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Ritilan

Ritilan I. DEFINITION OF ADD AND HISTORY OF RITALIN When Jason was five, his mother, Cathy, had to take him out of preschool because of his temper tantrums. She tried behavior management and parenting courses, to no avail. Eventually, Jason was diagnosed with ADHD and given the stimulant Ritalin, which controlled his outbursts. “It was like Dr. Jekyl and Mr. Hyde,” Cathy said. Jason flourished for the next six years, even winning his fifth-grade citizenship award. In sixth grade, however, his medication stopped working, and he became aggressive again. But Jason’s teachers did not believe he had a disability and refused to allow any special “accommodations,” like extra time to take tests. At Christmas, Jason was so depressed that he threatened to kill himself. After three weeks’ treatment at a psychiatric hospital, he was put on Adderall, another stimulant, which helped him recover. Now he is back at school, this time with a full time teacher’s aide and other accommodations for his disability. “He just had a midterm evaluation,” Cathy said, “and his teachers all said that he was a delight to have in class.” Like Jason, more and more children are being diagnosed with ADHD or its less hyperactive cousin, attention deficit disorder (ADD). And, correspondingly, during the past decade the production of stimulants used to treat ADD has risen dramatically, (see Graph 1.). However, an increasing number of parents, doctors, and public health officials are becoming alarmed about the jump in the use of Ritalin and amphetamines to treat ADD. In the last year, at least three prestigious medical journals published articles examining whether the condition is being overdiagnosed and American children are being drugged unnecessarily, (NEA Today, 25). Attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD) are generally characterized by abnormal levels of hyperactivity, inattentiveness, and impulsivity that generally show up before a child is seven years old. Although most cases are assumed to be inherited, a small percentage are thought to be caused by central nervous system damage in early childhood, which could be associated with general birth problems, such as an umbilical cord wrapped around the neck, or malnutrition during pregnancy. Experts say that ADD can easily be confused with learning disabilities, especially dyslexia, since 25-40 percent of ADD kids- some say as many as 90 percent- also have a learning disorder, mostly related to reading. In fact, some public health experts say that ADD is not a real medical condition. Others say that it is often confused with normal behavior and misdiagosed. For instance, elevated lead levels in the blood can also cause ADD symptoms, (McCormick, 3). Most ADD cases are treated with one of four stimulants- Ritalin, Dexedrine, Adderall and Cylert. By far the most widely used is Ritalin, which is manufactured by a Swiss company, Novartis Pharmaceuticals Corporation. These stimulants are used to calm children down and help them to focus on their schoolwork. There is no definitive medical test for ADD, and that is part of the problem. The best that doctors have come up with is a vague formula. Children are said to have the disorder if they exhibit at least six of these (and other) behaviors for at least six months, and if some of the behaviors were present before age seven: · Has trouble paying attention to details; makes careless mistakes in schoolwork · Has trouble concentrating on one activity at a time · Talks constantly, even at inappropriate times · Runs around in a disruptive way when required to be seated or quiet · Is easily distracted by things going on nearby · Impulsively blurts out answers to questions · Misplaces school assignments, books or toys · Seems not to listen, even when directly addressed · Often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort, (Buonomano, 8). The symptoms must be present in two or more settings, such as at school or work and at home. There must also be clear evidence of “clinically significant impairment” in social, academic or occupational functioning. Physicians did not begin to link childhood attention and behavior problems to biological causes until the turn of the century. In several lectures to the Royal College of Physicians in England in 1902, British physician George Frederic Still described twenty pediatric patients who were aggressive, defiant, excessively emotional or “passionate,” lawless, spiteful, cruel, dishonest and who displayed little “inhibitory volition.” He theorized that they probably had a basic “defect in moral control” that was either hereditary or due to pre- or post-birth injury, (Hartman, 42). A lot has happened since then though. Between the years of 1940 and 1960, many psychiatrists began using drugs to treat mental illness. Ritalin was first used to treat hyperactivity in 1961, and in 1968 the American Psychiatric Association (APA) first listed “hyperkinetic reaction of childhood” as a disorder in the second edition of its Diagnostic and Statistical Manual (DSM-II). In the 1970s, research focused more on “attention deficits” as causing behavior problems, but some members of Congress began questioning whether scientists were trying to medicate away energetic childhood behavior. On September 29, 1970, a House Government Operations subcommittee held a hearing on the federal government’s role in sponsoring research on the use of behavior-modification drugs on elementary school children. When asked why a child’s high energy level was considered a “disease,” educator and author John Holt testified, “We consider it a disease because it makes it difficult to run our schools as we do… for the comfort and convenience of the teachers and administrators who work in them,” (Buonomano, 9). The subcommittee expressed concern that school personnel were pressuring parents to give their children stimulants. Since the 1990’s, however, Ritalin use has skyrocketed. In 1994, the broadest definition yet for ADD was published in the DSM-IV. NIMH researchers found that hyperactive children’s brains are about five percent smaller than the brains of non-ADHD children. In 1995, the DEA warned that Ritalin was being diverted for illegal use. In 1997, it was determined that the number of students