Rethinking Ritalin
Is it overprescribed for children with ADD?
By Kathy Koch

Arecent National Institutes of Health conference called inconsistent diagnosis and treatment of children with attention deficit disorder “a major public health problem.” The most popular drug for treating ADD is Ritalin, or methylphenidate. In the past decade, methylphenidate production rose eightfold while production of amphetamines, also used to treat ADD, jumped 20-fold. Critics argue. . . .

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Are attention deficit disorder (ADD) and attention deficit hyper-activity disorder (ADHD) legitimate medical diagnoses?

Russell A. Barkley Ph.D. Director of psychology and professor of psychiatry and neurology, University of Massachusetts Medical School. Written for The CQ Researcher, October 1999.	Sydney Walker III Southern California Director Neuropsychiatric Institute, and founder, Behavioral Neurology International. Written for The CQ Researcher, October 1999.

What Is ADD?

Attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD) are generally characterized by abnormal levels of hyperactivity, inattentiveness and impulsivity that generally show up before a child is 7 years old.

Although most cases are assumed to be inherited, a small percentage are thought to be caused by central nervous system damage in early childhood, which could be associated with general birth problems, such as an umbilical cord wrapped around the neck, or malnutrition during pregnancy.

Experts say ADD can easily be confused with learning disabilities, especially dyslexia, since 25-40 percent of ADD kids -- some say as many as 90 percent -- also have a learning disorder, mostly related to reading. In fact, some public health experts say that ADD is not a real medical condition. Others say that it is often confused with normal behavior and misdiagnosed. For instance, elevated lead levels in the blood can also cause ADD symptoms.

Most ADD cases are treated with one of four stimulants -- Ritalin, Dexedrine, Adderall and Cylert. By far the most widely used is Ritalin, manufactured by a Swiss company, Novartis Pharmaceuticals Corp. Stimulants calm children down and help them focus on schoolwork.

Some 20-50 percent of children are thought to outgrow ADD by adulthood, but the percentage of adult sufferers is unknown.

There is no definitive medical test for ADD. Children are said to have the disorder if they exhibit at least six of these (and other) behaviors for at least six months, and if some of the behaviors were present before age 7:

-- Has trouble paying attention to details; makes careless mistakes in schoolwork

-- Has trouble concentrating on one activity at a time

-- Talks constantly, even at inappropriate times

-- Runs around in a disruptive way when required to be seated or quiet

-- Fidgets and squirms constantly

-- Has trouble waiting for a turn

-- Is easily distracted by things going on nearby

-- Impulsively blurts out answers to questions

-- Misplaces school assignments, books or toys

-- Seems not to listen, even when directly addressed

-- Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort

The symptoms must be present in two or more settings, such as at school or work and at home. There must also be clear evidence of “clinically significant impairment” in social, academic or occupational functioning.

[1] The two conditions are often referred to interchangeably as ADD.

Footnote: 1. The two conditions are often referred to interchangeably as ADD.