As I began to think about what I wanted to write my essay about, I thought of all the topics in education that I would like to know more about. I finally choose ADD/ADHD and the use of Ritalin as my subject matter. Not being a parent or an experienced educator as of yet, I see America’s propensity to over medicate reaching our youngest population. I think the statement by Dr. Breggin is quite profound, “When we drug millions of children to make them more compliant and easier to manage at home and in school, it says more about our society’s distorted values than about our children” (Breggin 1998). I know from my experience in the health care profession, that Americans believe in medication to create a better life for themselves. That can be as simple as getting an antibiotic for the slightest cold or as complex as medicating ourselves to fight a chronic condition.
We live in a society that wants everything done quickly. We drive through for our food, banking, prescription pick-ups, and car washes. We develop our pictures in an hour and pay for our gas at the pump. We watch 50 channels of television in a second. Television has learned that it has to be gripping in order to keep up with our wandering minds. We even have televisions that allow you to watch more than one channel at a time. We wonder why our children have trouble paying attention. When do we do anything that requires anything but the most miniscule amount of our attention? How do we expect children to practice the learned behaviors of watching and listening, if we never teach it to them? We spend the first few years of their lives showing them the frenzied world in which we live and then we send them to school and wonder why they can’t sit still. Do we ever sit still?
Besides our social ramifications behind ADD and ADHD, I have a great concern for placing children on drugs such as Ritalin. Not only are we teaching them they are not responsible for their actions, we are showing them they can use a substance to alter their behavior. Is that an appropriate lesson for children? I don’t advocate taking every child off Ritalin, but I do think it is much too widely prescribed and not enough research has been done on the subject. I would think that every person should be concerned when they see a large number of children on a drug that is a methamphetamine and in the same drug class as cocaine. Do we want to put a chemical like that into the bodies of our children? How do we look at the big societal picture to help solve this problem?
As I began my research, these were some of the questions I had. I knew the use of Ritalin was wide spread, but I had no idea the extent. Today in the United States approximately 2 million children are diagnosed with ADD and ADHD (Treva 1999). It is more common in boys than girls with boys having an occurrence 2 to 3 times more often than girls have. The production of Ritalin has increased seven-fold in the last 8 years and 90% of it is consumed in the United States (Gibbs 1998). Shouldn’t that cause us to question the sheer number of children we have sedated in this country? We depend on medication as a country and are teaching our children to do so also. Many countries would see this as a problem. Nearly half a million prescriptions for medications like Ritalin written in 1995 were written for children between the ages of 3 and 6 (Gibbs 1998). Also the percentage of children with an ADHD diagnosis that are being placed on medication jumped from 55% in 1989 to 75% in 1996 (Gibbs 1998).
Now that I have illustrated some of the statistics behind our country’s ADD/ADHD children, perhaps I should talk a little more about what exactly an ADD/ADHD child is. ADHD does not have physical signs that can be recognized in the patient. Most diagnoses are made through observation and over a period of time. The most common behaviors fall into the three following categories: inattention, hyperactivity, and implusitvity.
People who are inattentive have difficulty staying on task. They spend much of their time on things they are interested in and have trouble staying with things that don’t interest them. Learning something new or completing a task can also be difficult for them. Their mind tends to go from one thing to another quickly.
People with hyperactivity are always in motion. These people cannot sit still. They are the people always fidgeting, moving around or out of their seat. They are noisy and will frequently tap or touch everything. Sitting in one place for any period of time is a challenge for them. They also tend to bounce from one thing to the next while trying to do many things at once.
Impulsive people have difficulty curbing their immediate reactions before they act. They are the students who will strike out an another student or object or blurt out inappropriate comments. They may have a hard time waiting for things or waiting their turn. These students will often holler out the answer before the question is even asked.
The Diagnostic and Statistical Manual of Mental Disorders or DSM, is a diagnostic reference book that contains a set of criteria for the ADD/ADHD patient. Several questions are considered when diagnosing a patient with this condition. First, how do these behaviors effect the person? Are they having an affect on their ability in the classroom or with friends? Is this a long-term problem? How long has the patient had this condition? Does the problem only occur in a specific setting or does it occur frequently? Another indicator is a sign of inattention, hyperactivity or impulsivity.
