The Age Of Ritalin

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Given the explosion in ADHD diagnoses and Ritalin use over the past decade, the disorder is surprisingly ill defined. No one is sure that it's a neurochemical imbalance that can be corrected with medicine, much the way daily insulin shots help diabetics. There is no blood test, no PET scan, no physical exam that can determine who has it and who does not. For many children, Ritalin is the answer simply because it works. "It's a fixed, stable, low-dose drug," says Dr. Philip Berent, consulting psychiatrist at the Arlington Center for Attention Deficit Disorder in Arlington Heights, Ill. He argues that critics who claim diet, exercise or other treatments work just as well as Ritalin are kidding themselves. "The quickest way to end that criticism is to spend a week with a hyperactive child," Berent says. "We aren't talking about kids who ODed on Halloween candy. The protocol for diagnosing ADD [and ADHD] is very well defined."

But it's not hard to find doctors feeling a little queasy about the process. An evaluation needs to be so nuanced that the checklist of symptoms used by experts can seem like a terribly mechanical method for judging a condition so individual and personal. For borderline kids, a thorough professional assessment is essential.

Tim and Charlene kept resisting putting their daughter on Ritalin. "You don't want your kid to personify the rumors--that the medication makes them dopey or slow," Tim says. "That's the stereotype. All my co-workers and family had opinions that were antimedication." But a year ago, they finally tried it. "It was awesome," says Tim. "It worked great." At least for a while, until they discovered that Ritalin heightened Erin's obsessive-compulsive disorder. "She would turn the lights on and off seven times. She would flush the toilet four times and stop; then three times and stop; then four times and stop. There was a numerical sequence."

So long as it doesn't do any damage, what's the harm in giving even mildly distracted or willful kids a pharmaceutical boost? For one thing, doctors say, there is still some concern about side effects, such as decreased appetite, insomnia or the development of tics. "A very small percentage of children treated at high doses have hallucinogenic responses," the NIH experts concluded, arguing that more research is needed to shape guidelines for doctors and parents. For many families, of course, such risks seem a small price to pay for the enormous relief Ritalin can offer.

But the parents with the most firsthand experience see other, more subtle effects as well. Though Ritalin use can boost young children's self-esteem just by helping them "fit in," teenagers often struggle with their self-image, wondering if their whole personality is shaped by a pill. Some parents balk at giving their child a drug related to "speed," even if it isn't addictive.