Like birth, menstruation, and menopause, the unfolding of childhood is an inherently natural process. Nevertheless, every morning before going to school, 3 to 5 percent of American schoolchildren take a mind- and behavior-altering prescription drug called Ritalin (methylphenidate).1 They do so because they have been diagnosed as having a "disease," called "Attention Deficit Hyperactivity Disorder" (ADHD).

It may seem paradoxical to give stimulants to children who are hyperactive in order to calm them down. But this is done because these drugs often have the reverse effect on children than they do on adults. Although the actual impact of Ritalin and similar substances on the brain and mind of young people is poorly understood, children diagnosed with ADHD often continue to take it for years.

What happens to the youngsters who take this medication? Their actions tend to be more goal-directed and "on task" than before. They often become less distracted by things going on around them, and better able to stay focused on their schoolwork. They tend to become less aggressive, less apt to get into trouble, and generally more docile and compliant. They follow rules better.

These changes make them easier for adults to manage. Psychiatrists, parents, and teachers are often pleased with the changes they see in a child who is put on Ritalin, who may appear to be "finally settling down."

I have been dismayed to learn, however, that the drug usually does nothing to enhance learning or improve actual academic achievement beyond the short term.2 Actively seeking to find evidence for enhanced learning in children on Ritalin, psychiatrists Russell Barkley and Charles Cunningham analyzed 17 studies on the subject, and called the results "uniformly discouraging."

In 1995, a school board member from Litchfield City, Connecticut named Patrice Fitch publicly described her daughter's response to Ritalin: "In the classroom, she became more likely to pay attention or do what the teacher instructed. Yet, while she may have had her pencil poised over the work assignment, closer inspection revealed that she was not actually forming the answers but instead imitating the stance. While Ritalin made it possible for Amanda to sit more or less calmly in her chair, it did not help her to learn."4

Conequences
Approximately one-third of the children diagnosed as hyperactive do not become less restless on Ritalin. Some actually become more agitated. At best, the drug can help those children who have been accurately diagnosed to focus their minds so they can temporarily absorb information better. But others become withdrawn and stare off into space, not responding to much of anything. While these children no longer make trouble for their teachers or get into fights, they begin to exist in a state of disconnected social isolation.5

Even for those children whose behavior does respond as intended, the effect is only a temporary suppression of symptoms, not a cure. When children stop taking Ritalin, they are back where they started, only now they may also have to deal with a rebound effect from the medication, which may make them more distraught than ever.

And then, as with any drug, there are inevitably adverse side effects.6 Many children crash when their dose wears off, behaving even more uncontrollably than they did before. The Physicians' Desk Reference lists more than 25 symptoms-ranging from anxiety to hair loss to convulsions-that have been observed in Ritalin users having no preexisting conditions. Reactions include nausea, insomnia, headaches, weight loss, and a slowing of growth. Some children develop bizarre compulsive behaviors, such as insistent biting of their fingers and nails until they bleed. Other reactions include elevated heart rate, increased blood pressure, and a serious disorder known as Tourette's Syndrome, characterized by repetitive involuntary movements or tics.

Are there long-term side effects from the drug? This is an important question' because children are often placed on this medication for many years. It is also a frightening question, because to date no adequate longterm studies have been performed.7

Although more difficult to quantify than physical side effects, there are emotional and psychological consequences to labeling a child as having ADHD and putting the youngster on drugs. Having this kind of a diagnosis and treatment become a permanent part of a child's health files and educational records hardly helps her or him build self-esteem and selfrespect. In 1993, pediatric neurologist Fred Baughman, M.D., asked in the AMA journal, "What is the danger of having these children believe they have something wrong with their brains that makes it impossible for them to control themselves without a pill? What is the danger of having the most important adults in their lives, their parents and teachers, believe this as well?"8

Others have asked what the implications are of telling a child, "Say no to drugs, but don't forget to take your behavior-controlling, consciousness-altering medication before lunch." What happens to children when the full weight and authority of the medical profession tells them to take drugs to control their behavior? How will children learn to understand their emotions and deal with them constructively if they are told to take a drug to make them go away?9

When Clinical Psychiatry News discussed the heavy use of illicit drugs among adolescents, the journal lamented the increasing numbers of young people falling prey to substance abuse. Ironically, right next to the article, and visually overpowering it, was a prominent ad for Ritalin.'°

Ciba-Geigy, the company which manufactures Ritalin, says that the drug is not addictive if used as directed. But like cocaine and amphetamines, it is classified by the Drug Enforcement Agency as a Schedule II drug, meaning that among those substances regarded as having medical use, it is considered to have the highest potential for abuse. And even CibaGeigy acknowledges that some youngsters buy or steal the drug from classmates' sniffing and injecting it to get high.

