Better children through chemistry?

The number of American children taking drugs to combat attention deficit disorder (ADD) has grown to between 1.5 million and 3 million; the number taking antidepressants is also rising. Does this mean that a problem is being taken care of, or that a problem is being created? The answer depends on one's point of view. Some psychiatrists, psychologists, and parents think the press has sensationalized the coverage of Ritalin (methylphenidate) and other psychopharmaceuticals for children. An article in Parade magazine calls the use of Ritalin controversial. An editorial in the Wall Street Journal, headed "Attention Deficit Disaster," questions whether ADD even exists.

"People ask, 'Where does the Ritalin controversy come from?' In the scientific community there is no controversy," says Dr. Russell Barkley, director of psychology and professor of psychiatry and neurology at the University of Massachusetts Medical Center in Worcester. Ritalin is the drug of choice for ADD, he says, and a physician who does not consider prescribing it for a child with the disorder could be accused of malpractice.

"I think the press has tilted a bit toward emphasizing possible overprescribing of Ritalin, which is a legitimate concern, and not given enough attention to the benefits of Ritalin when given to properly diagnosed patients," says Dr. Jack M. Gorman, professor of psychiatry and vice chair for research at Columbia's College of Physicians & Surgeons. The subject is simply not treated fairly, even in major magazines, says Barkley. It is his experience that news stories about ADD and the use of Ritalin and other drugs contain shreds of scientific data presented in the worst light, with outrageous headlines or a tabloid spin.

On the other hand, to those who believe ADD is overdiagnosed, ill-defined, or nonexistent -- or who regard the use of pediatric psychopharmaceuticals as an attempt to produce "better children through chemistry" -- the coverage may be more accurate. Several articles in the lay press note that the percentage of ADD diagnosis and Ritalin use varies greatly within the United States, not only from state to state but town to town and is much higher in the United States than anywhere else in the world. Part of the problem is that no hard-and-fast tests exist for ADD or other psychological problems such as depression.

Recent articles also render dueling statistics. A July article in the online magazine Salon stated that 3 million American children receive amphetamines (including Ritalin) to control ADD or ADD with hyperactivity and another 600,000 take antidepressants such as Prozac (fluoxetine). The article does not give the source of the statistics, but an October 1996 Associated Press story cites the National Association of School Nurses as saying that Ritalin is being used by 3 million school children. A study published in Pediatrics in December 1996 gives lower numbers, stating that 1.5 million children ages 5 through 18 take Ritalin.

"To my knowledge, there are no studies that actually document overdiagnosis, but there is the concern that some children may get Ritalin who don't have ADD, just as some children get antibiotics for sore throats when the diagnosis of strep throat hasn't been made," says Gorman.

Barkley points out that much information against psychopharmaceuticals has came from the Church of Scientology and its Citizens Commission on Human Rights (CCHR). He has often debated on talk shows with people who doubt that ADD exists at all, he notes. Not all critics of psychopharmaceuticals are from CCHR, but the organization is active in debating this and other areas of psychiatry.

Dr. Laurence Greenhill, medical director of the Columbia-Presbyterian Medical Center's Disruptive Behavior Disorder Clinic and a researcher at the New York State Psychiatric Institute, notes a surge of anti-Ritalin stories in the late 1980s when the CCHR was questioning use of the drug, but that the national support group Children and Adults with Attention Deficit Disorders (CHADD) has been a factor in getting better coverage. "CHADD has been a very strong influence in terms of promoting full treatment for kids, all forms of treatment," he says. Still, Greenhill thinks most press coverage has been well- handled. "There are sometimes concerns about medications, but they are based on hearsay."

That the sensationalism may be subsiding could be due to CHADD's advocacy, as Greenhill notes, or that more journalists have had experience, either personal or professional, with someone who has ADD or uses these medications. The use of psychopharmaceuticals such as Ritalin is not as much of a stigma as it once was, adds Greenhill. Taking medications at school--any medication--was once a subject of ridicule, he says, but now so many children do it for so many different medical conditions that it has been widely accepted.

CHADD was described in the Wall Street Journal editorial as "'having grown powerful by feeding parents' concerns about [ADD]". For its part, CHADD keeps track of stories about ADD and publishes a "Media Watch" column in its newsletter. In the October/November 1997 issue, the column cited the WSJ editorial and noted that CHADD sent a rebuttal letter that was never published. As Joan Aho Ryan, director of communications for the organization, notes in the column, "Our goal is not to eliminate all negative coverage. Obviously, that's not realistic." The goal, she states, is to get objective and accurate news about ADD to the public. Given society's widespread disagreements about disorders like ADD, however, disagreement about what defines objectivity and accuracy in press coverage is unlikely to subside. --Valerie DeBenedette

Related Links:

  • National Attention Deficit Disorder Association

  • Press release on ADD management, National Association of School Nurses/Novartis Pharmaceuticals

  • Arianna Huffington, "Peppermint Prozac," U.S. News, August 18, 1997

  • Press release on Research Unit in Pediatric Psychopharmacology, Columbia College of Physicians & Surgeons

    VALERIE DeBENEDETTE is a free-lance science and medical journalist whose work has appeared in 21stC, National Cancer Bulletin, Cosmetic Dermatology, Drug Topics, The Physician and Sportsmedicine, and the Gannett Suburban Newspapers. She is the author of Caffeine (Springfield, N.J.: Enslow, 1996).