Ritalin and Its UsesIn recent years, more and more kids seem to be on a prescription drugcalled Ritalin(methylphenidate). This drug is being handed out more and more bydoctors as a way of treating Attention Deficit Hyperactivity Disorder, a complexneurological impairnment that prevents kids from concentrating. According tothe Drug Enforcement Agency, it rose fron 200 grams per 100,000 people to over1400 grams per 100,000 people in the last fifteen years. The National Instituteof Mental Health estimates that about one student in every classroom is believedto experience the disorder. The rate of Ritalin use in the United States is atleast five times higher than in the rest of the world according to federalstudies.
Are doctors just catching this disabling affliction more often? Ordoes society just want a convenient way to solve a complicated problem. Ritalin is a central nervous system stimulant that is somewhat similarto amphetamines. It was created in 1955, classified as a controlled substancein 1971, and became the drug of choice for ADHD in 1981. It is also used intreating narcolepsy. It is thought to activate the brain stem arousal systemand cortex, and, like cocaine, works on the neurotransmitter dopamine.
Itappears to increase the levels of dopamine in the frontal lobe where attentionand impulsive actions are regulated. When taken in its intended form under adoctor’s prescritption, it has moderate stimulant properties. There has been agreat deal of concern about it’s addictive qualities and adverse affects. ADHD is a relatively new disorder. It was introduced in 1980, where itwas labeled ADD(attention deficit disorder).
In the 1950’s, children weresimply labeled “hyperkinetic. ” The term “hyperactivity” was added in 1987,hence the name ADHD. Not all children have the hyperactivity, and thus arelabeled to have ADD. ADD is not treated with Ritalin; antidepressants are morecommonly used.
One of the problems with the label ADHD is that just because achild may be overly hyper, doesn’t mean the child is not paying attention. Theproblem is, the child is paying too much attention to too many things at thesame time. ADHD is children’s #1 childhood psychiatric disorder. The prevalence isthree times as likely in boys than girls. The children tend to be very bright,but are poor students because they cna’t settle down.
They blurt questions outbefore they are asked. They can’t wait their turn, stop fidgeting their legsand tapping their pencils. They tend to be forgetful, have problems followingdirections, and lose things easily, as well as their tempers. This behavioroccurs constantly.
This may be a reason why teachers and school psychologistsare adament in their beliefs; these kids are disrupting their classrooms, sothey want the problem solved immeditately, and take the “quick fix” approach. Experts believe that more than two million children (3-5%) have the disorder. Some scientists believe ADHD is a result of a problem in pregnancyranging from fetal alcohol syndrome to exposure to lead in utero. Otherssuggest that ADHD is hereditary. Dr. Russel Barkley, of the University ofMinnesota reports that nearly half the ADHD children have a parent, and morethan one third have a sibling, with the disorder.
Ritalin as prescribed is taken orally, and takes effect in about 30minutes and lasts for about 3-4 hours. Kids usually take 5-10 mg doses threetimes a day. Although many experts report that Ritalin is a positive treatmentin 9 out of 10 patienst, and many parents and students claim the drug is abenefit in their lives’, there are many who question the drug’s long-termeffects, dangers, misdiagnosis, and non-medical abuse. Diagnosis forADHD isn’t as easy as you think. There is no blood test, no x-ray, or no catscan to determine a biological cause for the disorder. Teachers, even inpreschool strongly advocate the drug(negative reinforcement???).
Schoolpsychologists are even prescribing the drug before giving an evaluation becausethere are so many referrals and a lack of school psychologists (1:2100 students). Many times, it has been shown, that psychiatrists who often diagnose for ADHDin children, are disdiagnosing disorders similar to ADHD such as learningdisabilities, depression or anxiety disorders; disorders that do notneccessitate Ritalin as a therapy. Some doctors who are reluctant to prescribeRitalin find that the childeren’s parents just switch doctors and find doctorswho will. Unfortunately, this is surprisingly easy.
Doctors surveyed by theArchives of Pediatric and Adolescent Medicine said they send ADHD children homein about an hour. The children are not only sent home with just a prescription,but rarely any follow up care of additional therapy is adnministered. Expertsin the field of ADHD say behavior modification techniques and extra help inschool is a better way in treating the disorder. Since it takes time to sitdown and go through therapy sessions, and it takes time for parents to fit tisall into their lifestyle, a pill is much more convenient. There are no longterm studies on the effects that it has on children, so many fear whatcomplications may occur later on in life.
Correct diagnosis would occur if doctors would take the time to providea complete examination of the patient. To make a correct ADHD diagnosis, it isimportant to review the child’s family history, give abstract cognitive tests,observe their behavior, and run a slew of behavioral exams. Other disordersmust be ruled out first. Parents need to make sure a complete evaluation iscarried out before putting a pill in a child’s mouth.
One would think thatevery parent would explore every option before relying on medication only. Diagnosis would also be much easier if doctors could find a flaw in thebrain. Several studies have shown that ADHD brains look and function slightlydifferent that “normal” brains. PET(positron emission tomography) has shownthat ADHD brains use less glucose in the prefrontal lobe. The prefrontal lobeis the center for impulse control and attention. By using less glucose-orenergy, this would then agree with the child’s behavioral problems.
Other testsshow that there is less electrical activity in the same region of the brain. Nonetheless, these studies have not yet been proven to be the cause for thedisorder. Many people are concerned with the non-medical use of Ritalin, also. Ritalin is a Schedule II controlled substance, which means it is a very powerfuldrug, and in the same category as cocaine, methadone, and methamphetamines.
TheManufacturer of Ritalin, Ciba-Geiby Corporation, cautions doctors that manyadverse side effects are possible under normal dosage such as: nervousness,insomnia, decreased appetite, nausea, vomiting, dizziness, heart palpitations,headaches, rise in heart rate and blood pressure, skin rashes, itching,abdominal pain, weight loss, digestive problems, toxic psychosis, psychoticepisodes, and severe depression upon withdrawal. Many question if such a drugshould be so freely handed out to children because of it’s possible dangerouseffects. Parents are even trying to lessen the restrictions on Ritalin so theywon’t have to make monthly doctor visits. It’s rise on the black market has also been increasing. Since it is sowidely available, many kids sell the pills for 3-15 dollars a pill. The buyersthen crush up the pill and snort it, giving an intense high similar to cocaine.
Some also dissolve it in water and inject it intravenously. In these forms, itis highly addictive, and withdrawal symptoms are also similar to cocaine. Someof the side effects at these high doses may be life threatening: loss ofappetite(may cause serious malnutrition), tremors and muscle twitching, fevers,convulsions, and headaches(may be severe), irregular heartbeat andrespiration(may be profound and life threatening), anxiety, restlessness,paranoia, hallucinations, delusions, excessive repetition of movements andmeaningless tasks, and formicaton(sensation of bugs or worms crawling under theskin). It seems to be abused by high school kids and college studentspredominantly. Although the drug is too complex to manufacture illegally, andit doesn’t create the euphoric effect that cocaine has, it seems to be an aid instudying for final exams. It allows students to stay up all night allowing themto cram much easier.
It is important to remember that too many children in America aresuffering from this ailment, and yet too many kids are getting pills instead ofproper care. Although Ritalin currently seems to be an effective way intreating Attention Deficit Hyperactivity Disorder, we must not treat thisdisorder hastily. Our society must realize that prescription drugs can havejust as many complications as street drugs. Befor writing out a prescription,or carelessly diagnosing ADHD, we must remember that these are kids we aredealing with. They put all their faith in us to help them, and not just tomedicate them.
