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 adults 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 other 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.
From New Scientist, 28 November 1998
It seems that the strategic importance of power investing children's
bodies remains, only the tactics change. I'll expand on this later if
people are interested.
Jon.
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