Detour for Ritalin Issue

A polarizing debate over the growing use of the drug Ritalin to treat attention-deficit hyperactivity disorder in children has now been thrown to the courts. That is the wrong place to address this subtle medical issue. What’s needed, for a start, is government research that might settle the dispute.

Ritalin has been used to treat ADHD for more than a decade and has been highly successful in some children for whom nothing else works. But controversy ballooned in the late 1990s, when the use of Ritalin among children nearly tripled.

Class-action lawsuits were filed last month in California and New Jersey by some of the same lawyers who pressed high-profile actions against gun makers and the tobacco industry. The suits, alleging that Ritalin’s manufacturer conspired with the American Psychiatric Assn. to inflate the drug’s market, appear to be cynical attempts to mine the industry’s deep pockets. For instance, they depict as conspiratorial common practices like drug company funding of a disease advocacy group. The group, Children and Adults With Attention-Deficit/Hyperactivity Disorder, was indeed an early supporter of Ritalin use in children, but disease advocacy groups frequently receive funds from drug companies and it is perfectly legal, if somewhat troubling.

Nevertheless, the lawsuits do help underscore the legitimate fears of parents who question the use of Ritalin and find themselves at odds with educators, psychologists and the doctors who believe in the drug’s ability to help hyperactive children lead more normal and stable lives.

Earlier this year, members of Congress and the White House called for action to reverse the sharp increase in Ritalin use, asking Steven Hyman, the director of the National Institute of Mental Health, to study whether the rise might signify a growing tendency in the United States to explain away behavioral problems as hard-wired organic brain diseases. However, the studies the NIMH has since launched focus not on answering such larger questions but on more limited issues like whether the long-term use of Ritalin in children is safe.

Part of the problem with Ritalin use, or overuse, is that the definition of ADHD is ambiguous. The Web site of the National Institute of Mental Health, for instance, says it is characterized by “an inability to sustain attention and concentration.”

There is indeed subjectivity in the Ritalin issue, a matter that science is unlikely to resolve soon. Many psychiatrists, for instance, fundamentally disagree about how to define normal behavior, about where to draw the line between fidgeting and abnormality.

But the NIMH can and should do more to address parents’ specific worries: Why is this drug being used in the United States dramatically more than in the rest of the developed world? Is it being used too hastily because it provides an easier solution than other interventions?

As the recent lawsuits suggest, if parents don’t get better guidance soon, they may increasingly take their case to the courts. That may be a way to vent frustration, but it would hardly provide solutions.