UNRAVELING THE RITALIN RIDDLE IN A FIDGETY CULTURE

The Office of Drug Enforcement estimates that by 2000, fully 15
percent of school-age children will be taking Ritalin for something.
The question remains, "For what?" - brattiness, boredom, reluctance,
defiance? Whose attention is truly deficient - kids' or parents'? (Or
both?) Lately more adults are appropriating the diagnosis, using it
to retroactively explain their own disappointments in life.

Few people familiar with Ritalin are neutral about it. A milder form
of speed and structurally kin to cocaine, Ritalin is used to treat
attention deficit disorder, a grab bag of unruly behaviors that
interfere with some children's ability to learn and obey.

Once called ADD and now ADHD to include hyperactivity, the disorder is
fully as controversial as its treatment. At one extreme are exhausted
parents who believe family life would be unlivable without Ritalin;
their enthusiasm is shared by those who profit from the 700 percent
increase in sales since 1991, including its manufacturer, which
quietly contributed nearly $1 million dollars to ADHD support groups.
Critics fear a generation of kids drugged into compliance instead of
developing internal resources; they blame the psycho-medical
establishment for pathologizing yet another human problem, and point
to the lack of clear biological evidence that ADHD exists at all.

Between the opposing shores is a roiling sea of confusion. There's
little doubt that Ritalin works - it is a powerful drug, after all -
but no one knows why. How can a stimulant calm a "hyperactive" child,
anyway?

Advocates claim it is "paradoxical," that Ritalin "activates the
inhibitor," a vague calming mechanism presumed to reign in the seat of
volition, the frontal cortex.

Detractors note that since Ritalin increases focus in all kids, it's
not treating any special disorder. The official psychiatric diagnosis
requires a behavior checklist, including "not remaining seated when
expected to do so" (Criterion A2b) and "having difficulty awaiting
one's turn" (A2h).

Since the verdict turns on the perceived frequency of transgressions,
it's easy for frazzled caretakers and sympathetic helpers to confer
the subjective diagnosis - and no laboratory tests to prove them wrong.

One thing is irrefutable: The suffering of families wrestling with
their kids' maddening behavior. Many devoted, careful parents struggle
for years to differentiate "can't" from "won't"; finally baffled by
the self-defeating behavior of their otherwise good and intelligent
kids, they're relieved to blame a neurological glitch.

In this they get passionate support from "Understanding ADHD" by
Christopher Green and Kit Chee (Ballantine, 320 pages, $12.95), which
claims to be "The Definitive Guide" but is packed with muddy
assertions: "There is controversy only in the media, not in reputable
professional circles," and "academics ... only see what they read in
books, while we have to cope with the variables of real life." (One
breezy heading is "Reality before Science.")

Stretching the loose diagnostic net to include "behavior out of step
with parenting," the authors warn that, without Ritalin, ADHD "can
drag clever parents and children down the social and financial scale."

Such achievement concerns are indicted in the thoughtful "Running on
Ritalin" (Bantam, 386 pages, $25.95), where pediatrician Lawrence
Diller worries that Ritalin is being cynically prescribed to narrow
the gap between IQ and performance in a kind of "cosmetic
psychopharmacology."

Alarmed by the increasing demand for a drug whose long-term effects
remain unknown, he demonstrates how contributing psychosocial factors
- - family dynamics, attitudes toward free will and responsibility,
marital dysfunction - are trampled down in the stampede to make kids
successful: "Should we, even with the best intentions, force kids into
academic and career paths not well-suited to their personalities and
abilities, and then medicate them to raise their motivation?"

Pace, not pride, is the true architect of "Generation Rx" in the
provocative "Ritalin Nation: Rapid-fire Culture and the Transformation of
Human
Consciousness" by Richard DeGrandpre (Norton, 284 pages, $23.95), where ADHD
results `from our growing addiction to speed and excitement."

Constantly bombarded and increasingly jaded by ever-faster, brighter
and bigger stimulation, and lacking the unplugged ability to amuse
themselves and tolerate stillness, some kids need the bounce of
Ritalin just to maintain a basic level of interest: "Studies have
documented how (ADHD) children turn into normal children under
sensory-rich conditions ... and how these children begin to fall apart
when the sensory stream begins to fade."

Fidgeting, an official symptom of ADHD, can be interpreted as self-
stimulation to jazz up slowness, an alien and uncomfortable state. An
eighth-grade teacher puts it simply: "Kids are restless because they
don't have anything inside. They're so used to being
entertained."

As a college professor seeking an updated Abnormal Psychology text, I
received a dozen crackling new ones designed for the attention span of
today's students. Full of jangly, Web-ish insets and colors, only one
trusted readers to endure two paragraphs of text without a summary and
perky sidebar about some celebrity, scandal, or psychological X-file -
which is a lot like TV news, when you think about it.

DeGrandpre addresses the harried hurried of every age when he asks,
"Can you sit still, and if so, can you do it comfortably and
regularly?" Claiming that "attention-deficit behavior is more
prevalent and getting worse, but it's not because any brain disorder
has been found," he prescribes "deliberate living" as the antidote.
His suggestions for easing the daily pace are comprehensive and
sensible, but will not satisfy those seeking a quick fix - which is
precisely his point.

As things stand, it appears that Ritalin is medicating a host of
character traits, rather than any biological disorder. The psychiatric
bible, DSM-IV, cites "bossiness" and "stubbornness" as signs of ADHD,
saving another affliction for the truly spiteful: ODD (Oppositional
Defiant Disorder), which labels kids who "often deliberately annoy
people" and "argue with adults."

Do we really need more personality "diseases"? Somehow we survived
1984 without fulfilling every Orwellian prophecy (although public
videocams do resemble telescreens, and afternoon TV get-'em shows are
fully as cathartic as the Two-Minute Hate). But Aldous Huxley's
prediction of universal drugging may be coming true, given the
increasing popularity of instant physical solutions - everything from
jumbo lattes and Viagra to liposuction. At this rate, Ritalin may well
become the soma of our brave new world.