According to DSM some of the signs of inattention include:
- Becoming easily distracted by irrelevant sights and sounds
- Failing to pay attention to details and making careless mistakes
- Rarely following instructions carefully and completely
- Losing or forgetting things like toys, or pencils, books and tools needed for a task
Some of the signs of hyperactivity and impulsivity include:
- Feeling restless, often fidgeting with hands or feet, or squirming
- Running, climbing, or leaving a seat in situations where sitting or quiet behavior is expected
- Blurting out answers before hearing the whole question
- Having difficulty waiting in line or for a turn
As I read these I thought, that describes just about everyone I know in some way or another! There are criteria along with the demonstration of those behaviors that a child must exhibit before they can be labeled ADD/ADHD. The above behaviors must appear early in life, preferably before the age of 7 and occur for at least 6 months. These children also must exhibit these behaviors more frequently or more severely than their peers do. And lastly the behaviors must create a handicap for in the person’s life (National Institute of Mental Health 1996).
ADD/ADHD can be diagnosed by a number of professionals. Psychiatrists are probably the best option as they can not only diagnose the condition, but they can prescribe the medication if needed and provide the patient and their family with counseling. A Psychologist, which is common in today’s schools, can diagnose the condition and provide necessary counseling, but they are unable to prescribe any medication. A number of different physicians such as Pediatricians, Family Practice Doctors or Neurologists, can diagnose and medicate the patient but frequently do not provide much needed support and counseling. If a patient is just given medication and not taught the coping skills needed, as soon as the medications wears off so do its benefits. Unfortunately it is easier for many physicians to prescribe a drug to try to deal with the problem. Many insurance companies today will cover the cost of a prescription but neglect to provide counseling to go with the medication. In a society that looks for the “quick fix” medication is seen as the solution.
When a patient is diagnosed with ADD/ADHD, the first thing the mental health worker should do is look for other causes. It is important to rule out any possible reasons for a patient’s behavior. This can include depression, petit mal seizures, hearing and vision concerns, allergies, diet and nutrition problems, anxiety and difficult situations in the patient’s personal life. Once those possibilities have been eliminated, the specialist will review the patient’s medical, and if school aged, school records. They try to understand what the patient’s home and classroom lives are like and how the patient interacts with these situations. Often the mental health worker may come in and observe the patient in his or her own environment. The child should spend at least an hour with the mental health worker for assessment. Unfortunately many insurance companies will not pay for this service. Frequently teachers past and present are asked to rate observations of the patient and compare their behavior with their peers. While the teacher is not a medical professional, they are a good base of knowledge for that specialist to use. It is believed that teachers know many children and can be objective in their comparisons.
Once all the information is gathered a treatment plan is chosen. The specialist may try the patient on a few different medications before finding the one and the dosage that are suitable for their patient. It is recommended that the patient be on the medication for at least one week before deciding to change medications. It is important once the patient is on the medications they receive positive reinforcement for their improved behavior. The only way to determine how much medication to give a patient in this case it by trial and error of dosages. Would you want to do that with your child and a medication that was going to sedate them? When the dosage is determined, we often talk about how wonderfully the medication is working rather than making the patient responsible for their actions. It is also important for the families to receive therapy to help them improve their reactions to the patient. For young children learning how to remove that child from a frustrating environment is important. In the classroom it is helpful for the teacher to make exceptions and allowances for their students. For example, the disorganized student may need to have instructions written out for them whether that be on the board or their desks, and then when they forget what it is they need or are to be doing, they can refer to this list. Also, for the constant daydreamer it may be beneficial to tape a checklist on each student’s desk and then periodically ask, “who is with me?” When the student is off somewhere else in their heads, they make a check mark. This will help them see the number of times they are not with the rest of the class.
While all of this information is very useful, I still want to know what causes ADD/ADHD and how do they know a patient has it before prescribing medication. While no one knows what causes ADD/ADHD most specialists agree that more research needs to be done. It is believed that the level of brain activity and the person’s ability to pay attention are linked. The brain’s main source of energy is glucose. People who are not able to pay attention brain uses less glucose therefore indicating they were less active. Brain scans were able to show the difference in a patient’s brain activity. The National Institutes of Health concluded ADD/ADHD is not caused by: too much TV, food allergies, excess sugar, poor home life or poor schools. They did conclude however, that the mother’s use of cigarettes, alcohol or other drugs during pregnancy distort the fetus’s developing nerve cells. Another interesting note is that children who have ADHD usually have at least one close relative with the disease (National Institute of Health 1996). Also, fathers who had ADHD as a child were one third more likely to bear children with the disease.
