounters provoke a "fight, fright or flight" response.
The concept of sensory integration was pioneered in the 1960s by
occupational therapist A. Jean Ayers. Used to treat autism and
pervasive developmental disorders, it's being extended to milder
learning disabilities and sensorimotor problems faced by
At the moment, the therapy's popularity is
outpacing hard data proving that it works. So
far the evidence of efficacy comes mostly
from single-case studies and clinical
anecdotes, says Marjory Becker-Lewin, an
occupational therapist in Manhattan who
uses the approach. "We'd all like to see
more comprehensive research -- large
double-blind studies." Meanwhile,
practitioners in San Francisco and New York
report waiting lists.
The actual treatment involves sensory
stimulation programs, exercises and play-like
therapy designed to calm nerves, modulate
sensory input and help kids coordinate
appropriate responses to a noisy and chaotic world. Occupational
therapists mix and match treatments to the needs of each child.
In Henry's case, therapy includes firm brushing of his arms and legs
with soft plastic brushes that resemble those used by surgeons to
scrub. Brushing followed by joint compression was performed every two
hours by his parents at the beginning, though that has tapered off
somewhat. Named the "Wilbarger protocol" after its developer,
occupational therapist Pat Wilbarger, the treatment is believed to
stimulate nerve fibers, release soothing neurochemicals and quell
overreactions to normal touch. It's a subtle, firm-touch technique that
parents shouldn't try without professional guidance.
Henry's regimen also includes exertion: vigorous games of basketball
to hone his motor skills, a trampoline in his room for jumping and a
large ball on which he reclines. He also does what his mom calls "heavy
work," which includes wearing a weighted vest and chewing on gum.
"His body craves the pressure," she says.
The third ingredient is "listening therapy," or music that's filtered --
with the base tones muted -- so that Henry must reach to hear the
different pitches, focusing on the input from his ears to his brain.
The treatment seems to work for Henry. "We started doing brushing
therapy, and on the very first night he slept better. The night terrors
stopped," Ms. Hawley says. His reading skills have also improved,
along with his self-esteem. The downside: Henry doesn't like the
brushing. In particular, he frets about classmates' reaction when his
parents come to school once a day to provide the treatment. But when
the parents back off, his progress slips.
Help also comes from a psychotherapist, a tutor and the
antidepressant Paxil. Many such kids get combination therapy.
Nonetheless, Ms. Hawley says, "if we could choose one thing, we would
choose occupational therapy."
Such testimonials are fueling demand for treatment. Other parents
swear it quells biting and compulsive behavior. The appeal of a benign,
noninvasive, touch therapy speaks to parental concerns about overuse
of the stimulant Ritalin for attention deficit hyperactivity disorder.
Proponents also argue that sensory integration is in step with findings
about the neurobiologic basis of behavior.
Ms. Freeman says sensory integration may help some kids avoid
medication, but she avoids calling it a drug substitute. "I'm not ruling
out drugs," she says. "I like to try this first."
The American Occupational Therapy Association in Bethesda, Md.,
says it doesn't endorse this or any other single approach. But enough
members use it that the association maintains a special interest group
on sensory integration.
Pediatric psychotherapist Annette Hess of Kaiser Medical Center in
San Francisco has seen patients thrive on the therapy. "What is it
that's helpful here?" she asks. "Is it the interaction with the parent, the
actual brushing, the relationship with the occupational therapist, the
order and predictability of the ritual, or all of them combined?"
Ms. Hess says she doesn't know. But relieved parents, she says, "don't
Parents who want to know more about sensory integration may want to
consult the book "The Out-of-Sync Child," by Carol Stock Kranowitz, or
a pamphlet available through occupational therapists, titled:
"SenseAbilities, Understanding Sensory Integration," by Maryann Colby
Trott, Marci. K. Lauren and Susan L. Windeck.
