The Magazine

Readin', Ritalin and 'Rithmetic

Education's new three R's.

Mar 11, 2002, Vol. 7, No. 25 • By MELANA ZYLA VICKERS
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EVERY DAY AT LUNCH HOUR last year, Karen Gayhart busied herself piling up the green, plastic pill trays at the health clinic of Great Neck Middle School in Virginia Beach, Va. Scooping out little, round Ritalin or Adderall pills one at a time, she and other clinic workers quickly emptied four of the 30-dose trays into the hands of the adolescents lining up at the office door.

In this public school serving an affluent section of the city, roughly 10 percent of the students were taking highly addictive, mind-altering prescription drugs every morning, noon, and night. All in a controversial effort to improve their ability to settle down and concentrate on learning.

This year, Gayhart handles only two trays. Is that because some of the students' parents, teachers, and doctors have backed away from the drugs, recoiling from the now-familiar news that their community is among those that lead the nation in dispensing psychostimulants to children? Is it because they've heard the studies suggesting Ritalin may cause long-term, genetic-level brain changes in children? Or because they've read the Drug Enforcement Administration warning that high doses of such drugs "often produce agitation, tremors, euphoria, tachycardia, palpitations and hypertension" or that "psychotic episodes, paranoid delusions, hallucinations and bizarre behavioral characteristics similar to amphetamine-like stimulant toxicity have been associated with methylphenidate (Ritalin) abuse"?

Nope. "It's because kids are taking morning doses that last longer," says Gayhart, explaining they don't need to top off at lunch. Carol Flach, who supervises close to 100 nurses in the district, sees the trend in all her schools: Some parents may have stopped giving their children the drugs, she says, but most of the noontime change is attributable to extended-release versions of the drugs.

The experience at Great Neck Middle School neatly illustrates how, nationwide, the drugs used to treat children's Attention Deficit Hyperactivity Disorder (ADHD) have gone from popularity to infamy to stealth. The disorder--estimated by a panel of experts convened by the National Institutes of Health to affect 3 to 5 percent of school-age children--has among its core symptoms "developmentally inappropriate levels of attention, concentration, activity, distractibility, and impulsivity" that can impair a child's functioning at home, school, and with peers. Through the 1980s and early 1990s, many parents who had their difficult-to-control children diagnosed with ADHD reached for drugs such as Ritalin, which appeared in short-term clinical trials to alleviate the symptoms of the disorder.

Soon after finding their way into parents' medicine cabinets, though, the drugs met with a firestorm of controversy when reporters and politicians noticed that the number of prescriptions for ADHD drugs was approaching 20 million per year. Preschool children were being given the drug, news reports said, and some parents were complaining of pressure from schools to put their children on the drugs. All of this despite the fact that the condition which the drugs are meant to treat is the subject of heated dispute among medical professionals, and that the drugs' benefits are limited at best.

There is no diagnostic test for Attention Deficit Hyperactivity Disorder, according to the NIH panel. Its symptoms are the same as those for childhood depression, anxiety, chronic stress, and abuse. The NIH experts add that "further research is necessary to firmly establish ADHD as a brain disorder" and that there are "questions concerning the literal existence of the disorder, whether it can be reliably diagnosed, and, if treated, what interventions are the most effective."

But rather than decline in the face of such uncertainty and controversy, Ritalin use has exploded: 17,618 kilograms of Ritalin and like drugs will be produced this year, up from 14,957 kilos in 2000 and 3,708 kilos in 1992. Attention Deficit Hyperactivity Disorder has become the most commonly diagnosed mental health condition among children in the United States, and over 80 percent of the children so diagnosed take drugs as treatment.

Two potential brakes on the drugs' spread--one legal, one in public-health research--have nonetheless begun to get traction. Republicans in the state legislatures of Connecticut, Michigan, and Virginia have pushed laws restricting their public-school systems from pressuring parents to put their rambunctious children on psychostimulants. Politicians in Minnesota, New York, Texas, and Wisconsin are following suit.