The Age Of Ritalin

(5 of 6)
Other parents talk about a "Ritalin rebound" and find themselves struggling with whether the drug's benefits outweigh its costs. Kathleen Glassberg, a computer-software sales representative in Long Island, N.Y., used to dread her 12-year-old daughter's return from school each day--and the two-hour crying jag that followed. "She'd hold herself together all day, but the minute she got home she'd have this breakdown," Glassberg says. Glassberg has carefully built an after-school routine of household tasks and time-management techniques to help her daughter focus. "You'd be asking the impossible to have my child come home, have a snack and do her homework right away. So instead, she comes home, lays her books down, and we go for a walk around the block. It gives her time to vent and re-attune herself."

Last spring Erin's parents took her off Ritalin and enrolled her at UC Irvine's Child Development Center, a model program that specializes in ADD and ADHD. She attended the school's summer program. "It was a horrid summer," Tim recalls. "Behavior modification was controlling a lot of things, but the impulsivity would snowball. She would be told not to touch something--whether a car's gearshift or a radio or a computer. You'd say 'Don't touch,' and she would look at you and you could see she heard, but you'd see her hand slowly moving toward it--and she knew if she touched it, she would have to take a time out or lose her TV privileges--but she would touch it anyway. And when the consequences happened, she would have an hourlong temper tantrum. It made for a no-fun life."

There is also some argument about the age that treatment should begin. Nearly half a million prescriptions were written for controlled substances like Ritalin in 1995 for children between ages 3 and 6. "Kids ages 4 to 5 are just as impaired as older children, so there is no reason not to treat them," says William Pelham Jr., director of clinical training in the department of psychology at the State University of New York at Buffalo. He adds, however, that before a physician treats such a young child with stimulants, he should begin by suggesting techniques parents can use to control his or her behavior.

But this is where treatment too often falls apart. Even doctors who have seen Ritalin's positive, sometimes miraculous effects warn that the drug is no substitute for better schools, creative teaching and parents' spending more time with their kids. Unless a child acquires coping skills, the benefits of medication are gone as soon as it wears off. "You can't just give medicine and fail to teach," says Stephen Hinshaw, director of the clinical psychology training program at the University of California, Berkeley. Drug treatment may set the stage, but studies suggest that children need constant reinforcement to help them control their impulses: through behavioral therapy, special education, family therapy or a combination of all three.