PHIP Newsletter Vol 2, Issue #5
March 13, 1996
Ritalin: Wonder Drug or Cop Out for A.D.D.?
by Linda S. Davis
Children, and adults, diagnosed as having ADD/ADHD often experience difficulty concentrating on a specific task or sitting still for extended periods of time, exhibit a tendency towards impulsive behavior, and demonstrate poor social skills. Ritalin, which is a central nervous system stimulant, has become the drug of choice for treating ADD/ADHD patients. Many people have heard of Ritalin, the trade name for methylphenidate. If you have a child that has been diagnosed as having Attention Deficit Disorder (ADD) or, the double whammy, Attention Deficit Hyperactive Disorder (ADHD), that child has probably been given a prescription for Ritalin at one time or another.
RITALIN'S USAGE IS CONTROVERSIAL
Despite Ritalin's popularity, however, there exists some controversy concerning its use. There are some health professionals who don't necessarily feel that ADD/ADHD is a "disorder." Others who accept that ADD/ADHD is a disorder, object to the indiscriminate use of drugs to treat it. Finally there are those who feel that the ADD/ADHD issue is just another cop out, a way of telling people that their disruptive behavior is not their fault; they are sick, so they are not responsible for their actions.
ADD/ADHD: JUST ANOTHER FAD?
There is a school of thought that maintains that ADD/ADHD is not a disorder at all. Rather, it distinguishes a type of personality. There are individuals who can sit still and pay attention in class or concentrate on a specific task or who exhibit "good" social skills. Then there are those individuals who get fidgety during a boring class or impulsively jump from project to project or who just don't fit in socially. One argument takes the position that these individuals are not "sick" or suffering from any type of disorder. Instead, they just have a different personality, a different way of dealing with the world.
Instead of medicating these individuals so they exhibit "acceptable" behaviors, proponents of this belief argue that the environment where these individuals live and work needs to be changed. For children, this might involve having smaller class sizes so the children get more individualized attention, changing teaching methods to encourage more teacher-student interaction, or making sure all the students are being challenged. Adults who exhibit behaviors fitting the ADD/ADHD profile would have to make adjustments in their lives to deal with this. They would need to find professions that would continually challenge them and that suit their particular personality traits.
There might still be individuals who would require some type of medical treatment to help them acquire or learn the control necessary to be successful but this treatment would not necessarily have to include Ritalin. Changes in diet, family counseling, or combinations of these with limited usage of drugs have been shown to be effective in some patients.
MEDICATING INSTEAD OF SOLVING THE PROBLEM
There are many, who do believe in drug treatment. In 1995, there were over two million children in the United States taking Ritalin. However, many health professionals, as well as a growing number of parents and educators, believe that ADD/ADHD is a disorder, but they don't agree that a long-term course of medication is the answer.
Some health professionals believe that even hyperactive children should not be treated solely with Ritalin. While it is true that most children do show improvement while on Ritalin, the effects last only several hours. Increasing the dosage to increase the effects often has side effects of poor appetite and insomnia. Another option is to have the children take the medication two or three times per day. If medication has to be taken during school hours, though, some children feel the stigma of being different or having something wrong with them which can add to the problems they already have.
Instead of rushing into a course of medication for ADD/ADHD patients, some health professionals are advocating that the underlying causes for their patients' behaviors be identified and dealt with first. This might include ruling out food allergies, family problems, problems at school (personality clash with a teacher or another student), or some sort of learning disability. Once the causes for the behaviors have been identified, it's quite possible that they can be dealt with by some means other than medication. These medical professionals believe that a stimulant medication, such as Ritalin, should be used sparingly and only for a limited time.
Getting the Attention It Deserves
Ritalin was the drug of choice for treatment of ADD/ADHD during the 1980s and it's still popular today. There is increased interest, though, in questioning its indiscriminate usage. Not everyone accepts that ADD/ADHD is a true medical disorder but most would agree that there are individuals who sometimes have trouble fitting in. Additionally, individuals (especially children) should not be given the impression that they are not responsible for their actions. Instead of writing out a quick prescription of Ritalin, perhaps it would be better to examine more closely what's going on with the patient. It's quite possible that a different course of treatment might be more effective.
Linda Davis, MPA, is a freelance writer who specializes in personnel and information management issues. She can be contacted via e-mail at Linda Davis E-Mail firstname.lastname@example.org