Resolution to Ban Ritalin
Text of a Presentation given
by Patti Johnson
Colorado State Board of Education
in October, 1999
SPECIAL NOTE: The following is the text of a paper
presented by Ms. Patti Johnson, a member of the Colorado State Board of
Education. In this paper, she is attempting to pursuade her fellow members
the Colorado Board of Education and others in attendance that Ritalin and
other medications are to blame for the problems faced by schools in the
1990's. Copies of this article were distributed at that meeting. Ms.
Johnson's text follows these remarks with no additional annotation or
comments. After reading this, you may also be interested in reading the
Annotated Version with Commentary by Bob Seay.
Similar papers have been presented to State and
Local School Boards across the United States in an effort to persuade
of various agendas.
ADD on About.com appreciates those of you who help
to keep us informed. If you have news, send an email so we can spread the
Here is the text of Ms. Johnson's paper:
The Ritalin phenomenon caught my attention in 1994.
As I walked with some children in a parade, one six-year-old boy intrigued
me. He was precocious, energetic and a delightful companion. When I dropped
him off at his home, I mentioned these traits to his mother. She startled me
when she replied, Thats not what his teacher says. She told me he has
ADHD (Attention Deficit Hyperactivity Disorder) and needs to be put on
Ritalin. I urged the mother to have her son tested before drugging him. He
was so bright, and his level of energy seemed normal for a little boy. What
if he just needed a more challenging curriculum or a different learning
environment? Now that I know much more about Ritalin, I feel even more
strongly that all options should be explored before resorting to Ritalin.
In 1991, the Federal Education Department said
schools could get hundreds of dollars in special education grant money each
year for every child diagnosed with ADHD. Since then ADHD diagnosis shot up
an average of 21% a year. Ritalin production has increased 700% since 1990.
These data suggest a link between money and Ritali
n use. According to the Drug Enforcement Administration (DEA), the U.S. buys
and uses 90% of the worlds supply of Ritalin. Approximately 4 million U.S.
children are on Ritalin. 10 to 12% of U.S. boys are being treated with
Ritalin. No other nation is following our example. In fact, Sweden banned
methylphenidate (Ritalin) in 1968 after reports of widespread abuse.
Ritalin is highly sought after by the drug-abusing
population. According to Drug Abuse Warn Net (DAWN) it represents the
greatest increase in drugs associated with abuse, and the highest number of
suicides and emergency room admissions. Ritalin is classified as a schedule
II, or most addictive drug, on par with cocaine, morphine, PCP and
metamphetamines. The DEA has noted serious complications associated with
Ritalin, including suicide, psychotic episodes and violent behavior.
According to Washington Times [Insight magazine], the common link in the
recent phenomenon of high school shootings may be psychotropic drugs like
Ritalin. The International Journal of Addictions lists over 100 adverse
reactions to Ritalin-paranoid psychosis, terror and paranoid delusions among
them. Ritalin can have other serious side effects including disorientation
the central nervous system. It is an amphetamine, capable of inducing sudden
cardiac arrest and death. Twelve year old Stephanie Hall of Canton, Ohio
the day after her Ritalin dose was increased.
The medical community has expressed alarm over the
widespread use of psychotropic drugs for children. Dr. Fred Baughman Jr.,
pediatric neurologist, said of psychiatrists, They have proven several times
over that chronic Ritalin/amphetamine exposure they advocate for millions of
children causes brain atrophy (shrinkage). The National Institute of Health
(NIH) reported, We do not have an independent valid test for ADHD, and there
are no data to indicate that ADHD is due to brain malfunction. Further
research to establish the validity of the disorder continues to be a
problem. The NIH also reported that Ritalin and other stimulant drugs result
in little improvement in academic or social skills, and they recommend
research into alternatives such as change in diet or biofeedback.
