Ritalin on Trial

While some Houston parents fight what they charge is "a river of Ritalin" running through the schools, one father has gone to court to try to prove that, for his son, Ritalin use is Ritalin abuse.

Fort Bend school officials have declined to talk about whether overuse of Ritalin is a problem in their school district, except to point out that it is physicians, not educators, who prescribe the medicine. As to how many children are actually taking Ritalin on a regular basis, Fort Bend officials say they don't know; they haven't any data on that. And legally, they're not required to keep such figures. So while some Fort Bend parents have been making sarcastic comments about a "river of Ritalin" flowing through the district, they can't be sure if their anecdotal evidence is true systemwide. And so far, school officials haven't made it any easier for them to know.

In October 1993, when Williams took her son's prescription to a local Randall's to be filled, she found that the pharmacy was out of the drug. There was a national shortage, one that some people have blamed on a bureaucratic foul-up in Washington by the DEA, and one that some have charged was manipulated by Ritalin's manufacturer, New Jersey-based Ciba-Geigy, to stir up public concern and help increase the drug's "quota" -- the amount the manufacturer is legally allowed to produce by the DEA.

In a report on methylphenidate released last October, the DEA contended that Ciba-Geigy "issued a press release and sent over 400,000 letters to health-care professionals accusing the DEA of creating an impending shortage of their product." Ciba-Geigy also alerted the membership of Children and Adults with Attention Deficit Disorders, or CHADD, that a shortage was imminent, the DEA reported. CHADD members protested to Congress and, according to the DEA, "many parents rushed to their physicians to get multiple prescriptions for methylphenidate in order to ensure they had several months' supply on hand. In short, Ciba-Geigy was contributing to a situation which promoted the increased sale of product through panic buying."

The DEA also reported another interesting fact about CHADD, a 30,000 member association that distributes expertly printed brochures on ADD. Over the last five years, while Ritalin usage soared, Ciba-Geigy had given nearly $750,000 to CHADD.

CHADD has also lobbied to have Ritalin taken off Schedule II, the DEA's list of nationally monitored drugs that includes amphetamines, cocaine and morphine-based drugs. Prescriptions for Schedule II drugs are not renewable with a phone call; they must be rewritten in triplicate and signed by a physician on a monthly basis. CHADD's national president says that CHADD's membership wants relief from this burden.

Mary Richard, a counselor of college students with learning disabilities at the University of Iowa who serves as the volunteer president of CHADD, says the organization exists to provide information, not to promote a medication. In any event, Ciba-Geigy's contributions never amounted to more than 11 percent of the organization's budget, she says.

CHADD probably deserves some credit -- or responsibility -- for the increased use of Ritalin, Richard says, because it has lobbied so hard to get information out to schools and the public about ADD. But she's not concerned about overdiagnosis of the syndrome or overuse of Ritalin. If anything, she says, ADD is underdiagnosed. There are principals who don't believe in ADD and school systems that don't recognize it as a learning disability, she claims. And as for the dangers of Ritalin, Richard insists, "When it is properly prescribed and properly used, it is safe."

CHADD's literature heavily emphasizes the need to use multiple therapies to deal with ADD. The problem is, many insurance companies will pay for drugs to treat ADD, but are less likely to pay for the long-term, and expensive, educational and talking therapies that some ADD experts say their patients need.

Jay Tarnower, a Houston child psychiatrist with a team practice devoted to helping people with ADD, says that while Ritalin and other medications are enormously helpful, "the pill doesn't teach skills. What it can do is create the biological environment to learn skills."

Because 30 to 60 percent of children with ADD have learning disabilities, Tarnower says, they need to have their individual learning styles identified. They can then be taught study, organizational and time-management skills and learn strategies to deal with their emotions. Tarnower says he has ADD himself, but manages it without taking drugs. Instead, he constantly writes lists and spends a lot of time organizing his daily and weekly goals.

According to Tarnower, an effective diagnosis of ADHD requires several hours of observation and work. He believes that only board-certified child psychiatrists should prescribe Ritalin, and that pediatricians and other non-specialized physicians should get out of the business of doing so. Besides learning disabilities, he says, afflictions such as epilepsy and depression should be eliminated as a possible source of behavioral problems before a child is diagnosed as needing Ritalin. But while the literature on ADHD stresses that successful treatment of the syndrome requires a complex web of therapies, time management training and other teaching techniques, what most ADHD children get, according to the DEA, is a pill.

Connie Hall is the mother of two boys who underwent Ritalin therapy during the last few years, and she was dismayed by the side effects. Hall lives in the suburban town of Stafford, and her sons, Nick and Tony, attended public schools in the Stafford Municipal School District.

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