Now that I understand ADD/ADHD somewhat, what are the treatments beyond medicating our children? Important steps include: psychotherapy, cognitive-behavioral therapy, social skills training, support groups, and parenting skills training. Psychotherapy works with patients to accept themselves and their disease. They are able to discuss patterns of their behavior and try to find alternative ways to handle their emotions. Cognitive-behavioral therapy provides assistance with immediate issues. Patients can learn hands on ways to deal with their disease. It is very easy to give a young, out of control child a pill knowing they will calm down shortly. If ADD/ADHD makes them strike out at people, this type of therapy can help them find alternative ways to express that emotion. They can help the disorganized person find a way and pattern to organize themselves and their lives. Social skills training also helps with learning new behaviors. The patient learns how to respond to others in a more appropriate fashion. They learn to understand facial expressions or tones of voice or gestures helpful in understanding other people. Support groups connect people who have a common issue. It is helpful for patients to understand they are not the only ones struggling with this disease. Parenting skills training helps parents to obtain the tools and techniques to help manage their child’s behavior. They are also encouraged to look for a child’s strengths and to point out what the child does well rather than focusing on the negatives.
In addition to the above treatments there are a number of controversial treatments. The medical community tends to dismiss these treatments as not being scientifically proven, however there is so little scientific evidence on ADD/ADHD that I think that is a little hypocritical. These treatments include: biofeedback; restricted diets; medication for inner ear problems; megavitamins; chiropractic adjustments and bone realignments; treatment for yeast infections; eye training; and special colored glasses. I would like to address a couple of those treatments. It is suggested by a number of people that an elimination diet will help to show what types of foods an ADD/ADHD child is “turned on” by. In 1994 researchers in Australia reported the affects of yellow dye in hyperactive children. It was a double blind placebo study in which 200 suspected hyperactive children participated. Artificial colors were eliminated from their diets for 6 weeks. Of the 200 children 150 noted behavioral improvements in their children. Then 23 children who were considered reactors were given yellow dye. Twenty-one of these children reacted when the dye was administered, but when given a placebo they did not react. Some of the behavioral changes included irritability, restlessness and sleep disturbances (ADD/ADHD Online 1999).
Doctors suggest eliminating artificial coloring, refined sugar and caffeine from your child’s diet. They also recommend trying fatty acid supplements or magnesium supplements. Some of the signs of deficiencies in fatty acids are excessive thirst and urination, dry brittle hair and nails and dandruff. All of these are interesting alternatives to consider even though the medical profession doesn’t yet embrace them. Remember a time when chiropractors were considered “crazy” or when it was scandalous to go to an osteopathic doctor? The United States is very slow to embrace new theories and ideas. It would be beneficial to look to Europe and Asia and compare their treatment methods. When we consider 90% of all the Ritalin produced is used in the U.S., we see that other countries must be using different methods to treat people with ADD/ADHD.
Something else to consider is the number of children abusing Ritalin. As it is in the same drug class as cocaine, it can provide a high for people when snorted or injected. The National Institute of Health claims that while Ritalin can be addictive for teenagers and adults if misused, these medications are not addictive in children. I just find that terribly hard to believe. Are they assuming children will not misuse the drug or do they believe children’s bodies respond to the medication differently? The growing availability of the drug allows more room for abuse. Some teenagers grind Ritalin up and snort it or dissolve it in water and “cook” it for intravenous injection. Ritalin is a Schedule II controlled substance like most narcotics. When purchased in a pharmacy with a prescription, a tablet costs about .25 to .50 cents each. When being sold on the illicit drug market, Ritalin goes for $3 to $15 per tablet (Indiana Prevention Resource Center, 1995). This is an extremely dangerous predicament. Ritalin is made for oral consumption and includes ingredients that the stomach can absorb; however when injected or inhaled, they can be extremely hazardous to the point of overdose and death. Ritalin is becoming the drug of choice on college campuses and students say that it is more popular than pot and readily accessible (Tennant 2000). Students are taking these drugs to prepare to compete at the college level and continue on throughout their college careers. Widespread stories of students “snorting” Ritalin ranges from The University of Wisconsin to Harvard. If we are overprescribing these types of medication, are we also making them readily accessible for abuse? Will this be the next phenomenon like sniffing chemicals to get high?