If we care about childrens health, we owe it to
them to explore healthful ways to improve their classroom performance and
deportment. I would start with an observation: In the 1950s we did not have
millions of children unable to concentrate in the classroom. What has
changed? First, the classroom climate. The traditional classroom was
to be a quiet, well-ordered environment. Desks were arranged so that all
students could make eye contact with the teacher, see the demonstrations and
read instructions. Students were not permitted to distract or disrupt
The teacher was presumed to know more than the children, and so gave direct,
whole group instruction, guiding students step by step in learning new
skills, modeling standard English grammar and syntax in the process. Time
spent learning disciplines of cursive writing by practicing ovals and push
pulls. Subjects were taught separately. Elementary students had a short
recess in the morning, a half-hour recess after lunch and a short recess in
Progressive educators undermined this approach and
gave us the open classroom in the 1960s. Yet, structure makes so much sense.
When adults are faced with tasks such as balancing the checkbook or figuring
our income tax, we tend to seek out quiet place where we can hear ourselves
think. Children are more sensitive to stimuli than adults, more easily
distracted. Insisting that they become self-directed learners, fending for
themselves in a noisy, chaotic, confusing, classroom can do them a
Therapists have had success with children diagnosed
as ADHD by providing a calm, soothing, structured environment. Scientists
finding that the discipline of cursive writing develops part of the brain
associated with self-control. Recent test scores, common sense, and science
seem to lead us toward the conclusion: Traditional classroom instruction and
age appropriate recess time is very effective. It is hard to tell todays
process classroom from yesterdays recess. Desks are arranged in groups.
Students cannot see the teacher and distract one another. The failed Whole
Language method has replaced phonics. Students are passed on to the next
grade whether or not they have learned to read. Children spend their time
ambling around the room, chatting with classmates, playing computer games,
and even lying on the floor. Discipline is sometimes lax and supervision is
casual. Subjects are combined into long blocks of time. Some schools have
abolished recess altogether.
Many of those children go home to empty houses
they play more video games, surf the Internet, and snack on
chemically-altered, heavily-sugared, artificially- flavored junk food.
Wouldnt it make sense to provide more attention, more supervision, more
exercise, and more nutritious foods before prescribing potentially harmful
psychotropic drugs to render children compliant? Could attention deficit
disorder really mean that children suffer from a deficit of attention as
as displaying it?
This brings to mind another change since the 1950s.
According to film critic Michael Medved, in the 1950s the TV camera lingered
on one scene an average of 45 seconds, whereas in the 1990s the average is a
maximum of 5 seconds per scene. Children come to school after having watched
thousands of hours of flashing cartoons and shows that jump from one scene
the next. We could reasonably conclude that television has contributed to
shortening or disrupting childrens attention span. If their television
viewing were limited would they be more receptive to classroom instruction?
Recently I listened to a frustrated mother complain
on a radio talk show that her 18-month-old had too much energy. She
why she felt she had to drug him. He was wearing her out. At 18 months he
climbing straight up the bookcase.
Could some cases just be a matter of perspective on
what is normal behavior? One frustrated mothers hyperactive child may be
another mothers proud future Olympic gymnast.
It is not my intention to judge parents,
and doctors, or to dismiss the genuinely hard cases. My only motivation is
provide information that could help schools and parents make sound decisions
about the health and welfare of their children.
Colorado State Board of Education, 2nd
Broomfield, Colorado 80020
It suggests that abuse of Ritalin - a drug that thousands of students take to help them concentrate in school - is far more common than has been believed. "This is probably an underreporting. It's a conservative figure," Marshfield psychologist Frederick Theye said of the 16 percent who said they had been pressured to part with the drug. "We had several of them say to us spontaneously, 'I was asked to sell or give this to my classmates.' That was our first warning that this (abuse) was out there."
