The use of the stimulant methylphenidate, commonly known by its brand name Ritalin, to calm elementary school students who are hyperactive and inattentive has been doubling every four to seven years, according to a report in today’s Journal of the American Medical Assn.
In 1987, almost 6% of elementary school students in Baltimore County, Md., were being treated with the drug, an average of one in every 17 students, according to physicians Daniel J. Safer of the Baltimore County Health Department and John M. Krager of Johns Hopkins University. That number has risen from 1% in 1971.
The results suggest that more than 750,000 elementary school students around the country are being treated with methylphenidate, the researchers said. The number may climb to more than 1 million in the early 1990s. Some critics have charged the drug is being overused.
“Medication treatment for hyperactive children in the United States has emerged from its minor treatment role in the 1960s to become the dominant child mental health intervention in the late 1980s,” the researchers wrote.
In a study that has been continuing since 1971, the researchers also found that methylphenidate is being used increasingly to treat girls, secondary school students, students from low-income households and children who were simply inattentive in school without any behavioral problems.
“We were a little surprised that the rate was climbing as steadily as it has,” Safer said in a telephone interview. But he noted that they expect the rate of use to level off because most of the children in Baltimore County who need the drug are already receiving it.
Various estimates suggest that 4% to 10% of pre-adolescent children suffer from attention-deficit hyperactivity syndrome, for which Ritalin is most commonly prescribed. The syndrome interferes with the child’s ability to pay attention in class and causes disruptive behavior.
“It is the most common psychiatric disorder of children,” said psychiatrist Josephine Elia of the National Institute of Mental Health. And methylphenidate, she said, is “very effective in decreasing impulsivity, improving attention and decreasing hyperactivity.”
“If a child truly has an attention disorder, then he has a chemical problem and needs Ritalin as much as a diabetic needs insulin,” said developmental pediatrician Martin Baren of Orange, who specializes in the treatment of hyperactive/inattentive children.
Safer conceded that the incidence of methylphenidate use in Baltimore County is unusually high. Maryland, Michigan, Utah and Georgia have the highest per capita use of the drug in the country. The state’s high rate was taken into account in their estimate of nationwide use, he said.
(California ranks 36th in the country in per capita use of methylphenidate, according to the Federal Drug Enforcement Administration, which regulates the production of all controlled substances. The rate of use in California is less than half the rate in Maryland, and about 14% below the national average, according to the DEA.)
The use of methylphenidate has been controversial in the past. At least 13 lawsuits have been filed throughout the country on behalf of parents distressed by the effects of the drug on their children. One still-unresolved suit against the Glendale Unified School District charges that a 7-year-old was threatened with suspension unless he took methylphenidate prescribed by a county psychiatrist. Many suits have charged that the drug numbed the children’s senses, produced insomnia and loss of appetite and even led to psychotic behavior.
A Los Angeles-based group called called the Citizens Commission on Human Rights--a long-standing opponent of psychiatry and an affiliate of the Church of Scientology--has campaigned aggressively against the drug. The group claims that the drug is given to 14 million children to keep them in “chemical straitjackets,” that it is highly addictive and that it predisposes the children to delinquency.
Scientists dismiss such claims. “It’s definitely not addictive, and the common side effects are very mild--loss of appetite, possible weight loss and perhaps some nausea when they start taking it,” Elia said. “If it is being used appropriately and if the children are benefiting, then the benefit-to-risk ratio is very good.”
But even the drug’s strongest proponents concede that some teachers and parents have pressured physicians to prescribe methylphenidate and that some physicians do so without making sure the child needs it.
“The biggest problem is that many children are placed on it . . . after a 10- to 15-minute evaluation by a physician,” Baren said. “It takes a four- to six-hour evaluation to show that a child has an attention-deficit disorder, and many doctors simply don’t do that.”
But when it is used properly, he said, “it can save a child’s life as far as school is concerned.”