CRITICS' OBJECTIONS GROW AS RITALIN USE INCREASES

DALLAS -- Chris Davis misses his mom.

As he sat with Glen Pearson, a Dallas school district psychiatrist, he
talked about how she died last spring from breast cancer -- and how much he
loved her.

Since her death, 12-year-old Chris has struggled emotionally and gotten in
trouble repeatedly at school.

"He wants to get into it with the other kids," said the boy's father, Larry
Marshall. "He's hyper."

Pearson decided that Chris needed counseling -- and a prescription for Ritalin.

In use for a quarter-century to treat attention deficit/hyperactivity
disorder, Ritalin has soared in popularity in recent years -- largely,
advocates say, because of greater public awareness and better diagnosis.

In 1998, the latest year for which figures are available, roughly 716,000
Ritalin prescriptions were written in Texas, according to the Department of
Public Safety. That's up from about 192,000 in 1990.

Many doctors, parents and educators swear by Ritalin as a safe and
effective treatment that allows many children to succeed in school for the
first time.

But these days, critics are speaking out louder and louder. They say ADHD
is an inexact diagnosis made on children who have a wide range of problems.
They also believe that Ritalin, a potent stimulant, can have troubling side
effects, including insomnia, decreased appetite, stomachaches and
headaches. And, they say, resorting to drugs to control unruly children
doesn't address underlying behavioral or academic problems.

Dr. Timothy Robertson, a psychiatrist at Luther Hospital and Midelfort
Clinic, has heard and examined the pros and cons of Ritalin.

For him, the bottom line with the drug is that it be used carefully and
properly, he said.

That requires taking the time to accurately diagnose a child, which,
Robertson believes, requires a careful history of the child and gathering
information from the family and school. Careful follow-up, with attention
to side effects, is crucial, he said.

Last fall, the Texas Board of Education heard impassioned testimony from
Ritalin supporters and critics, and then narrowly passed a resolution
expressing concern about the drug.

"There are documented incidences of highly negative consequences in which
psychiatric prescription drugs have been utilized for what are essentially
problems of discipline," states the resolution, which estimates that 1
million Texas students take Ritalin or related drugs.

State school boards in at least four other states -- Arkansas, Colorado,
Maryland and Pennsylvania -- also recently have held hearings on the drugs.

Mental health advocates are scrambling to head off what they see as
mounting opposition to ADHD as a diagnosis and Ritalin as a treatment.

There is a "nationally organized, well-financed ... public disinformation
campaign designed to ban the use of psychotropic medications in school and
label ADHD and other childhood mental illnesses as frauds and lies," said
E. Clarke Ross, chief executive officer of Children and Adults with
Attention Deficit/Hyperactivity Disorders.

"The critics always spotlight a handful of children who have experienced
significant complications or side effects from medication," he said. "But
what about the millions of children who have been helped by medication?"

In 1999, 10.6 million Ritalin prescriptions were written in the United States.

"If a child has ADHD and has a good response to Ritalin, you find that it
can be very hard to help them do well without it," said Robertson, of
Luther/Midelfort.

Robertson writes a prescription for Ritalin "multiple times a day," he said.

Medical associations recently have issued statements saying Ritalin and
related drugs are safe when taken properly. The medications are "by far the
most widely researched" treatments for ADHD and can "result in immediate
and often dramatic improvement in behavior," according to the American
Psychiatric Association.

The American Medical Association says "there is little evidence of
widespread overdiagnosis or misdiagnosis of ADHD or of widespread
overprescription" of Ritalin and similar drugs.

The U.S. Surgeon General's Office, in a 1999 report, called Ritalin and
related drugs "highly effective" for 75 to 90 percent of ADHD sufferers.

However, such endorsements from the medical establishment have not allayed
the concerns of Ritalin's detractors.

Last year, a lawsuit was filed in South Texas against Novartis
Pharmaceuticals Corp., the manufacturer of Ritalin. Also named as
defendants were the American Psychiatric Association and Children and
Adults with Attention Deficit/Hyperactivity Disorders.

The plaintiffs -- parents whose children took Ritalin -- said they wouldn't
have allowed the "drugging" of their children if they had known that ADHD
was "an extremely subjective and broad" diagnosis.

The suit, one of four recently filed across the country, accuses the
defendants of promoting the diagnosis of ADHD to boost Ritalin sales and
failing "to warn of the serious side effects associated with Ritalin use."

The lawsuit is pending in federal court in Brownsville, Texas.

Lawyers for the plaintiffs are seeking class status so other people could
become plaintiffs.

As many as 2.6 million school-age children in the United States have ADHD
- -- or about one per classroom, according to the National Institute of
Mental Health.

Dallas school district officials aren't quick to recommend Ritalin and
related drugs, said Pearson, director of mental health care for the
district's nine Youth and Family Centers. The centers are clinics on school
campuses that offer medical and mental health services.

Ritalin is prescribed only as part of an overall treatment plan that can
also include counseling, impulse management and social-skills training,
Pearson said.

"It's never an only treatment, and it should almost never be a first
treatme nt," he said.

Schools become involved in Ritalin treatment because the drug is usually
taken two or three times a day, including once at school.

Medical personnel there are responsible for keeping custody of the
medication and dispensing it.

Only 22 percent of the 3,411 students who received mental health services
from the district last year were placed on Ritalin, said Jenni Jennings,
executive director of the Youth and Family Centers.

"Many kids with hyperactive behavior are not actually hyperactive," she
said. "They are suffering from depression and anxiety."

Dr. Mary Ann Block, a Hurst osteopathic physician who is a Ritalin
opponent, operates a clinic that treats attention and behavior problems
without drugs. She says that low blood sugar, allergies and nutritional
deficiencies often are the root of problems labeled as ADHD.

"Today, ADHD has grown into an industry," she writes in her book "No More
Ritalin." "Doctors, pharmaceutical companies, psychologists, psychiatrists,
neurologists, pediatricians, family practitioners, tutors and schools all
own a piece of this industry."

Some parents say they were reluctant to place their children on Ritalin but
had no success with other treatments.

"We tried natural products," said Brenda Weikel of Rockwall, Texas, whose
13-year-old son began taking Ritalin in the first grade. "We tried no
sugar. Medication was the last resort.

"Now he's doing very good," she said. "When he brought home his report card
this last six weeks, it was the first time he didn't have anything lower
than a B. He was so excited."

Her two other sons, ages 11 and 15, also take Ritalin.

"It helps me," said her youngest son, Krystofer Foster. "Last year when I
didn't take it, I kept on getting my name on the board every single day. I
had too much energy, and I kept acting up.

"This year, when I started taking it, I didn't always have my name on the
board," he said. "It calms me down, and it helps me to where I don't do
anything bad."

The growing debate over Ritalin underscores the heightened awareness that
schools have over students' mental health, said Dr. Howard Adelman,
co-director of the Center for Mental Health in Schools at the University of
California at Los Angeles.

"There are a series of major factors -- barriers to learning -- that need
to be fully addressed, and schools have to play a meaningful role," he said.

"If you don't address them directly, you haven't gotten the kid engaged in
learning."

Knight Ridder News Service The Leader-Telegram contributed to this report.