The study also found lax security for storing Ritalin and other medications in many schools. Policies ranged from keeping Ritalin under lock and key to allowing students to carry it around in their pockets and take it as needed. "What we're saying to (schools) is: 'Heads up. This is a potential area for concern, and you ought to be proactive rather than reactive,'" They said. The study involved 53 rural and small-town schools in Wisconsin that collectively enroll 15,800 students. Of those, 161 students who have been treated for attention deficit/hyperactivity disorder at the Marshfield Clinic for at least five years were surveyed and included in the study. Results were published in the medical journal Developmental and Behavioral Pediatrics
"We lived with it," says Tim, of his daughter's behavior--the tantrums, the hitting, covering herself in Vaseline head to toe, day after day. He and his wife Charlene took parenting classes through their church and tried to be fair and firm. "We thought maybe she was just strong willed," Charlene said. By the time they put four-year-old Erin in preschool near their home in a town south of Los Angeles, "she couldn't keep her hands to herself," Charlene says. "She would hit other kids. And she would hug anyone at any time. She would hold hands when other kids didn't want to. She would do pesky, bothersome things to kids, like touching their hair or their sweaters. It was as if, since she couldn't make friends, she was saying, 'I'm going to get you to relate to me.'" In class she was not able to stay focused, even though the teacher-to-student ratio was 1 to 3. Is there a parent in America who has heard the talk or read the best sellers about attention-deficit/hyperactivity disorder (ADHD) and the drugs used to treat it without wondering about his or her child--the first time he climbs onto the school bus still wearing his pj's or loses his fifth pair of mittens or finds 400 ways to sit in a chair?
The debate goes straight to the heart of our expectations and values. How dreamy is too dreamy? Where is the line between an energetic child and a hyperactive one, between a spirited, risk-taking kid and an alarmingly impulsive one, between flexibility and distractibility? What if a little pill makes everything a bit easier, not just for severely impaired kids but for those who teachers say are a little too spacey or jumpy or hard to settle down? Is there something wrong with the kids--or is there something wrong with us? For years Ritalin has been a godsend for children who were so hot-wired they were simply unreachable, and unteachable. In severe cases, the benefits of Ritalin (and the family of related drugs) on these children's ability to function and learn and cope are so direct that advocates say withholding the pills is a form of neglect. "I used to take her fingers from her face and tell her, 'This is Mom. This is Planet Earth. This is today, and you need to brush your teeth,'" recalls Natasha Kern, a Portland, Ore., literary agent who identified her daughter Athena's troubles early on. These are the kids who get expelled from nursery school for disrupting every story circle and demolishing every Lego tower. Parents despair at seeing their children sad or lost or cast out; they hate themselves when they lose their tempers after the sixth meltdown of the day. These kids can be very bright, very charming--and impossible to live with.
"They think of things that are fun and creative at the rate of about 10 per second," says Kern. "While you are trying to put out the fire they set toasting marshmallows on the stove, they are in the bathtub trying to see if goldfish will survive in hot water." But it is not the severe cases so much as the borderline ones--the children who occupy that gray area between clear dysfunction and normal unruliness--who raise the tough ethical issues, both public and private.
The pace at which Ritalin use has been growing has alarmed critics for a while now. Some doctors find themselves battling anxious parents who, worried that their child will daydream his future away, demand the drug, and if refused, go off to find a more cooperative physician. Some parents feel pressured to medicate their child just so that his behavior will conform a bit more to other children's, even if they are quite content with their child's conduct--quirks, tantrums and all.
LONG DAY'S JOURNEY: For years Phylicia's mother resisted having her daughter evaluated, despite her disruptive behavior. "I thought it was a matter of patience. She needed more structure and she would grow out of it," says Weta Payne. But eventually Weta saw that she needed help and got professional advice. Phylicia went on Ritalin and tried behavior modification. Although parents are advised to tell their children's school about any special needs, Phylicia's mother kept her teachers in the dark--for fear of being stigmatized. "I didn't want her to be labeled that she needs medication," says Weta Many doctors won't discuss the matter publicly because the issues are so hot.
