By Carmela D'amico
In this first of a three-part series which examines Attention
Deficit Hyperactivity Disorder (ADHD) and its cure, we will focus
on its most common treatment: Ritalin (methylphenidate). Because
of the alarming proportions in which this drug is being prescribed
to American children-most recent statistics estimate somewhere
around five million prescriptions are now being written each year1
-we will seek to uncover the reasons behind this fact. We will
present the more prominent statistics as well as some of the professional
opinions that surround this controversial drug.
Next month, we will uncover the underlying causes of ADHD-causes that are as wide and varied as the symptoms the label seeks to define. While analyzing the various causes, we'll attempt to convey that the path to curing ADHD, rather than merely suppressing the symptoms with daily dosages of pills, lies in comprehending and then addressing the source(s) of the disorder itself.
Some of the information that will be presented in the first two articles may, at first glance, seem discouraging to those whose lives are affected by ADHD. However, there is hope: Contrary to what many people have been led to believe, ADHD is often a curable condition. In the third of our series, we will discuss the methods of healing ADHD.
What Is Attention Deficit Hyperactivity Disorder (ADHD)?
Attention Deficit Hyperactivity Disorder (ADHD) is a label that seeks to define and simplify an extremely complex set of individualized "symptoms." These symptoms most commonly include: an inability to sit still for sufficient periods of time, difficulty in paying close attention and following through with projects, forgetfulness, fidgeting, hyperactivity, impulsivity, inability to concentrate and excessive, disruptive chattering. Children who exhibit these behavioral traits often suffer both academically and socially as they struggle to conform to the expectations of their peers and authority figures.
The debate over whether or not ADHD is a valid disease does not arise from disagreement over the fact that upward of six million US children exhibit some or all of these traits. Instead, the controversy is rooted in the two-fold question of what should be done about it. First, what causes these symptoms? Secondly, what is the best way to treat them? The camp is divisively split and which side you take is dependent on what you perceive to be the purpose of medicine and the definition of healing.
Allopathic "Management" or Holistic Cure?
Those holding an allopathic (Western medicine) view of health are likely to view relief of the symptoms as a "cure" in and of itself. They see ADHD as a biological, genetic disease, which most successfully benefits from treatment with psychotropic drugs (most commonly Ritalin, with Adderall as a close runner-up). By choosing medication to suppress the symptoms of ADHD, they tacitly affirm that there is no cure for this disorder, and that the best treatment is long term, even life-long, stimulant/psychotropic management of the condition.
Those who hold a more holistic (alternative) view are likely to see the relief of the symptoms as secondary to getting to the root of what has caused them in the first place. They assert that ADHD is environmentally and/or biologically induced and therefore highly treatable via natural, non-pharmaceutical means which "reverse" the causes which produced the symptoms in the first place, and that using pharmaceutical drugs as a means of relief is a short-term fix that subsequently delays or halts altogether the prospect of an actual cure.
The following question often arises: If a drug like Ritalin works (meaning that it relieves the symptoms of ADHD)-which it does, then what's the harm? If a child is able to refrain from disrupting his classroom or from driving his parents crazy, who's to say that drugs aren't benefiting everyone involved?
One of the biggest difficulties parents confront when they receive an ADHD diagnosis is deciding whether or not to manage their child's symptoms with medication. Though perhaps concerned about this, parents have been led to believe that ADHD is not curable. Consequently, they do not think in terms of actually healing their child and accept the Ritalin prescription as the primary means to restore normal behavior in their child and bring peace back into their lives. And, as a short-term solution, it may well be an appropriate choice of action for some.
Our research, which will be presented more fully in the second article, suggests that symptoms of ADD/ADHD is often caused by: 1) disorganized neural pathways, 2) too thin of neural pathways, 3) a compromised vestibular (inner ear) system, 4) toxin overload, 5) chemicals in our food supply (especially dyes and preservatives), 6) sugar and 7) inadequate nutrition. These are caused by numerous environmental and lifestyle factors and can be corrected with appropriate non-drug therapies.
How Ritalin "Works"
Ritalin, an amphetamine, unnaturally increases the speed at which the child can process external information (sight, sound, touch, smell and cognitive information) by forcing faster processing through weak and disorganized neural systems. Though from an outside perspective it may seem as though the child is functioning normally, what is truly happening is that even more damage is being done, since, in order for the symptoms of ADHD to present themselves in the first place, the child's neural pathways must already be in a frail, compromised state. To rush information through these passageways at such an accelerated pace is to further tax a debilitated system.
