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 adu]ts 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: Patrick Henry