Production of Ritalin has increased more than sevenfold in the past eight years, and 90% of it is consumed in the U.S. Such figures invite the charge that school districts, insurance companies and overstressed families are turning to medication as a quick fix for complicated problems that might be better addressed by smaller classes, psychotherapy or family counseling, or basic changes in the hectic environment that so many American children face every day. And the growing availability of the drug raises the fear of abuse: more teenagers try Ritalin by grinding it up and snorting it for $5 a pill than get it by prescription. "Let's not deny Ritalin works," says J. Zink, Ph.D., a Manhattan Beach, Calif., family therapist who has written several books on raising children and who lectures extensively around the country. "But why does it work, and what are the consequences of overprescribing? The reality is we don't know."
For parents, even harder than the abstract social questions are the very personal ones they confront when they see or hear that their child is struggling. Will Ritalin help? Will it change her personality? Is it fair for me to make this choice for him? Does it send the signal that she is not responsible for her behavior? Is the teacher suggesting it just to make her own day easier? Will he have to take it forever? What if all children would be a little happier, perform a little better if they took their pills like vitamins every morning? Do we have a problem with that? Given all the debate about how to diagnose ADHD and how to treat it (and the same for its related condition, attention-deficit disorder, or ADD), experts in the field believed it was time to convene a kind of science court to sort through the evidence and arguments on all sides. So last week in Bethesda, Md., several hundred doctors, experts and educators gathered for a long-awaited consensus conference held by the National Institutes of Health to examine the data on how well Ritalin works.
Conclusion: very well--better than researchers imagined--but in ways and for reasons that are still not entirely clear (see box). And yet the real consensus that emerged was how much we still need to learn. The experts warned that not enough is known about the risks and benefits of long-term Ritalin use; that there is too little communication between doctors, teachers and parents; and that a pill alone is no magic bullet. Some combination of behavioral therapy and medication seems to be most helpful for children with the severest problems, but there is no data to determine what combinations work best. Her parents took Erin to a psychiatrist just before her fifth birthday. "He saw us for 45 minutes," Charlene says. "He read the teacher's report. He saw Erin for 15 minutes. He said, 'Your daughter is ADHD, and here's a prescription for Ritalin.' I sobbed."
Charlene had a lot of friends who did not believe in ADHD and thought maybe she and Tim were just being hard on Erin. "I thought, 'Maybe there is something else we can do,'" Charlene says. "I knew that medicine can mask things. So I tore up the prescription." Tim thought that it was possible the doctor's diagnosis was too hasty and didn't want to believe it. "Part of us said, 'How can he look at a kid for 15 minutes and judge?'" Says Charlene: "I believed she had ADHD, but I knew we needed a two-pronged approach." Among the most eloquent in his skepticism about the use of Ritalin for children who are not severely disabled is Dr. Lawrence Diller, author of Running on Ritalin (Bantam Books; $25.95). He wonders whether there is still a place for childhood in an anxious, downsized America. "What if Tom Sawyer or Huckleberry Finn were to walk into my office tomorrow?" he asks. "Tom's indifference to schooling and Huck's 'oppositional' behavior would surely have been cause for concern. Would I prescribe Ritalin for them too?" In Diller's view, many Americans are so worried about their jobs, the marketplace and their children's chances for success that they place impossible pressures on kids to perform, at younger and younger ages. "In order for them to succeed, we make them take performance enhancers," Diller says. "
A society that depends on medication to cope does so at its own risk." There used to be different niches for people with differences in talent, skills and personality, he argues, but Americans are becoming more and more programmed to force their children into a mold. "There is an emotional cost, and eventually there will be a physical cost of taking square and rectangular people and fitting them into round holes," he says. "Performance enhancers--Ritalin, Viagra and Prozac--will remain popular until people question this goal." Three days after Erin started kindergarten, her parents got their first call from the teacher. "She was a sweet lady. She tried to work with us," Charlene recalls. "But she said, 'I've been teaching 40 years, and I've never seen a child like this.'" Adds Tim: "You could see Erin was trying to sit still, but she was trying all these different ways--rocking, lifting one leg, sitting on her hands." Because California law requires that schools provide appropriate education for each child, the parents met with school officials. After evaluating Erin, they said she was not a "special needs" child and could be treated in the classroom. "The only ones who did not believe that were us and the teacher," says Tim. "ADHD does not mean you are missing a limb. She looked normal, but she was slightly off."
