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Published Friday, December 1, 2000 12:00:00 AM
Reprinted from DailyBulletin.com.
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As our society moves into the 21st century it has become apparent that the American medical community's unique legacy to the science of childdevelopment and child rearing is a potent psychotropic drug. Ritalin is the drug of choice for Attention Deficit Hyperactivity Disorder and every year more of our children are taking it. No other country comes close to ours in Ritalin consumption.
In February of this year an article in The Journal of the American Medical Association documented that in one Midwestern community 1.4 percent of the preschoolers between the ages of 2 and 4 were prescribed Ritalin. "Shocked," "concerned" and "surprised" were just some of the responses by the American medical community. However, it is insincere for anyone in the American medical community to be surprised at the current situation. In fact, while this statistic elicits concern in many of us it does not even meet the expectations of some of the Ritalin "experts" who still talk about ADHD being underdiagnosed.
While ADHD might be one of the most intensively studied pediatric conditions, we still have no proof of any underlying neurobiological deficit. If the parent wants a prescription, the parent will get a prescription; it's as simple as that. If you want proof, read the August issue of The Journal of the American Academy of Child and Adolescent Psychiatry. Scientists found that in one community approximately 50 percent of the children who were receiving Ritalin did not meet the standard medical diagnostic criteria for ADHD.
Scientists can argue all day about the cold hard data collected by statisticians but it also helps to put a name and a face to the numbers. For every child who I could hold up as an example documenting Ritalin abuse, the pro-Ritalin advocates would simply say that I have found an isolated anecdote that means nothing. So let's take the case study of a child who the Pro-Ritalin advocates feel should be medicated. It tells us volumes about why we have an epidemic of Ritalin use in this country."Sarah, 14, chooses to sit in the back of the classroom and much of the time she's doodling in her notebook or staring out of the window. She seldom completes assignments and often forgets to bring the right books to class. Her desk is a mess and she generally can't find what she's looking for. Then she gets weepy and says that nobody understands her."
Sarah's story is on the web site of the Department of Psychiatry at New York University. According to the experts at NYU her diagnosis is ADHD, and the treatment of choice for her is Ritalin. This little girl is crying out, "Please understand me!" and the American medical community's response is, "Medicate her."
Is Ritalin quick, easy and cheap? Yes. Will it work? Probably, if by work you mean make her easier to control. But the real question is, will it help her?
You be the judge - but first put yourself in her shoes. A girl crying out for help who ends up with a prescription for a mood-altering drug says much more about how as adults we treat children then it says about "neurobiological deficits" in our children.
The medication of Sarah and millions of other children is an experiment run amok. The National Institute of Mental Health is planning to spend $5 million to investigate the safety of these drugs in children as young as 3. What responsible parent, doctor or government is going to volunteer a 3-year-old child for this experiment? Probably not the British; they are talking about banning these drugs for their children under 5 years old.
If you think you have ADHD you can take a test at http://www.med.nyu.edu/Psych/public.html . The test has twelve questions which require a simple yes or no. Examples of the questions include, "Is it hard for you to get organized?" or "Do you have a hard time starting tasks or projects?" If you answer yes to a single question you are advised, "Based on the above answer you may be experiencing symptoms that may be a part of ADHD." As you scroll down the page you are told, "The test is designed to give a preliminary idea about the presence of ADHD symptoms that indicate the need for an evaluation be a psychiatrist."
After all the money and time spent studying this so-called disease, is this the best the experts can do? A test that anyone living and working in the modern world would certainly fail.
The real question here is, "Does this test sound like good marketing or good science?" To be very blunt: The test is a silly gimmick which might be good for business, but it has nothing to do with science.
The debate about the use of Ritalin and other psychotropic drugs for children urgently needs voices from other fields. The medical bio-ethicists, whose voices are often heard when the topic of genetically altered tomatoes is discussed, are somehow silent when the topic of normalizing children with psychotropic drugs is discussed. They are ignoring this debate at their own peril.
American physicians prescribe 90 percent of the Ritalin produced worldwide, and the experts defend these prescriptions in the name of "science." Yet it is hard to take these same experts seriously when they give us a test like the one described above. For too long the American medical community has listened to a small group of "experts" who believe that upwards of 3 percent, 5 percent or even 10 percent of our children have broken brains.
If the American medical community wants to reverse this trend it needs to stop asking, "What is wrong with our children?" Instead it needs to look in the mirror and ask, "How have we come to believe that it is acceptable to medicate children so that they can make it through the school day?"
The question is a matter of ethics and not science.
- Jonathan Leo is associate professor of anatomy at Western University of Health Sciences in Pomona.
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