Ritalin: Lifesaver or Crutch?

According to the American Psychiatric Assn., 3% to 5% of schoolchildren have attention deficit hyperactivity disorder, most commonly known as ADD/ADHD. In 1998, the National Institute of Mental Health presented a study showing that although Ritalin, the widely prescribed drug for treatment, soothes children and helps them focus, it is not a long-term solution. Yet since 1990, use of the drug has increased by 700%, raising questions of overtreatment and misdiagnosis. MAURA E. MONTELLANO spoke with a parent and a child psychologist.

‘It’s Made a World of Difference’

GINGER JAFFE: Paralegal; mother of child on Ritalin

My son Alex is 9 and has been on Ritalin since he was 5 years old. I knew something was different about him right from the beginning. He could never stay put for a long period. He was always fidgeting, even in the baby swing. When he was 2, he was constantly falling and climbing on everything. We had to put a chain lock on his room because he was always gettting out at night.

The doctor kept saying he just had high energy, that he was just being a boy.

When we put him in preschool, he wasn’t bad but he was always bothering others. When he got to kindergarten, he would come home sad because he couldn’t write as quickly as the others. He couldn’t focus on the work. He couldn’t color within the lines.

He didn’t have a lot of friends. He was always talking, touching, bothering. He annoyed people because he was so hyper. The teacher finally told me not to bring him back because he was too immature and disruptive.

We were told to test him. We took him to a pediatric neurologist who specialized in ADD. The doctor had him do all types of tests and tasks. He had him write, answer questions. Finally, he was diagnosed as hyperactive and with ADD. The doctor prescribed Ritalin.

I remember the first time I gave him a dose after he woke up. A little while later, it was time for us to leave for school but I couldn’t find him anywhere. I finally found him in the car, sitting there waiting for me. He was just sitting there, looking out the window, calm and quiet. I couldn’t believe it. It kind of scared me. He was able to just sit still like anyone else and I wasn’t used to it. There was a world of difference.

In the morning before he gets his medicine, he is talking, moving, doing funny voices, being a comedian. You have to follow behind him, help him get dressed because he doesn’t focus. Once he gets the pill, he puts on his own shoes, gets himself ready.

He is constantly talking, always asking questions, one right after the other without pause. It is very hard to get him to get to bed because he is so hyper. We have to calm him down and rub his feet. It’s difficult getting him to relax. When he is not on his medicine and he gets mad, he doesn’t know what to do with the anger. It’s so frustrating for him. He can’t take too much stimulation. He breaks his furniture, he’ll cut his T-shirts, he bangs his hands on the wall. It’s frustration energy that he’s trying to relieve.

He will be on medication all his life. He knows he needs this Ritalin. He can tell when he needs it. He gets teased at school, kids call him mental and he doesn’t like it. He gets angry and blames me for “giving him” ADD.

Recently the doctor upped his dosage and he went into a serious depression. He wanted to die, he wanted to go be with God. His dosage has been lowered and he is doing much better.

The first time I gave my son the pill, I cried. I didn’t want to be drugging my child. But his doctor told me that it was either the pill or my son sitting in class, not learning. It was either Ritalin or him having no friends because he simply couldn’t make them.

We go to a behavior therapist as well. You can’t just give the medicine and expect that to make things better. It wasn’t until we got into behavior therapy that we realized there were other things to deal with. The Ritalin makes him behave, but we have to train his behavior. You can’t have one without the other. Ritalin is not the only answer, but it works.

‘The Drug Alone Is Not Enough’

BUNNI TOBIAS: Licensed educational psychologist, Lake Forest

ADD/ADHD has become America’s No. 1 child psychiatric disorder. Three and a half million children have been diagnosed with some form of ADD/ADHD. Research tells us that by the year 2000, it’s estimated that more than 8 million children may be on Ritalin. Ritalin use in the United States is five times higher than the rest of the world combined and the United States uses 90% of the world’s Ritalin.

Look what a child has to carry around if he or she is diagnosed with ADD/ADHD. It has a label, preconceived picture; it’s a life sentence. What’s even sadder for me is the parents. They carry guilt like they did something bad, like they damaged their child. We are living in a quick-fix society. As soon as kids flit, squirm, distract or just space out, it is assumed that they have ADD/ADHD.

Parents and teachers and other child professionals must develop a trained eye to better observe and then remediate the issues that keep children from meeting their greatest potential. We need to find out why kids are having these problems. Currently, there is no objective tool for determining ADD/ADHD. No one has proved anything consistently. Subjective tools, like questionnaires, are used. Subjective testing is considered the least accurate measure.

I look at all developmental issues: their visual system, motor systems, auditory problems, behavior problems. Auditory processing where kids look confused and withdraw is because language is moving faster than they can comprehend it. Life is chaotic and kids don’t get the flow of things. When behavior expectations are inconsistent, children act out to test where the limits are. A lot of stress creates tremendous turmoil and distraction for kids: divorce, death, alcoholic parents, violence. Some kids’ systems don’t function adequately so they become frustrated, but this does not necessarily mean they are ADD/ADHD. They are being asked to do something they simply can’t.

Some kids have allergies and sensitivity to environmental stuff. This all impacts their behavior and their ability to think and act. One common problem I find is low blood sugar. Kids all of a sudden go ballistic or they mood-shift and suddenly can’t sit still. One of the first things I ask parents is to tell me when these things happen. The two most common times are around 10 a.m. and 4 p.m. when the kids’ blood sugar is down. I ask parents what their kids eat and almost always their diet contains too much sugar. Allergies are miserable as well. These kids go bonkers when they eat something they are allergic to. All these problems create the look-alike symptoms of ADD/ADHD.

Some kids require medication but that’s not always the case. When all these problems are resolved, the need for medication decreases until they don’t need it.

I am not against medication. All I am saying is don’t ignore the other things that are going on. Medication suppresses symptoms, but it dulls kids down.

They say kids who use Ritalin grow up and use drugs. I say that kids who grow up without having their problems resolved will grow up and self-medicate however they can. Kids who figure out their problems will learn to overcome obstacles.