Running on Ritalin: A Physician Reflects on Children, Society, and Performance in a Pill - Hardcover

Diller, Lawrence H.

 
9780553106565: Running on Ritalin: A Physician Reflects on Children, Society, and Performance in a Pill
Hardcover
ISBN 10: 0553106562 ISBN 13: 9780553106565
Verlag: Bantam Dell Pub Group, 1998

Inhaltsangabe

An even-handed, well-informed assessment of the widespread use of Ritalin to young children diagnosed with Attention Deficit Disorder examines the ethical and social implications of the drug and offers advice for those considering using it.

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Über die Autorin bzw. den Autor

Lawrence H. Diller, M.D., attended the College of Physicians and Surgeons, Columbia University, and trained at the renowned Child Study Unit of the University of California, San Francisco, and the Mental Research Institute of Palo Alto.  In addition to professional publications, he has written for Family Therapy Networker and for the Hastings Center Report, where his 1996 article on Ritalin became national news.  He practices in Walnut Creek, California, and lives nearby with his wife and two young sons.

Aus dem Klappentext

provocative and newsworthy as Listening to Prozac and Driven to Distraction, a physician speaks out on America's epidemic level of diagnoses for attention deficit disorder, and on the drug that has become almost a symbol of our times: Ritalin.

In 1997 alone, nearly five million people in the United States were prescribed Ritalin--most of them young children diagnosed with attention deficit disorder. Use of this drug, which is a stimulant related to amphetamine, has increased by 700 percent since 1990. And this phenomenon appears to be uniquely American: 90 percent of the world's Ritalin is used here. Is this a cause for alarm--or simply the case of an effective treatment meeting a newly discovered need? Important medical advance--or drug of abuse, as some critics claim?

Lawrence Diller has written the definitive book about this crucial debate--evenhanded, wide-ranging, and intimate in its knowledge of fam

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Ritalin Ascendant: A Doctor's Dilemma

Something is awry, all right, but something not entirely medical in nature.
--Robert Coles, M.D., The Mind's Fate

It's midday at an elementary school in a comfortable American suburb. The lunch bell has just rung, and kids are noisily pouring out of classrooms to enjoy a brief recess in the schoolyard before mealtime.

Inside, next door to the principal's office, the school secretary is arranging bottles of medication on a tray. Scotch-taped to the tray are little photos of fourteen children, labeled with their names and keyed to the bottles. Though by now she pretty much knows who gets what, at the beginning of the school year this system helped make sure she didn't make mistakes--that each of the children taking Ritalin at school received the right pill and dose.

At least a dozen more youngsters among the 350 attending this school took the same medication at home before school but aren't required to take a midday dose. At a nearby school of similar size, the kids getting Ritalin are organized in ten-minute shifts because their number exceeds thirty. And this weekday ritual is carried out--with variations in the number of kids and the personnel responsible for handing out the pills--at schools across the United States.

Attention deficit disorder, or ADD--the condition for which the medication Ritalin is most commonly prescribed--was formerly called hyperactivity, as reflected in its alternative acronym: ADHD (attention deficit/hyperactivity disorder). Its diagnosis is based on problems with attention, focus, impulsivity, or overactivity at school or at home. Since 1990 the number of children and adults diagnosed with ADD has risen from about 900,000 to almost 5 million as we near the end of the decade. This figure--derived from the amount of medication prescribed for ADD--suggests a problem of epidemic proportions.

The sharp rise in ADD diagnosis is directly tied to another startling statistic--a 700 percent increase in the amount of Ritalin produced in the United States during the same time period. An increase of this magnitude in the use of a single medication is unprecedented for a drug that is treated as a controlled substance. Ritalin belongs to the class of drugs known as stimulants, and it is closely related to amphetamine. Although Ritalin has been around for a long time, some people are still surprised to learn that it is essentially a form of speed. Others do know this but believe that the drug has a paradoxical "calming" effect on children, an effect different from the one it produces in adults.


I vividly recall the first time I witnessed the change that some children exhibit when they start taking Ritalin. One of our patients at the Child Study Unit was a little boy who had never been able to play with a toy for more than a minute without throwing it aside and racing off. After Ritalin, he sat and played quietly for twenty minutes, while his parents and I marveled at the transformation.

