WASHINGTON, APRIL 12, 1999-Millions
of Americans, most of them children, take Ritalin every day because
they have been diagnosed with Attention Deficit Disorder (ADD),
which prompts an important question: Why is such a powerful
substance-one that shares many characteristics with cocaine and
other amphetamines-so widely prescribed to young children?
In "Why Ritalin
Rules," an article appearing in the April/May 1999 issue of
Policy Review, consulting editor Mary Eberstadt draws on the
past decade's professional and popular literature on the topic and
uncovers four main reasons.
For one, the way Ritalin (clinically
known as methylphenidate) works is widely misunderstood by the
public. It improves attention span the same way amphetamines do-by
stimulating the central nervous system-and has the same potential
adverse effects, including weight loss and insomnia. Numerous
medical studies, including laboratory tests with animals, have
shown virtually no difference between cocaine and methylphenidate,
she says. In fact, the Drug Enforcement Agency (DEA) classifies
Ritalin as a Schedule II drug, subjecting it to the same strict
controls as morphine.
Another reason for Ritalin's rise,
Eberstadt says, is the "extraordinary political and medical clout"
of the support group CHADD-Children and Adults with Attention
Deficit Disorder. The group's history includes its 1995 petition to
the DEA to reclassify Ritalin as a Schedule III drug, which would
subject it to fewer controls and make it easier to obtain. It also
includes the fact that CHADD accepted nearly $900,000 in donations
during the early 1990s from the pharmaceuticals giant that
manufactures Ritalin.
A third reason for Ritalin's
popularity involves the ever-changing definition of ADD itself,
Eberstadt says. Medical experts tend to rely on diagnostic tests
that focus almost exclusively on behavior, but "the distinction
between what is pathological and what is not remains unclear." As a
result, many physicians use a positive response to Ritalin to
confirm a diagnosis of ADD, even though almost anyone-child or
adult-becomes more focused and less aggressive on the drug.
But the primary reason for all those
prescriptions? "Compliance," Eberstadt says. "One day at a time,
the drug continues to make children do what their parents and
teachers either will not or cannot get them to do without it: Sit
down, shut up, keep still, pay attention."