PAY ATTENTION

Who really benefits from drugs given to hyperactive children?

A WEEK ago, a panel of experts met in Washington DC to hammer out a
consensus on one of the most extraordinary drug phenomena of our time---the
massive surge in the use of Ritalin to treat children with attention
deficit disorder and the related attention deficit hyperactivity disorder.

The statistics are staggering. Since 1990, the number of American children
and adults thought to be taking drugs for these conditions has leapt
sevenfold and now stands at around 4 million. In some schools, 15 per cent
of children are diagnosed as having ADD or ADHD, and regular Ritalin
handouts have become a daily feature of classroom life. And while other
countries have yet to embrace the drug with quite such enthusiasm, some are
heading the same way. In Britain, the number of Ritalin prescriptions is
doubling every year.

Unfortunately, the panel was on a hiding to nothing. For the bleak truth is
that there is no consensus about Ritalin---nor even about the clinical
validity of the conditions it is prescribed for. Ask a dozen psychiatrists
and you'll get a dozen different opinions about the Ritalin explosion and
sharply contrasting views on whether the drug is being prescribed too freely.

Search the Internet and you'll come across thousands of sites offering
parents and teachers conflicting advice. Newspaper and magazine articles
tell of parents and children whose lives were apparently transformed by the
drug---as well as other families who fought on without it, and eventually
saw their seemingly uncontrollable children triumph.

Feelings run high, but solid, unequivocal data that can cut through the
mass of personal testimony and prejudice are few and far between. Ritalin
is, after all, an amphetamine-like stimulant which can be abused at high
doses. And despite decades of research, nobody really understands what
causes ADD or ADHD. There are some results that suggest certain genes may
predispose children to the conditions, but the link is far from conclusive.
And while brain imaging studies indicate that children with ADHD may have
sluggish frontal lobes, this does not help much because frontal lobes are
involved in so many aspects of behaviour and learning.

As a result, we are left without blood tests or brain scans that can
provide unequivocal evidence. Diagnosis must rely entirely on assessments
of behaviour. And the problem here is that many of the symptoms---such as
restlessness and impulsiveness---are found to some extent in all young
children.

What makes the explosive growth in the use of Ritalin even more problematic
is that while the drug clearly calms hyperactive children down and makes
them easier to deal with, there is no evidence that it helps them achieve
more at school. In studies that monitored children in the US for up to 14
months, for example, the drug made little or no difference to either
academic performance or social skills.

Such findings will be grist to the mill for Ritalin's gainsayers, who have
long argued that the drug simply makes children docile, while creating the
risk of long term damage to brain chemistry. The way they see it, the
people who really benefit from Ritalin are the teachers, parents and her
children in the classroom, not the children who are actually taking the
risks.

Many critics go further still, arguing that ADD and ADHD are bogus
conditions that mask emerging cultural problems. Certainly, the world is
awash with information and distractions for children, and while parents'
aspirations for their offspring have never been higher, many have little
time and energy to spend nurturing them. Most children probably have fewer
opportunities to let off steam than their parents did. And in the climate
of the past decade, nobody should be surprised if people have become more
willing to blame emotional problems on brain chemistry and genes rather
than, say, poor parenting and schooling.

Such factors may help to explain the suddenness of the ADD epidemic, but
they cannot be the whole story. A couple of decades ago, many doctors were
reluctant to accept that young children could suffer from depression. Today
that view seems absurd.

Ritalin is not a miracle substance that will transform the fortunes of
every hyperactive, fidgety kid on the block. But nor is it a crude chemical
cosh that guilt-ridden parents and teachers are using in place of
counselling and discipline to control what is really nothing more than
youthful exuberance and boisterousness. For some children, the drug can be
a godsend. The problem is knowing which ones to give it to, and where to
draw the line in doling it out.

Checked-by: Richard Lake