Given the explosion in ADHD diagnoses and Ritalin use over the past decade, the disorder is surprisingly ill defined. No one is sure that it's a neurochemical imbalance that can be corrected with medicine, much the way daily insulin shots help diabetics. There is no blood test, no PET scan, no physical exam that can determine who has it and who does not. For many children, Ritalin is the answer simply because it works. "It's a fixed, stable, low-dose drug," says Dr. Philip Berent, consulting psychiatrist at the Arlington Center for Attention Deficit Disorder in Arlington Heights, Ill. He argues that critics who claim diet, exercise or other treatments work just as well as Ritalin are kidding themselves. "The quickest way to end that criticism is to spend a week with a hyperactive child," Berent says. "We aren't talking about kids who ODed on Halloween candy. The protocol for diagnosing ADD [and ADHD] is very well defined." But it's not hard to find doctors feeling a little queasy about the process. An evaluation needs to be so nuanced that the checklist of symptoms used by experts can seem like a terribly mechanical method for judging a condition so individual and personal. For borderline kids, a thorough professional assessment is essential. Tim and Charlene kept resisting putting their daughter on Ritalin. "You don't want your kid to personify the rumors--that the medication makes them dopey or slow," Tim says. "That's the stereotype. All my co-workers and family had opinions that were antimedication." But a year ago, they finally tried it. "It was awesome," says Tim. "It worked great." At least for a while, until they discovered that Ritalin heightened Erin's obsessive-compulsive disorder. "She would turn the lights on and off seven times. She would flush the toilet four times and stop; then three times and stop; then four times and stop. There was a numerical sequence." So long as it doesn't do any damage, what's the harm in giving even mildly distracted or willful kids a pharmaceutical boost?
For one thing, doctors say, there is still some concern about side effects, such as decreased appetite, insomnia or the development of tics. "A very small percentage of children treated at high doses have hallucinogenic responses," the NIH experts concluded, arguing that more research is needed to shape guidelines for doctors and parents. For many families, of course, such risks seem a small price to pay for the enormous relief Ritalin can offer. But the parents with the most firsthand experience see other, more subtle effects as well.
Though Ritalin use can boost young children's self-esteem just by helping them "fit in," teenagers often struggle with their self-image, wondering if their whole personality is shaped by a pill. Some parents balk at giving their child a drug related to "speed," even if it isn't addictive. Other parents talk about a "Ritalin rebound" and find themselves struggling with whether the drug's benefits outweigh its costs.
Kathleen Glassberg, a computer-software sales representative in Long Island, N.Y., used to dread her 12-year-old daughter's return from school each day--and the two-hour crying jag that followed. "She'd hold herself together all day, but the minute she got home she'd have this breakdown," Glassberg says. Glassberg has carefully built an after-school routine of household tasks and time-management techniques to help her daughter focus. "You'd be asking the impossible to have my child come home, have a snack and do her homework right away. So instead, she comes home, lays her books down, and we go for a walk around the block. It gives her time to vent and re-attune herself."
Last spring Erin's parents took her off Ritalin and enrolled her at UC Irvine's Child Development Center, a model program that specializes in ADD and ADHD. She attended the school's summer program. "It was a horrid summer," Tim recalls. "Behavior modification was controlling a lot of things, but the impulsivity would snowball. She would be told not to touch something--whether a car's gearshift or a radio or a computer. You'd say 'Don't touch,' and she would look at you and you could see she heard, but you'd see her hand slowly moving toward it--and she knew if she touched it, she would have to take a time out or lose her TV privileges--but she would touch it anyway. And when the consequences happened, she would have an hourlong temper tantrum. It made for a no-fun life."