The Dangers of Ritalin
Ritalin (methylphenidate) has been classified by the US Drug Enforcement Agency (the DEA), as a Schedule II drug, along with cocaine, morphine, methamphetamines, opium and barbiturates. Chemically, it most closely resembles cocaine, which may explain some of the more disturbing truths associated with it.2
A study conducted at the University of Berkeley (one of the few long-term studies conducted in regard to Ritalin use) concluded that Ritalin tends to act as a "gateway" drug. The study, which followed 500 children over the course of 26 years, found that Ritalin "makes the brain more susceptible to the addictive power of cocaine and therefore, doubles the risk of abuse."3 A similar study, documented by Richard de Grandpre in his book, "Ritalin Nation," showed that when given the option of choosing between Ritalin or cocaine, laboratory monkeys did not show a preference for one or the other. In fact, many preferred Ritalin, which has a slower "let down" period than cocaine.
Given the drug's proven similarity to cocaine, it is no wonder that the DEA has recently reported that "Ritalin ranks in the 'Top 10' controlled drugs stolen from doctors and pharmacists," concluding that the reason for this is that "kids crush and snort it or inject it" in order to get high.4 But, the fact of the matter is that most kids don't have to steal it. They can buy it, for, on average, seven dollars a pill.5 In fact, recreational use of this drug has elevated right along with its prescription rate. The DEA reported a 16% increase in Ritalin abuse from 1992 to 1995, while the Drug Abuse Warning Network (DAWN) states that "the sky-rocketing use of Ritalin represents the greatest increase in drugs associated with abuse, and causes the highest number of suicides and emergency room admissions."
The International Journal of Addictives lists over 100 adverse reactions to Ritalin, including paranoid psychosis, terror and paranoid delusions.13 It's no surprise that much of the school violence our nation has witnessed over the past decade has been instigated by teens who were being prescribed Ritalin or similar psychotropic drugs. Often, a fluctuation in dose precipitates such an episode.14
Aside from such adverse reactions, Ritalin also has numerous potential side effects, many resembling those of cocaine's: nervousness, insomnia, blood-pressure fluctuations, dizziness, loss of appetite, motor tics, depression and headaches. Withdrawal symptoms are also strikingly similar: fatigue, disturbed sleep, depression, psychosis and suicide.6
Ritalin as A Performance Pill
What about the effects on a child's self-esteem (the reason most teachers encourage parents to consider the drug)? By forcing a child to be dependent on a drug, we are telling that child s/he is incapable of functioning on an acceptable level without it. Though many psychiatrists attribute feelings of isolation and loneliness to untreated cases of ADHD, many children report such feelings as a result of taking medication.
According to the National Institutes of Health, "There is currently no independent, valid test for ADHD,"7 which makes prescribing medication for it more or less a crapshoot. Additionally, symptoms of ADHD can be easily confused with, among other things, certain learning disabilities, clinical depression and post traumatic stress disorder. Giving medication to a child suffering from one of these can all but muzzle a cry for help, since one of the observable characteristics of Ritalin is that it makes the children taking it much more compliant.
It is a natural parental instinct to want children to succeed and to be accepted, even if it means conforming to preset social norms. Dr. Lawrence Diller, author of the best-selling book, "Running on Ritalin" has written that, "Ritalin will help round and octagonal peg kids fit into rather rigid square educational holes."
Research shows that classroom performance is the only positive short-term outcome of Ritalin use. Richard de Grandpre writes in a recent article, "Dozens of objective studies have assessed the long-term effectiveness of stimulants on children's academic performance, social development and self-control. None has shown them to be effective for anything but controlling the kids' behavior-an effect that vanishes once the drug wears off."8
It is interesting to note that Ritalin prescriptions began to escalate at the same time corporal punishment was being banned in the schools. It seems that once the behavioral tool that teachers had so long had at their disposal got revoked, a different tool, inevitably, rose up to take its place.
Because of its short-term effect and its only positive attribute being that the child's classroom behavior improves, many doctors and educators are beginning to consider Ritalin not much more than a performance pill. There is growing concern that ADHD is just a convenient label to throw over those whose learning styles are perhaps more hands-on and activity-oriented than others. Clearly, there are children who exhibit behavioral problems, but whether these problems are biologically rooted and not just a valid response to an increasingly information-addled society, is at the ethical crux of the Ritalin debate.
In the words of Dr. Peter Breggin, a leading spokesperson on the detriments of prescribing medication to treat ADHD, "We are the first adults to handle the generation gap through the wholesale drugging of our children. We may be guaranteeing that future generations will be relatively devoid of people who think critically, raise painful questions, generate productive conflicts or lead us to new spiritual or political insights."