If you think the side affects of misuse are frightening, consider the side affects of normal dosages used properly. They include: nervousness and insomnia; loss of appetite, nausea and vomiting; dizziness, palpitations, headaches; changes in heart rate and blood pressure; skin rashes and itching; abdominal pain, weight loss, and digestive problems; toxic psychosis, psychotic episodes, drug dependence syndrome; and severe depression upon withdrawal (Indiana Prevention Resource Center 1995). These side affects are to be watched for on even the lowest dose of the medications, however on the higher doses, there are even more additional side affects. Also, the drug package inserts warn that “a small number of patients, fewer than 1 percent, may experience side effects, including abnormal dreams, agitation, hostility, suicidal thoughts and delusions” (Locy 2000). With an estimated 1.5 million youngsters receiving antidepressants in 1996 alone, that is about 15,000 who could be effected with these side effects (Locy 2000). Think about the violence in schools today, do we need to add in another factor? I think that some patients do need the medication, however before giving my child a medication that can cause those types of side affects, I would explore every alternative option. I think both the educational and medical societies are using this medication as a “quick fix” solution. Not enough is known about what causes ADD and ADHD and there is no conclusive way to test for the disease. Many physicians are prescribing the medication at the parent’s request without evaluating the child fully. They are also neglecting to provide therapy to work in conjunction with the medication.
Many of the medications prescribed are not approved by the FDA for use in children. Antidepressants are not approved for children under the age of 6, but millions of these prescriptions are written every year by doctors who can still legally prescribe these medications to children. Doesn’t that concern anyone? Children are not just small adults. The chemical process and metabolization process is very different in children than in adults. A child’s brain is rapidly developing and we are feeding it chemicals that have been shown to slow or stop development in order to “control” our children. There are ethical questions regarding the testing of medication on children, therefore it becomes very difficult to know the effects of those drugs. One study was done by the National Institute of Mental Health (NIMH), which is terribly flawed. The study was not a placebo-controlled double blind clinical trial (Breggin 2000). This means that all the participants in the study were given the medication and that the researchers observing the effects of the medication knew the participants had been given the medication. This may cause the researchers to be “seeing” an effect they may not have seen if they were unsure of the participant’s medication status. Other factors to flaw the study were: there was no control group of untreated children; 32% of the group was already on medication at the start of the study; the number of participants was quite small, and boys significantly outnumbered the girls; the children themselves did not feel they had improved; all the principle investigators were well-known drug advocates and the parents and teachers were exposed to pro-drug propaganda (Breggin 2000).
It is interesting to note that in 1998 NIMH sponsored conference on ADHD and not one of the original experts had any history of voicing opposition or reservations to using drugs to treat this problem. However, once this was pointed out, the NIMH did invite protractors to its conference. The consensus the panel came back with is quite interesting. The panel raised fundamental questions about whether ADHD is a “valid” diagnosis (National Institute of Health 1998). It also found no cause and no data to indicate ADHD is due to a brain abnormality and that Ritalin did not have long-term positive effects on academic achievement or social skills (Ross-Breggin, 2000).
Unfortunately it is our future that is getting shortchanged by this current situation. We need to look at the big picture and see ways to change our lives to help our children grow up medication and worry free. Parents and schools don’t want to admit that they are responsible for a child’s behavior. Much of the way a child behaves has to do with the environment around them. A large stressful event in a child’s life can easily produce behaviors similar to those described. Sometimes a child is not being respected and because a child will learn through modeling, they may in turn not show respect. Parents who choose to take their child off medication are being reported to Social Services by the school for abusing their child (Karlin 2000). What kind of message are we sending when a parent can’t decide not to give their child a mind-altering drug? The whole situation is getting beyond our control. Again, as I have stated numerous times in this paper, I don’t advocate the elimination of Ritalin and I don’t belittle the difficulties suffered by people with ADD/ADHD. I just think the rise in blanket diagnosis and medication usage are causes for concern. I think Time magazine hit the nail on the head when it said, “Americans are becoming more and more programmed to force their children into a mold. There is an emotional cost, and eventually there will be a physical cost of taking square and rectangular people and fitting them in round holes” (Gibbs 1998). The question in my mind is just what will be the price we pay?