This is the first of a three-part series on the controversies surrounding Ritalin, the frequently prescribed drug for childhood attention disorders
(CNSNews.com) - Prescribing Ritalin is not an exact science, one pediatrician admitted, but patients are normally helped rather than hurt by its use, and tales of abuse are exaggerated.
Not true, say critics of Ritalin and Attention Deficit-Hyperactivity Disorder, which doctors use as a basis for prescribing the stimulant. Referring to federal statistics, those critics charge Ritalin abuse levels have soared in the past few years.
Not only does the U.S. Drug Enforcement Agency classify Ritalin with cocaine and amphetamines as a Schedule II drug, but the use of such medication in children for a disorder that is basically a "fabrication" of the medical community is comparable to "disabling their brains," according to one physician with more than 30 years experience.
"Ritalin is harmful to the brain, and to overall growth," Dr. Peter Breggin said. "Ritalin addiction is becoming increasingly problematic ... and ADHD is a completely fabricated diagnosis with no medical or psychological basis to it."
Still, others in the same field as Breggin view Ritalin in a more positive light.
"There's a good response to [Ritalin]," said Dr. Bruce Meyer, a pediatrician with 30 years' experience who now works with the Columbus Children's Hospital in Ohio. "For the child who is defined by the criteria as having [an attention deficit disorder], there's a tremendous and remarkable success, so the child is able to function in school and function with peers."
Meyer is a general pediatrician, but he also works in the behavior and learning disability area, which means he "sees these kids" with attention disorders "all the time."
Confident in his personal ability to diagnose Attention Deficit-Hyperactivity Disorder, Meyer also admitted that between one and three of every 10 children referred to him for additional analysis and possible treatment are improperly suspected of having ADHD.
"Some come from the parent, some come in from the teacher," he said, adding that he did not know whether those to whom he refused Ritalin were later given the drug by different doctors.
It's a difficult disorder to identify, according to Meyer, so some children are erroneously referred for Ritalin treatment. However, by using proper testing, children can be accurately diagnosed, he said.
Meyer said he performs a complete evaluation of the patient's home and school life, incorporating the opinions of teachers, administrators, parents, clergy, and relatives into any decision to prescribe Ritalin.
"You spend a fair amount of time with the family and child," he said. "The family needs to supply information about [the student's behavior at] school as well as any other information. You put all that together, because there is no specific one test," and then the diagnosis can be made.
Therein lies the problem, according to critics of Ritalin and the diagnosis of ADHD.
Because the diagnosis depends entirely on the perceptions of behavioral abnormalities, opponents say, the margin for error is too wide. Some also accuse the medical field of fabricating the entire syndrome known as ADHD.
"It's not as acute as the numbers would indicate," Meyer said about the apparent explosion of ADHD and Attention Deficit Disorder diagnoses in the past decade. "But the diagnosis of this disorder has been going on over 30 years. It's been called other things, though, [like] minimal brain dysfunction, minimal brain damage."
Still, Meyer acknowledged some critics of Ritalin have a basis for argument; ADHD is "over-diagnosed," he admitted, with an estimated "five to 10 percent of kids in any school" branded with the attention disorder. Guidelines released just months ago, however, should help clarify the diagnosis procedures, he said.
The American Academy of Pediatrics released a report in May, explaining the diagnosis and evaluation procedures to use with patients between the ages of 6 and 12 who are suspected of having ADHD.
Prior to that report, doctors prescribed Ritalin based on information they had gathered from individuals close to the child who could prove he or she was too inattentive in formal and social settings to be considered normal, and was otherwise hyperactive, impulsive, failing in school, and displaying other behavioral problems.
The AAP has yet to release the follow-up to that report, which will detail the treatment methods for those with ADHD.
"First we had to develop diagnostic guidelines, and those were released earlier this year," said Sheryl Cash, with the public affairs department of the AAP in Illinois. "Then, we felt we had to develop treatment guidelines. We're working on that now. They should be completed within a year."
Diagnostic criteria for ADHD in children, according to the AAP's May report, includes an assessment of six or more symptoms of inattention, hyperactivity, and/or impulsivity that have continued for six months or longer in at least two social or formal settings, such as home and school.
The report said if a child often "makes careless mistakes in schoolwork," "does not seem to listen when spoken to directly," "has difficulty organizing tasks," "avoids, dislikes, or is reluctant to engage in tasks" such as schoolwork or homework, becomes "easily distracted by extraneous stimuli," and is "often forgetful in daily activities," he or she could possess an attention and hyperactivity disorder, if those symptoms are present in a way that is determined "inconsistent with developmental level."
Other signs indicating a potential disorder are if the child - to a degree considered abnormal - fidgets with his/her hands or feet, leaves his/her classroom seat unexpectedly, runs and climbs "excessively" in "inappropriate situations," has difficulty playing quietly, talks "excessively," "blurts out answers before questions have been complete," shows difficulty waiting for his or her turn, "often interrupts or intrudes on others," or behaves in an over-active manner.
While the AAP works to complete its treatment report, opinions and research findings on the safety of Ritalin - methylphenidate - continue to vary.
"It's not addictive," Meyer said, "but it can be abused. But for the routine day-to-day practice of treating kids ... it is a safe medication."