The Age Of Ritalin

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Even doctors who think ADHD may be underdiagnosed and are convinced of Ritalin's broad benefits emphasize the need to integrate drugs and behavior therapy. But it doesn't matter that children benefit from a multifaceted response if their health insurance won't pay for it. The trend over the past few years has been clear: the percentage of children with an ADHD diagnosis walking out of a doctor's office with a prescription jumped from 55% in 1989 to 75% in 1996. The number receiving psychotherapy fell from 40% in 1989 to 25% in 1996. "The reason Ritalin use has gone up is that we are in an era when psychiatric services are devalued and therapy is not paid for by insurance companies," says Jeff Goodwin, a former pediatrician who teaches at Walter Reed Junior High School in North Hollywood, Calif. "It is easier for physicians to prescribe a drug and categorize a disorder as hyperactivity than it is to deal with the problem. Health services are being cut back, so you have doctors saying, 'Take this and live happily ever after.'"

That is all the more reason for parents to gather as much information as they can, get a second opinion--and a third--before starting medication. In part it helps ensure that no one has unreasonable expectations about what drugs can and cannot do. And it increases the chances that treatment will be tailored to a child's individual needs. Vanderbilt University pediatrician Dr. Mark Worlaich hopes forums like the NIH conference last week will help correct some of the misinformation he sees every day. "The real issue that sometimes gets lost is that kids need to be successful in their activities."

In August Erin began taking Luvox for her obsessive-compulsive disorder, and in early October she started on Adderall, a combination of various stimulants. "For 4 1/2 weeks, we've seen heaven on earth," says Tim. "We have a semblance of family life." They spent a day recently at a church festival. "There were a lot of people there," Charlene says. "Normally that would produce a lot of anxiety for someone who has ADHD. But Erin had a great time." She can play games longer, take car trips, do homework. "I have a child I can relate to who is hearing me," Charlene says. "I'm not always in an adversarial situation." The fact that the medication seems to be working has liberated Charlene from irrational guilt. But she also sees that everything in Erin's life matters. The school. The behavior therapy. The rules and structure. The time and energy she and Tim devote to every waking hour. For them, the little pill is a wonderful tool, but they have had to learn to use it wisely.

--Reported by Ann Blackman/Washington, William Dowell/New York, Margot Hornblower/Los Angeles, Elisabeth Kauffman/Nashville and Maggie Sieger/Chicago