In England, physicians simply do not prescribe Ritalin or other stimulant medications for children." They are far more cautious than we are about drug use in children to begin with, and particularly so for drugs with pervasive central nervous system effects. Throughout western Europe children almost never receive medication for hyperactivity.

In the United States, however, it's a different story. Although the Physicians' Desk Reference specifically states Ritalin "should not be used in children under six years [of age]," that did not stop U.S. physicians from writing 200,000 prescriptions for Ritalin and similar stimulants in 1993 for children ages five and younger.'2In the U.S., Ritalin has been prescribed to children as young as 18 months old.

The 1980s saw a dramatic increase in Ritalin use among children in the United States which coincided with publication of influential work by the University of Pittsburgh's Stephen Breuning. His research was believed to have proven that stimulants such as Ritalin were effective answers to hyperactivity. But evidently Dr. Breuning was somewhat lacking in the noble spirit of open-minded scientific inquiry. In 1988, it was discovered that much of his data had been completely fabricated. It turned out that he had reported studies that had never been performed.'3

Breuning was sentenced to prison for this fraud, and articles condemning his actions appeared in major medical journals. Yet many teachers, pediatricians, psychiatrists, and parents are still influenced by the pro-Ritalin wave that washed across the country during the years when his "research" was believed to be genuine.

In the years immediately following Breuning's exploits, there was an exponential increase in the use of medication for children diagnosed with ADHD. A 1987 study found that 6 percent of all schoolchildren in Baltimore were on medically prescribed stimulant drugs.'4 An outraged public response in that city caused Ritalin use there to decline in the following few years, but in the rest of the nation, the number of children being dosed with this and other medically prescribed stimulants continued to increase.

By 1995, more than 6 million psychiatric prescriptions were being written every year for Americans under the age of 18. 15 And in 1996, the World Health Organization estimated that nearly 5 percent of all elementary schoolchildren in the United States were on Ritalin.16

Which Kids are Put on Ritalin?
The assumption is that these children have a brain dysfunction or disease Yet doctors prescribing Ritalin rarely, if ever, perform neurological tests." Instead, they take the word of parents or teachers, whose judgments are invariably subjective. The scores that are obtained from the various scales used to diagnosis ADHD give the appearance of scientific precision, as though they were measuring something tangible, like blood sugar levels. But in reality, ADHD is defined entirely in behavioral, nonmedical terms. The numbers merely sum up a particular teacher or physician's subjective impressions. In fact, a number of studies have shown that when parents, teachers, and clinicians rate the same child, they frequently come up with wildly differing scores.18

Who, then, are the children who get diagnosed with ADHD?

Some, who may be so unruly that they can completely disrupt an entire class, or who are impossible for their parents to handle, may benefit from the drug, at least in the short term. But many are simply children who have a strong sense of their own inner rhythms and timing. These youngsters often feel frustrated in authoritarian situations, and conforming to the rules of a classroom or of autocratic parents can be difficult for them. Such children are potential recipients of an ADHD diagnosis, because the American Psychiatric Association's criteria for ADHD officially points the finger at children who "interrupt others, and have difficulty following instructions."

Children who are especially intelligent are often bored in today's schools, and will sometimes try to answer their teacher's questions as quickly as possible, in the manner of game show contestant "whiz kids" eager to display their knowledge. This behavior, while hardly evidence of pathological brain chemistry, may nevertheless lead to a diagnosis of ADHD, because another of the of ficial criteria targets kids who "often blu* out answers to questions before they have been completed."

Children who are assertive by nature may also receive the diagnosis. One of the scales that is most widely used by parents and teachers to assess for ADHD is the Revised Conner's Questionnaire.'9 According to this scale, children are suspected of being hyperactive if they are "sassy," and guilty of "wanting to run things."

Then again, those children who happen to be especially sensitive or timid aren't exempt, because other criteria include being "shy," and having their "feelings easily hurt."

Kids who come from difficult family situations are also likely candidates for the diagnosis. Being "basically an unhappy child," and "feeling cheated in the family circle" are considered symptoms of ADHD.

It's hard to avoid the suspicion that just about any kid who doesn't fit easily into the school or family system might fall prey to the diagnosis and Consequently be treated with Ritalin. The Revised Conner's Questionnaire actually goes so far as to state that children who behave in a "childish" way are displaying a symptom of ADHD. And here all along I had thought that behaving in a childish way was a natural part of childhood.

In fact, the more I've looked at the diagnostic criteria by which children are labeled as having ADHD, the more I've begun to suspect that the only children who are completely safe from a diagnosis of ADHD are those who are so frightened to disobey that they are compulsively dutiful and obedient.

Are Our Schools for Compliance or for Learning?
Not being a particularly big fan of either Ritalin or our mass production school system, educator John Holt told Congress plainly that we give kids this drug so that "we can run our schools as we do, like maximum security prisons, for the comfort and the convenience of the teachers and administrators who work in them."20