ARE CHILDREN GIVEN RITALIN TOO OFTEN?

DOES anybody ever get the feeling that we're living in a ``Brave New World?''

When I hear government psychiatrists calling for studies ``to determine the
risks and benefits associated with treating children younger than age 5
with stimulants'' I want to call out a loud Valley Girl ``Hellooo!''

Like, how does one rationally respond to the news that children as young as
3 are increasingly being medicated with Ritalin -- despite a clear warning
in the Physician's Desk Reference guidebook against its use in children
under 6 years of age?

I appreciate that there are children whose problems can overwhelm the most
devoted parents' capacity for patience. Whenever I write on the subject, I
am assailed with objections from parents who accuse me of gross
insensitivity. Here is a recent example:

``My older son has been on medication since he was 5 years old. While he no
longer takes Ritalin (due to ``rebound,'' rather than ineffectiveness), he
absolutely requires medication to function in school and at home. It was
not an easy decision to make; however, the alternatives can be school
failure, profound discouragement, peer rejection and constant upheaval in
the child's life.

``You do a great disservice to those of us who struggle with this daily
when you talk of attention deficit disorder (ADD) as if all children
diagnosed with it are equal. Just as all diabetics do not require insulin,
all children with ADD do not require medicine. But for those whose ADD is
severe enough to require medication, withholding it can be as detrimental
as withholding insulin from a diabetic who needs it.''

This is a heartbreaking letter. And I've been in enough classrooms during
the past 13 years to know that there are children who just aren't making
it. For some kids, Ritalin might be the best temporary solution.

But what does it mean when 30 percent of ADD children, according to various
reports, are expected to have this disorder the rest of their lives? Or
that the number of diagnosed children and adults skyrocketed from 900,000
to 5 million in the past decade, and the production of Ritalin
correspondingly rose 700 percent?

`Pathologizing' childhood

I believe it means we're ``pathologizing'' childhood. American psychiatry
has staked its future on medication. Its primer is the Diagnostic and
Statistical Manual of Mental Disorders IV, which Sydney Walker, director of
the Southern California Neuropsychiatric Institute, terms ``a dangerous
book . . . a political document . . . compiled by powerful psychiatrists
who quibble over what constitutes a mental illness and what doesn't.''

Walker, a neuropsychiatrist and author of ``The Hyperactivity Hoax''
($23.95, St. Martin's Press), reports that when a psychology professor gave
students a list of symptoms delineated in the manual on mental disorders,
75 percent of the class fit the criteria for ``borderline personality
disorder.''

There is no agreement on how Ritalin itself works -- or even whether it
does -- despite the hundreds of studies which have examined the drug. In
the past few years, some research has focused on the similarities between
it and cocaine. Spearheaded by Nora Volkow, director of nuclear medicine at
Brookhaven National Laboratory in Upton, N.Y., the research confirms that
while Ritalin stays in the brain much longer than cocaine, it is -- when
administered orally -- not addictive. The route of administration, as
Volkow puts it, is the key factor here.

``The high from cocaine, which is only associated with the initial uptake
in the brain, is of very short duration,'' she explains. ``What happens
when a person injects Ritalin is they can't administer it as frequently
because it stays in the brain so long. The blood pressure goes up, and the
desire to move lasts much longer. Cocaine abusers will say the effects of
Ritalin, when you inject it, are very similar for their mental state. But
(Ritalin) has more physical effects, and because of that they like it less.''

More study needed

Volkow has since turned her attention to Ritalin -- documenting the very
same effects from that drug, when injected, upon the brain. A 1994 study in
Life Sciences, coauthored with Gene Wang, another Brookhaven scientist,
reported ``regional decrements in cerebral blood flow of 23 to 30
percent.'' It is a significant finding, she says, but one -- and this must
be emphasized -- that pertains strictly to injected Ritalin. Questions
nevertheless persist, because no study has ever attempted to disprove that
same effect when Ritalin is given orally.

``I do not know if these profound decreases of blood flow happen (for oral
Ritalin),'' Volkow concedes. ``My guess is it's likely to be much less of
an effect and not a concern, because a child's blood flow to the brain is
very high.''

Volkow says she hopes to do that study soon. She is concerned about what
the results may imply for elderly patients who are increasingly prescribed
Ritalin for depression. Many of these patients simultaneously suffer from
hypertension, arteriosclerosis and other vascular conditions which may put
them at considerable risk when given a drug that constricts blood flow.

``For children, I don't think it's a serious problem because the vascular
system is designed to be able to compensate for shifts in blood
profusion,'' says Volkow. ``But for elderly people with compromised
vascular systems . . . I am concerned.''

What are your questions? Phone (408) 920-5663, e-mail to solo@cruzio.com,
fax to (408) 271-3786, or mail them to Kids' Health, the Mercury News, 750
Ridder Park Drive, San Jose, Calif. 95190.