Dazed and Confused: The Riddle of Ritalin

Millions of kids in the United States have ADHD. The diagnosis is one thing, the treatment is another.

By Jessica DuLong

Six-year-old Sara had been to the library lots of times, but this trip was different.

"Her eyes were wide as saucers," explains Denise Lefton, Sara's mother (who prefers not to give her daughter's real name.)

"She was calmly walking around picking up and looking at individual books, then lining them back up again," Lefton remembers. "It was like a light bulb went off in her head. This is what calming down is."

It was an important day for Sara — the first day she took Ritalin, the drug she was prescribed to treat Attention Deficit Hyperactivity Disorder (ADHD). And for her mother, it was the culmination of days of indecision, worry and wondering: Should I give this drug to my child?

Characterized by a list of symptoms including difficulty sustaining attention, fidgeting and frequently interrupting, ADHD is the most commonly diagnosed disorder of childhood, according to the National Institute of Mental Health (NIMH).

An estimated 3 to 5 percent of school-age children are affected by ADHD (formerly known as ADD) and, on average, about one child in every classroom in the United States needs help for this disorder, the NIMH reports.

Yet, in editorial pages all across the country, the accusations fly.

Charges like, "we're drugging our toddlers," convey public concern that in coping with difficult child behavior, Americans are too quick to reach for the pill bottle.

While public outcry about medicating children with psychiatric drugs is nothing new, a study just released in the Journal of the American Medical Association (JAMA) has rallied increased concern.

The study showed that the use of psychiatric medications in children ages 2 through 4 rose drastically between 1991 and 1995. Researchers found that the use of stimulants — most commonly methylphenidate, the generic form of Ritalin — increased almost threefold.

These results reflect what some experts say is a disturbing trend.

Dr. Steven Hyman, director of the National Institute of Mental Health, told the New York Times that he was "more than shocked" at the findings. He called the use of psychiatric drugs in young children "an area of enormous concern."

If the experts are concerned, what should parents think?

According to Peter Jensen, M.D., Director of the Ruane Center for the Advancement of Mental Health at Columbia University, there is no great cause for alarm.

While there is less research on the long-term effects of stimulants such as Ritalin on children under six, there have been hundreds of studies on the affects in older children.

According to Dr. Jensen, these studies revealed "no apparent adverse effects that weren't totally reversible when the medication was stopped or the dosage reduced."

"While we don't have dozens of studies [in children age 6 and under]," explains Dr. Jensen, "the young children tend to respond well" to the medication.

Dr. Jensen acknowledges there is "always worry" in giving psychiatric medications to children at such a crucial point in brain development. But, for young children with extreme cases of ADHD, such as a child who runs into traffic or behaves in other dangerous ways, the medications "may be life-saving."

Though parents may be uncomfortable with giving their children psychiatric drugs, research shows that the medication works — and works better than behavioral treatment alone.

The NIMH released a study in December demonstrating that behavioral therapy alone was not the most effective treatment for ADHD. "Most children with ADHD need a combination of treatments which includes medication," explains Dr. Jensen, who was the study's lead researcher.

For parents like Lefton, medication makes a remarkable difference. When Sara was diagnosed at age 4, she was having problems in preschool. The teachers told Lefton that Sara was fidgety, she couldn't hold a pencil straight, and she couldn't sit still.

"As a parent I knew there were a lot of things she did differently," says Lefton. And once she found out the diagnosis, she explains, "I had to swallow the fact that my child's brain didn't work like mine."

Coming to terms with her daughter's diagnosis was only the first step. Lefton and her husband then had to decide what to do about it.

The decision to give Sara Ritalin wasn't easy.

"There's the fear that you're not going to see your true child, but the effects of some drug," explains Lefton. She was afraid of damaging her child and worried that Sara would be "numb or clouded."

Many parents have similar concerns. And contrary to public opinion, in Dr. Jensen's experience, choosing medication to treat ADHD is rarely a decision parents make lightly.

"Parents are worried about this," he explains. "They don't come to this because it's most convenient."

Yet, even if parents aren't just choosing carelessly, they may not have the best information if they're getting it from their regular doctor.

In choosing treatment, "the bottom line turns on expert diagnosis," says Dr. Jensen. "This is the realm for experts in child psychiatry, not for pediatricians."

In Lefton's case, finding the right kind of help has been an ongoing challenge. Even after they made the decision to use medication, finding new doctors and keeping up with treatment required tremendous energy.

Along with behavioral therapy, Sara has been taking Ritalin for three years. Treatment has required consistent monitoring and adjustment as she grows. "Every year it's something new, a new problem, a new issue," Lefton explains. "You don't just get it right then you're done with it."

Lefton still remembers the day she got her daughter's diagnosis. "I took that deep breath. Then I decided, if there was something wrong with my child I had to deal with it — now. Then I started running."

For many parents of children with ADHD, the running continues.

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