labeled as disabled hit ten percent of the total school population. In 1998, an NIH conference on ADD concluded that inconsistent treatment, diagnosis and follow-up for ADD children is “a major public health problem,” and that an accurate ADD diagnosis “remains elusive and controversial.” The conference learned that new studies show a clear link between certain allergenic foods and food additives and hyperactivity, but it refused to recommend more study on the effect of diet on ADD. In 1999, researchers reported in September that as many as 18-20 percent of the white, fifth-grade boys in some southeastern Virginia schools are being medicated for ADD. The Center for Science in the Public Interest said that at least 17 well-controlled studies conducted over the past two decades show that food dyes and additives and certain foods affect some children’s behavior, (Hartman, 24). It is clear to see that over the years the stimulant Ritalin has become increasingly popular for the treatment of ADD, but it has reached such a point to where it is being over-prescribed. To remedy the disorder, doctors are prescribing the “savior drug” for ADD patients, as though it is the only way to cure the problem. The over-prescription of the drug Ritalin to correct ADD produces many negative side effects upon patients and society. II. EXPLANATION OF THE EFFECTS OF RITALIN In the vast market of prescription drugs, Ritalin, the most highly prescribed drug for the treatment of ADD, also carries with it some of the greatest medical drawbacks. Attention Deficit Disorder stands tall as America’s number one psychiatric disorder, (Bailey, 52). Estimates suggest that more than two million children live with the disorder; in addition, according to Dr. Daniel Safer of Johns Hopkins University, over 1.5 million regularly consume Ritalin for the treatment of ADD, (52). Ritalin appears to be a popular choice for doctors, but the daily effects of the drug, which family physicians do not see, creates questions as to how well the drug actually works. Scientifically known as methylphenidate, Ritalin stimulates the central nervous system with similarities to amphetamines in the nature and extent of its effects; furthermore, it supposedly activates the brain stem arousal system and the cerebral cortex, (Barkley, 16). The key factor remains that doctors and researchers are not sure of what precisely occurs when Ritalin invades the human body. There have been no definite long-term studies done to assure parents that Ritalin does not more or less cause havoc in their child, nor does any disease accompany prolonged use, (Bonn, 2139). Testing results released by the Federal Drug Administration (FDA) in February of 1996, show a study of mice in which a rare form of liver cancer arose as a result of Ritalin; however, the FDA still regards Ritalin as "safe and effective," (2139). Offering almost as many side effects as the number of people who take the drug, Ritalin alters many different aspects of the body. A few of the adverse effects that the manufacturer cautions physicians to be on the lookout for include: nervousness and insomnia; loss of appetite, nausea and vomiting; dizziness, heart palpitations, headaches; changes in heart rate and blood pressure (usually elevation of both, but occasionally depression); skin rashes and itching; abdominal pain, weight loss, and digestive problems; toxic psychosis, psychotic episodes, drug dependence syndrome; and severe depression upon withdrawal, (Physician's Desk Reference, 1995). Most physicians would not admit to being blind about the true consequences of Ritalin, and most families never receive the needed information to make an educated decision about whether or not to take the drug, (Bonn, 2140). Being a potent drug with many numerous physical effects, Ritalin should not be respected by doctors who spend only a short amount of time with patients before prescribing the "wonder drug" as treatment. Findings of a recent survey by the Archives of Pediatric and Adolescent Medicine, report that almost half of the pediatricians surveyed said they send ADD/ADHD children home within an hour, (Diller, 63). Time appears to be on the side of the doctors, which leaves patients and their families holding a possible "time bomb" of Ritalin. With assembly line-like characteristics, physicians turn patients in one door and out the other without conversing with teachers, reviewing a child's educational level, nor doing psychological evaluations, (63). After a child uses all the Ritalin given with one prescription, a new prescription is required for additional doses, (Bailey, 5). Because of this, doctors as well as pharmacies benefit monetarily from the constant appointments to the doctor and the many prescriptions respectively, for a drug that may be doing more harm than good. However, a long-awaited study by the National Institute of Mental Health shows that drugs like Ritalin calm kids down even better than previously thought, only as long as the children continue taking them, (Eberstadt, 26). But there is no proof that in the long run the drugs help kids better grades or build better lives. Children with ADD are at higher risk than their peers of dropping out, of becoming smokers, of abusing alcohol or drugs, even of spending time in prison. This study provides stronger evidence than ever that medication can shift troubled kids to a better track, (26). But it echoes the frustrating finding of earlier studies that a little yellow pill is not enough, by itself, to keep them there. Using Ritalin creates psychological changes in addition to the medical effects that become evident. Throughout life every person loses concentration or does not pay attention to the present situation; however, if ADD was based upon the individual occurrences that all humans experience, then the entire world would be diagnosed with ADD and consuming Ritalin. Citing the main criticism of Ritalin, Diller states that the drug is simply a quick fix for children living in an impatient world, (64). “It takes more time for parents and teachers to sit down and talk to kids; it takes less time to get a child a pill,” states Dr. Sharon Collins, a pediatrician in Cedar Rapids, Iowa, where reportedly eight percent of the children are on Ritalin, (McCormick, 4). Parents many times initiate the pursuit