RITALIN IS BEING dispensed with a speed and nonchalance compatible with our drive-through culture, yet entirely at odds with good medicine and common sense.
The drug helps some people pay attention and function better; some of my own patients have benefited from it. But too many children, and more and more adults, are being given Ritalin inappropriately.Psychiatry has devised careful guidelines for prescribing and monitoring this sometimes-useful drug. But the dramatic jump in Ritalin use in the past five years clearly suggests that these guidelines are being ignored and that Ritalin is being vastly overprescribed.
The problem has finally been recognized by medical groups such as the American Academy of Child and Adolescent Psychiatry, the American Psychiatric Association and the American Academy of Pediatrics, which have written or are developing guidelines for diagnosing Attention Deficit Hyperactivity Disorder; and even the manufacturer of Ritalin, which issued similar guidelines to doctors last summer.
Under the pressure of managed care, physicians are diagnosing ADHD in patients and prescribing them Ritalin after interviews as short as 15 minutes.
And given Ritalin's quick action (it can "calm" children within days after treatment starts), some doctors even rely on the drug as a diagnostic tool, interpreting improvements in behavior or attention as proof of an underlying ADHD - and justification for continued drug use.
ADHD exists as a disorder primarily because a committee of psychiatrists voted it so. In a valiant effort, they squeezed a laundry list of disparate symptoms into a neat package that can be handled and treated.
Many people have ADHD symptoms that have nothing to do with their nervous systems and result instead from emotional distress, depression, anxiety, obsessions or learning disabilities.
For these people, who exhibit the symptoms of ADHD but suffer from some other problem, Ritalin will likely be useless as a treatment.
It's already clear that Ritalin can worsen underlying anxiety, depression, psychosis and seizures. More common but milder side effects include nervousness and sleeplessness.
The surge in both ADHD diagnoses and Ritalin prescriptions is yet another sign of a society suffering from a colossal lack of personal responsibility. By telling patients that their failures, misbehavior and unhappiness are caused by a disorder, we risk colluding with their all-too-human belief that their actions are beyond their control, and we weaken their motivation to change on their own.
And in the many cases where ADHD is misdiagnosed in children, we give parents the illusion that their child's problems have nothing to do with the home environment or with their performance as parents.
It must be true that bad biology accounts for some people's distracted and impulsive lifestyles. But random violence, drugs, alcohol, domestic trauma and (less horrifically) indulgent and chaotic homes are more-obvious reasons for the ADHD-like restlessness that plagues America.
With the demand for Ritalin growing, we must be increasingly wary about doling out a drug that can be beneficial but is more often useless or even harmful.
This essay by Dr. Richard Bromfield of the Harvard Medical School is excerpted from Priorities, the journal of The American Council on Science and Health.