There is also some argument about the age that treatment should begin. Nearly half a million prescriptions were written for controlled substances like Ritalin in 1995 for children between ages 3 and 6. "Kids ages 4 to 5 are just as impaired as older children, so there is no reason not to treat them," says William Pelham Jr., director of clinical training in the department of psychology at the State University of New York at Buffalo. He adds, however, that before a physician treats such a young child with stimulants, he should begin by suggesting techniques parents can use to control his or her behavior. But this is where treatment too often falls apart. Even doctors who have seen Ritalin's positive, sometimes miraculous effects warn that the drug is no substitute for better schools, creative teaching and parents' spending more time with their kids. Unless a child acquires coping skills, the benefits of medication are gone as soon as it wears off. "You can't just give medicine and fail to teach," says Stephen Hinshaw, director of the clinical psychology training program at the University of California, Berkeley.
Drug treatment may set the stage, but studies suggest that children need constant reinforcement to help them control their impulses: through behavioral therapy, special education, family therapy or a combination of all three. Even doctors who think ADHD may be underdiagnosed and are convinced of Ritalin's broad benefits emphasize the need to integrate drugs and behavior therapy. But it doesn't matter that children benefit from a multifaceted response if their health insurance won't pay for it. The trend over the past few years has been clear: the percentage of children with an ADHD diagnosis walking out of a doctor's office with a prescription jumped from 55% in 1989 to 75% in 1996. The number receiving psychotherapy fell from 40% in 1989 to 25% in 1996. "The reason Ritalin use has gone up is that we are in an era when psychiatric services are devalued and therapy is not paid for by insurance companies," says Jeff Goodwin, a former pediatrician who teaches at Walter Reed Junior High School in North Hollywood, Calif. "It is easier for physicians to prescribe a drug and categorize a disorder as hyperactivity than it is to deal with the problem. Health services are being cut back, so you have doctors saying, 'Take this and live happily ever after.'" That is all the more reason for parents to gather as much information as they can, get a second opinion--and a third--before starting medication. In part it helps ensure that no one has unreasonable expectations about what drugs can and cannot do. And it increases the chances that treatment will be tailored to a child's individual needs.
Vanderbilt University pediatrician Dr. Mark Worlaich hopes forums like the NIH conference last week will help correct some of the misinformation he sees every day. "The real issue that sometimes gets lost is that kids need to be successful in their activities." I
n August Erin began taking Luvox for her obsessive-compulsive disorder, and in early October she started on Adderall, a combination of various stimulants. "For 4 1/2 weeks, we've seen heaven on earth," says Tim. "We have a semblance of family life." They spent a day recently at a church festival. "There were a lot of people there," Charlene says. "Normally that would produce a lot of anxiety for someone who has ADHD. But Erin had a great time." She can play games longer, take car trips, do homework. "I have a child I can relate to who is hearing me," Charlene says. "I'm not always in an adversarial situation." The fact that the medication seems to be working has liberated Charlene from irrational guilt. But she also sees that everything in Erin's life matters. The school. The behavior therapy. The rules and structure. The time and energy she and Tim devote to every waking hour. For them, the little pill is a wonderful tool, but they have had to learn to use it wisely. - --REPORTED BY ANN BLACKMAN/WASHINGTON, WILLIAM DOWELL/NEW YORK, MARGOT HORNBLOWER/LOS ANGELES, ELISABETH KAUFFMAN/NASHVILLE AND MAGGIE SIEGER/CHICAGO
Does Your Child Need Ritalin? There is no definitive medical test for
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2. Having trouble concentrating on one activity at a time
3. Talking constantly, even at inappropriate times
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5. Fidgeting and squirming constantly
6. Having trouble waiting for a turn
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8. Impulsively blurting out answers to questions
9. Often misplacing school assignments, books or toys
10. Seeming not to listen, even when directly addressed
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NEW YORK (Reuters) - Richard Scruggs, the lawyer who led the settlement
between U.S. states and the tobacco industry in
1998, called the lawsuits against the makers of hyperactivity disorder drug Ritalin the country's ``next class-action battleground.''