to obtain Ritalin with hopes that the “miracle drug” can work to help their child achieve more. Parents seem to seek to find an ADD/ADHD diagnosis for their child so that he or she may possibly study more intently, focus on tests, and get better overall grades. Children obtain false senses of security, which leads many to put trust in a capsule or pill and disregard individual responsibilities to work without the aid of a drug. Children must learn to be held responsible for their behavior and a drug cannot correct every physical condition. Russel A. Barkley of the University of Massachusetts Medical Center states that “we are giving kids medication rather than dealing with their problems”, (Barkley, 2). Psychological dependence upon a medication is an addiction to something that is almost always not necessary, especially when Ritalin with its unknown effects is used as a tool by impatient parents. In addition, the illegal side effect of abuse is also a rising problem. Classified as a Schedule II controlled substance, Ritalin comes under strict regulations and quotas from the federal government dictating the amount of the drug that can be manufactured. Over the past several years, as ADD diagnoses increased, the manufacturing amounts have not increased sufficiently to allow for the increased demand. This has led to scattered and regional shortages of Ritalin. A diversion of drugs into the illegal street drug trade increases the shortages of the drug for legitimate medical purposes, (Romano, 10). Abusing the drug usually takes place by snorting or injecting Ritalin into the body which stimulates cocaine-like effects along with an armful of unwanted symptoms that invade normal biological processes (Bailey, 4). Intravenous use of Ritalin as Bailey explains, exposes the body to many dust particles and even smaller bacteria that can attach to the needle, flow straight into the blood, and contaminate the circulatory system, (4). Snorting Ritalin, which is more common, harms the body just as much as does intravenous abuse. Ritalin tablets contain hydrochloride salt which produces dilute hydrochloric acid when it comes into contact with moisture; once inside the nasal passages, the acid burns the tender nasal tissues which controls the olfactory sense in the body, (Bailey, 5). The price that some people pay to damage their bodies expresses the lack of common sense that abusers have. In the illicit street drug market, tablets usually cost between three to fifteen dollars for a tablet that is no larger than a tic tac in size. As ADD diagnosis increases, doctors’ demand for Ritalin increases to distribute to the patient; however, due to government restrictions on manufacturing quotas, the amount of the drug available is limited and abuse of the drug hinders the number of pills on the legal market, (Bailey, 2). One of the most common places of illegal sale of Ritalin lies on the school yards of America; enterprising children see the opportunity to make some money and neglect their parents’ waste of money every time a prescription is written, (McCormick, 3). Society reaps a harvest of malignant effects by the abuse of Ritalin and most people see nothing wrong. III. WHAT WE CAN DO TO HELP SOLVE THE PROBLEM Ritalin creeps into society as a drug with a big name and reputation for being used widely. But as its popularity increases for the treatment of the increasing ADD diagnoses, the question of who should and should not be drugged arises. The theory and practice of mental health in the United States and the relationship between health and illness also becomes questionable. As Dr. Mark Vonnegut wrote in The Boston Globe, The diagnosis of ADHD tells us more about ourselves then we want to know… (Parents) truly believe their child is suffering from an inability to learn or fit in, and without treatment will suffer peer rejection or academic failure. Vonnegut notes that these children are diagnosed because they are in conflict with adults… ADHD offers an explanation that absolves parents and teachers of having any responsibility for the conflict, (Buonomano, 8). The psychiatrists who design the scientific research, come up with the diagnostic categories and prescribe stimulant drugs, rarely explore how children are being viewed or taught. Most of the numerous educational and scientific journals tend to ignore matters such as classroom organization, teachers' attitudes toward the child, and all other elaborate components in the social system. Furthermore, by focusing on the symptoms and defining them as attention deficits, we ignore the possibility that the behavior is not a medical disorder, but an adaptation to a social situation. In effect, it turns our attention from the family or school and from seriously considering the idea that the "problem" could be in the structure of the social system. Social problems become medicalized, and the targets of therapeutic activity are more likely than not to be the socially impaired child. Children are being drugged unnecessarily. Children who are sad, anxious, angry aggressive or just plain disobedient are viewed as having and attention deficit. Even shy, dreamy children are being drugged. It seems as though childhood itself has come to be seen as a disease. By turning to pharmaceutical drugs as a quick-fix solution to their children’s more disappointing characteristics, parents are virtually bringing up a generation of people who have little sense of personal responsibility. Instead of learning how to improve themselves and the world they live in, children are being taught that they are somehow defective and should rely on drugs to make them “right.” God has given the knowledge to researchers and developers of pharmaceuticals to design drugs in order for people to benefit from the use. If doctors abuse the privilege to diagnose afflictions and distribute medicines, then society will become corrupt with drugs and illegal selling of drugs. Physicians must respect the privilege and give drugs to those who are medically in need of it and not just as a pacifier. Ritalin can be a help if the proper research and study is done to determine what the drug actually effects in the body and who requires the drug for healthier living and better focus on life. Bibliography:

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