Since then I have evaluated hundreds of children and adolescents for the diagnosis of ADD and treatment with Ritalin. Each individual and family has had a unique background, circumstances, and problems--but patterns have emerged. The most obvious pattern has been a distinct shift in the number and kinds of patients referred for an ADD evaluation. Over the first fifteen years of my practice, perhaps two dozen kids each year emerged from my office with an ADD diagnosis. Most of them fit the typical profile long associated with the condition: boys from six to twelve years old, extremely hyperactive and impulsive, functioning poorly (if at all) in a normal school situation. Many of these kids were quite out of control, and intervention with medication (usually Ritalin) was often needed to give other treatments a chance to work.


As of the early 1990s, however, my experience with families and ADD was clearly changing. The sheer volume of my cases went up dramatically, from two dozen a year to more than a hundred at present. I was evaluating more and more children under the age of five for the condition, as well as more children, teenagers, and adults with no signs of hyperactivity--people whose main problem was an inability to pay attention and get their work done. Many of this newer group of patients I judged to be less severely affected by ADD symptoms, and some I thought were doing fairly well.

Let me introduce some people from this later generation of patients whose situations raise questions for me about ADD and Ritalin:

Johnny Hester had just turned four when his parents brought him in. His headstrong behavior at home and in preschool had been driving his parents crazy and stressing his teacher, who suggested he might have ADD. Certainly the boy I saw in my office was very intense and determined, but he didn't race around constantly, and he played with toys almost normally. (He did raise a fuss when his parents asked him to put the toys away.) What I saw made me consider him only mildly impulsive and slightly distractible. And even without exploring his situation at school, I felt that family problems were contributing to his behavior. His parents, who had just reconciled after a separation, disciplined him inconsistently. They too were intense, both with full-time, high-pressure jobs. Having read about ADD, they insisted that I prescribe Ritalin on a trial basis.

Jenny Carter was a ten-year-old who worked too slowly and had trouble completing her assignments at school. Her parents complained that she didn't finish her chores at home, either. Sent to her room to clean up her toys, she'd be found dawdling or playing one of the games she was supposed to be putting away. Both parents worked and wanted her to help take responsibility for her two younger sisters. Jenny would stoically accept her punishments for incomplete work and missed chores, but she sounded sad about her situation when we met.

Jenny struck me as a bright, lovely child who was kind and thoughtful, had many friends, and wanted to please her parents and teacher. It just seemed as if her internal clock was set too slow for the rapid pace and the demands made on young people in late-twentieth-century America. She might have thrived, I imagined, had she been born earlier this century or before compulsory education was adopted. Now she was being evaluated as a candidate for Ritalin.

Gavin Donaldson was fifteen when I met him. Both his parents were Ph.D.'s, and they were concerned about Gavin; he wasn't getting the top grades they felt he could achieve if he overcame his "concentration problem." They worried about his college options, given his current grade-point average, which hovered just below B plus. Some of his teachers thought he was distractible, others that he was insufficiently motivated.
Gavin himself felt he was doing okay. He didn't mind getting a few B's and C's. He acknowledged that he was easily distracted from schoolwork; he could get A's if he cared more and tried harder, he told me, but he had other interests, such as music and his friends. He was sensitive to his parents' expectations and wanted to please them, but he wasn't enthusiastic about the idea of taking a medication that would affect his brain and personality. I suspected he felt that taking Ritalin would signal that he was inadequate as a person.

I thought the drug could probably improve his performance, focus him more on his schoolwork, perhaps even raise his motivation. His pleasure in doing better and winning his parents' approval might outweigh any loss of self-image caused by taking medication. On the other hand, his performance wasn't bad without it, and I believed his grades would improve once he found something that genuinely engaged him academically.

Karen McCormack, age thirty-three, single,...

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Verlag
Bantam Dell Pub Group
Erscheinungsdatum
1998
Sprache
Englisch
ISBN 10 
0553106562
ISBN 13 
9780553106565
Einband
Gebundene Ausgabe
Anzahl der Seiten
386
Kontakt zum Hersteller
Nicht verfügbar
Verantwortliche Person
Nicht verfügbar

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