The Mississippi attorney heads up a group of plaintiffs'
lawyers alleging in two lawsuits that the makers of the drug had conspired with psychiatrists to ``create'' the disease known as Attention Deficit Hyperactivity Disorder (ADHD).
Scruggs, who got his first taste of national class action suits with a successful run at the asbestos industry before tackling big tobacco, contends that the health of more than 4 million children is at stake because they are taking a drug that they do not need.
The two cases, filed in state court in Hackensack, N.J. and in San Diego federal court, name Swiss health care group Novartis AG (NOVZn.S), the American Psychiatric Association (APA) and nonprofit support group called Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD).
The suits seek class action status and billions of dollars in damages. The allegations are denied by both the company and the APA.
``The main complaint is that they (the defendants) have inappropriately expanded the definition of ADHD to include 'normal' children so that they can promote and sell more drugs and treat more people,'' Scruggs told Reuters in a phone interview Thursday.
``These suits represent the latest class-action battleground in the U.S., but since it involves kids, this is that much more important. Ninety percent of all Ritalin is sold in the United States. We think it's a pretty tough case to say that ADHD is a disease that doesn't exist in Europe, but exits here,'' he said.
Government officials, pharmaceutical companies and medical professionals have debated over the prescribing of Ritalin for Attention Deficit Hyperactivity Disorder (ADHD) in children for some time. The drug has been on the market for over 40 years, but it came under intense pressure when the White House launched an initiative in the spring to cut down on the number of children using the treatment, known by the chemical name methylyphenidate.
A Novartis spokesman in Zurich said he could not respond directly to the U.S. suits because he had not yet seen them.
But he dismissed the allegation that Novartis conspired with the American Psychiatric Association to invent the disorder.
``We don't think there is any merit in such class actions,''
he said, referring to a similar suit filed in Texas in May. ``We cannot see that we have any wrongdoing in this field.''
Regina Moran, a Novartis spokeswoman at the U.S.
pharmaceutical division in East Hanover, N.J., said the company still had not been served with papers pertaining to the suits as of late Thursday evening. She did point out, however, that Ritalin has been on the generic market for many years.
``Eighty percent of the market is generic right now, so it is a mature product for us,'' she said.
An official for the Washington D.C.-based American Psychiatric Association also cited similarities to the Texas suit, and had not seen the suit. But she said as in the Texas suit, the APA will ``defend itself vigorously'' by presenting a mountain of scientific evidence to refute these meritless allegations, and we are confident that we will prevail.
Scruggs, who tallied up $400 million in legal fees from the settlement with the tobacco industry, said public health was the main motivator in the Ritalin case, and the ultimate goal of the lawsuit is to change the way the drug is prescribed.
``Right now, virtually every child would fit the diagnostic criteria today for Ritalin. They are exploiting the fears of parents for the welfare of children to gain inappropriately, and I think that is very reprehensible and it can have a widespread affect on the health of American kids,'' he said.
The lawyers are seeking certification of a nationwide class, Scruggs said, and expect others will follow suit on basis that ``the criteria for disease are artificially broad so that they can include more kids and sell more drugs.''
But one industry expert was skeptical that such a suit would get very far.
``My sense is that the symptoms of ADHD are pretty well defined and there are a number of clinical criteria required before a child is allowed to go on the drug,'' Merrill Lynch analyst James Culverwell said from London.
``When the child does take the drug, it is generally remarkably effective. So any suggestion that this disease is make-believe seems highly unlikely,'' he said.
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