THE DRUGGING OF OUR CHILDREN
Over-diagnosis Leads to Over-prescription of Ritalin
February 8, 1997
Ritalin is over-prescribed as a medication for the treatment of supposed attention deficit/hyperactivity disorder in our children nowadays. Ritalin (also known by its generic name of methylphenidate) use has at least tripled in the past 5 years (1990-1995) and some studies suggest use is up an astounding 500%. Some psychiatrists and doctors are quick to explain away this increase as being due to a greater understanding of attention deficit/hyperactivity disorder (ADHD) and a greater acceptance amongst parents of the effectiveness of Ritalin as a proper and useful treatment.
There's no doubt in my mind that Ritalin is a useful and effective treatment for ADHD in children. There is a good body of research to back up its use for these disorders. But the research doesn't address the current phenomenon -- over-diagnosis of ADHD in children. Americans have a tendency, more than any other nation on this Earth I think, to want to pathologize behavior which they do not understand or which they have no patience for. If an older parent starts getting more cranky or forgetful, many people's first reaction is to say, "Oh, he must be getting Alzheimer's!" People's first reaction typically isn't to attribute the problems to general, normal signs of aging.
The same is true in the diagnosis of ADHD. Too many clinicians nowadays are too quick to diagnose ADHD in children based mainly (and often times solely) on the parents' description of the child's behavior. Since when did the parents become objective, third-party reporters of such information? Information from parents is necessarily biased toward their inclination of what they believe the problem is. Their description of their children's behavior, therefore, is likely to reflect their beliefs in any interview with an intake worker or clinician. This is Psychology 101, folks.
Many professionals in the field are very much aware of these biases and go to great lengths to ensure their diagnosis is based upon as much information as is readily available, including an interview with the child in question, the child's siblings, and often the child's teacher(s). This is not going too far. With all of this information in hand, only then can a fairly accurate and unbiased diagnosis be made. Further questions should result in some simple psychological testing which can also point to possible indicators of ADHD.
Instead of this, though, in our managed care environment today, clinicians have little time for extra information gathering and often aren't aware of the inherent psychological biases involved in the parents' reports of the child's behavior. They have to make diagnoses quickly, and often times in the case of ADHD, sloppily. They gloss over the DSM-IV criteria (which require the behaviors in question to be both maladaptive and inconsistent with current developmental level and will quickly check off 6 out of the 9 symptoms listed to get to the diagnosis. This type of diagnosis, not ADHD itself, is what likely causes the over-prescribing of Ritalin today. Often pressure is brought upon the clinician by the parents for a quick ADHD diagnosis. Soon after, a request for Ritalin follows.
Dr. Christian Perring of the University of Kentucky questioned the use of Ritalin in November, 1996, at The Third World Congress of Bioethics held in San Francisco. "According to Dr. Perring, the drug is currently prescribed to one out of every 20 young boys in the United States, and its use in children has jumped sharply in the past decade. Dr. Perring claims that the absence of specific criteria for ADHD makes many of these diagnoses unreliable and leads him to believe that this drug is being overprescribed. He also believes that trials should be conducted to determine whether more attention and discipline from parents and teachers could provide as much, if not more, help to some of these children. " (Reuters)
Dr. Lawrence H. Diller, an assistant clinical professor in UCSF's division of behavioral and developmental pediatrics, reported in the March/April, 1996 issue of The Hastings Center Report that "many of these factors [attributable to the rise in Ritalin prescriptions] are more social, cultural and economic than neurologic. I think the major factor is the educational pressure, followed by the pressures on parents." Dr. Diller believes Ritalin is often prescribed for convenience - it's easier, and sometimes cheaper, to prescribe a pill than attend family counseling or special education programs. Researchers with the National Toxicology Program, a branch of the National Institutes of Health, have "...uncovered a sign that the widely used children's drug Ritalin might cause cancer in mice," in January of 1996, when the mice were prescribed up to 30 times the normal equivalent dose in humans. (Reuters)
We should not be ignoring these warning signs. Ritalin use is not the answer to teenagers who are acting out. ADHD is a serious childhood mental disorder which should only be diagnosed in children who warrant it. Parents should not look to use this diagnosis as a means of bringing an active teenager in greater parental or teacher control. As with any mental disorder, great care should be used in the assessment of, and subsequent treatment of it.
ADHD in our society today is over-diagnosed which leads to the over-prescription of a powerful and potentially harmful stimulant. This does not discredit the need of Ritalin in the treatment of those children who truly suffer from serious, debilitating ADHD. But clinicians, parents and teachers should all be more careful and discriminating when thinking or suggesting that child has ADHD simply because he or she has energy, is active or thinks independently.
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Last reviewed: By John M. Grohol, Psy.D. on 27 Jan 2007
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