Recent journals of the American Medical Association and the American Bar Association have brought out into the open forum of public discussion a practice that has hitherto evaded coverage in ordinary media channels. This is the accelerating and frequently compulsory use of a drug called Ritalin on public schoolchildren.
Obtainable only by prescription, Ritalin (the doctors call it methylphenidate hydrochloride) is prescribed for hyperactive/inattentive (HA/I) children in order to calm them, help them tolerate frustration and become more attentive in class. This condition is called attention-deficit hyperactivity and is considered a serious neurobehavioral disorder.
In the 1960s, drugs played a minor role in treating HA/I children. In the 1980s, however, there has been a dramatic growth in the use of drug therapy for HA/I children and the use of Ritalin has become the dominant child mental health intervention.
According to the AMA Journal, regular biannual surveys by the Baltimore County Health Department reveal a consistent doubling of the rate of drug treatment for HA/I students every four to seven years. From 1971 to 1987, the percent of public elementary school students given HA/I drug treatment rose from 1% to 6%, or one in 17 students, or 1 or 2 pupils per class on the average.
Over the years 1975 through 1987, public middle school pupils receiving drug treatment rose from one-half of 1% to nearly 4%, and public senior high school pupils rose from .2% to .4%. The biggest increase was in the 3rd grade, where more than 7% of children are on HA/I drug treatment.
If the Baltimore statistics are typical, they suggest that 1.6 million of the 44.7 million U.S. schoolchildren may be taking Ritalin. Some asset that the national average is lower than the Baltimore figures and only 750,000 may be taking Ritalin now, but they concede that growth rates indicate that one million will soon be receiving drug treatment for HA/I.
The average duration of drug use for HA/I students is two years for elementary school students, four years for middle school students, and seven years for senior high students. Far more boys than girls are given the drug; the ratio is 4 to 1 in elementary school and 6 to 1 in middle school.
The Baltimore survey caused the AMA Journal to editorially raise the possibility that Ritalin “is now being prescribed for children who may not require it.” The editorial deplores “the tendency to indiscriminately label children as hyperactive or to use such terms as learning disability and inattention interchangeably.”
The AMA Journal writers find it “alarming” that 15-18% of those receiving the drug are not hyperactive at all but merely inattentive. The medical writers suggest that the increased use of Ritalin may be “the reflex use of a particular treatment prescribed for almost any child presenting a behavioral or learning problem.”
That is a powerful warning to parents of children who are given Ritalin, many of them pressured to do so by the schools. The use of Ritalin is highly controversial because of its troubling side effects.
Parents of a New Hampshire boy have gone to court to prevent a public school from requiring him to take Ritalin in order to attend special education classes. Two attorneys have filed at least 16 lawsuits alleging that Ritalin was wrongly prescribed, and a 15-year-old Canton, Massachusetts youth, convicted of second-degree murder and sentenced to life in prison, contended at his trial that Ritalin exacerbated his mental illness.
Dr. Jerry Wiener, president of the American Academy of Child and Adolescent Psychiatry, says that Ritalin’s side effects can include loss of appetite, insomnia, and feelings of sadness or irritability. Washington, D.C. attorney John Coale, who filed lawsuits in Minneapolis, Washington, and Atlanta, claims that his plaintiff children suffered side effects of stunted growth, depression, psychotic episodes, and aggressive and erratic behavior.
Coale is scathingly critical of the vague criteria defining “hyperactivity” in the psychiatric manual Diagnostics Statistical Manual of Mental Disorders. It includes “having difficulty remaining seated or playing quietly,” which Coale says “is ludicrous because it describes a 6- to 8-year-old; that’s the way they are.” Indeed, most parents would find that a fair description of any normal, active boy.
Boston attorney Lawrence Lafferty has filed nine lawsuits in Massachusetts and four in Washington, D.C. charging the prescribing doctors with medical malpractice in failing to diagnose and monitor the children properly failing to explain other alternatives to the parents. Other charges in the Ritalin cases include misrepresenting the drug and depriving children of their due process.
An investigation of the use and abuse of Ritalin, and especially of the role played by schools in encouraging its use, is long overdue.