Many children who are intellectually gifted also display some or all of what are considered to be traits of ADHD. Throughout history, there have been stories of the genius or inventor who was mistaken as a problem child. But is taking a drug like Ritalin going to affect a child's mind permanently, or if the child is gifted, "dumb" him down to a level of normality? We don't know. We do know that long-term stimulant abuse negatively affects the physical structure of the brain, causing "cortical atrophy (i.e. brain deterioration)."9
Who Stands to Gain?
If the only benefit a child may gain from taking Ritalin is better performance in the classroom, while the negative side-effects and possible adverse reactions are greatly disproportionate, who stands to gain from the sale of these drugs?
Clearly, the over-worked teacher, whose classroom is the twice the size it should be, breathes a sigh of relief over the fact that the boy who was loudly interrupting and bouncing in and out of his seat last week, sits quietly and pays attention now that he's taken his pill. And the parents of the girl who refused to do her homework and responded defiantly to every request are greatly pleased when she sits down to study unprompted and obsequiously obeys their commands. But behavioral improvements wear off when the drug does and, eventually, children, parents and teachers will be forced to confront the repercussions of delaying real coping mechanisms in lieu of a chemical straitjacket.
With an income of between "30 to 60 dollars per month per medicated child"10 it seems that pharmaceutical companies are the big winners here. Through alliances with supposedly unbiased organizations such as CHADD (Children and Adults with Attention Deficit Hyperactivity Disorder), drug manufacturers have created additional avenues for "hyping" their products. It was recently discovered that over the course of a few years CHADD had received over 1 million dollars from the maker of Ritalin, Novartis11 .
Dr. Lawrence Diller says, "I've been offered $100 to sit and listen to someone talk about ADHD, funded by Adderall, for fifteen minutes"12 The marketing of these drugs doesn't stop with physicians, "parent groups" or researchers, however. Drug companies are now going straight to the consumer.
In a recent issue of Parade magazine, a full page spread claims to be "Putting control of your child's ADHD right where it belongs...in your hands." The beneficent company so concerned with your child's well being is Shire US Inc., "your ADHD support company." Nowhere does the ad mention that Shire US Inc. is Shire Pharmaceuticals, the manufacturers of Adderall.
Ritalin is Not the Answer
As the consumption of psychotropic drugs reaches an all-time high, few of us seem willing to question why. However, since the pharmaceutical empires who create these drugs are big businesses which must turn hefty profits in order to survive, individuals not only have a right, but a responsibility to question their motives. In no area is this questioning more important than in the realm of our children's health.
The symptoms of ADHD are curable through nondrug methods. Giving Ritalin or any other stimulant or psychotropic drug to a child masks the actual health problems s/he is experiencing, and postpones an actual cure. Parents, doctors and teachers should realize that, in general, when children "misbehave" they are actually trying to communicate to us that something is wrong. An incapacity to sit still and listen, to pay attention or to follow through with things indicates that something in the brain is not working properly.
Our next article will delve much deeper into the underlying causes of ADHD, as well as discuss what differentiates a normal but "high-spirited" child from a child who is genuinely suffering from the effects of a neuro-behavioral disorder. It is our hope that in doing so, it will be clear that ADHD is not a set of behavioral defects which require medication.
(another view, written by Larry Cook)
1 "Does ADHD Even Exist?, John Breeding, Adbusters, July/August 2000
2 "Why Ritalin Rules," Policy Review #94, April/May 1999
3 "Ritalin: Violence Against Boys," Massachusetts News, October 29, 1999
4 "Ritalin: Violence Against Boys," Massachusetts News, October 29, 1999
5 "Factline on Non-Medical Use of Ritalin," William J. Bailly, Indiana Prevention Resource Center at Indiana University, Factline #9, November 1995.
6 Physician's Desk Reference, 1995 Edition, Montvale, NJ; Medical Economics Co., 1995
7 "Diagnosis and Treatment of ADHD," NIH Consensus Statement, Online, November 16-18, 1998
8 "A Dose of Reality," Adbusters, July/August 2001, Page16
9 A Dose of Reality," Adbusters, July/August 2001, Page16
10 "Ritalin: Violence Against Boys," Massachusetts News, October 29, 1999
11 "The Business of ADHD," Frontline, PBS, April 2001
12 "The Business of ADHD," Frontline, PBS, April 2001
13) "An Outline of Hazardous Side Effects of Ritalin," The International Journal of the Addictions, Richard Scarnati, (Volume 21, p 837-841)
14) "Ritalin: Violence Against Boys," The Massachussetts News, October 29, 1999