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Table of Contents:
What is Ritalin?
Who uses Ritalin?
What constitutes ADHD?
Who advocates Ritalin?
Pros and Cons to Ritalin
Alternatives to Ritalin
What is Ritalin?
Ritalin, or methylphenidate, is a stimulant derived from the same family as cocaine. Manufactured by the Ciba-Geigy Corporation, a division of Novartis, Ritalin sales have increased by 700% since 1990. The United States market accounts for over 90% of the sales (Breggin, 1998). Ritalin is dispersed in pill form in varying amounts, either for short or long effects; the short-term form lasts 3-5 hours while the long-term form may last 6-8 hours. (SR) Ritalin is the slow release form that lasts longer. Ritalin, like other stimulant medications, works by increasing the production of neurotransmitters, such as dopamine and norepinephrine, in the brain. (Reif, 1998)
Who uses Ritalin?
Doctors generally prescribe Ritalin as their first choice in treating ADHD, or Attention Deficit Hyperactive Disorder. Approximately 3-5% of children in the world have ADHD, of those, about 4 million take Ritalin (Breggin, 1998). It is thought that ADHD may occur from low levels of dopamine and epinephrine in the brain; although that is a highly controversial topic, it makes Ritalin an obvious treatment.
What is ADHD?
Many psychologists regard ADHD as a state deficit, where children are highly aroused to compensate for the body’s feeling of under arousal. (Kerns, Eso, Thomson, 1999) Three main features of ADHD are 1.Impulsivity, the children often act before they consider consequences 2.Hyperactivity, the children struggle to sit still 3.Inattentiveness, the children have difficulty focusing on a subject because of the overload of stimuli in the environment. Research may indicate that ADHD has biological origins and set symptoms, such as fidgeting, excessive talking, difficulty maintaining concentration, impulsive behavior, lack of focus and messiness. (http://www.mnsi.net/~collinsw/ritalin.htm) According to the Center for the Study of Psychiatry and Psychology, in a recent conference held by the NIMH, National Institute of Mental Health, the validity of the diagnosis of ADHD was held in question. (www.breggin.com) The cause of ADHD is unknown as of yet, and speculation is all psychologists have to diagnose and treat patients. The DSM-IV has categorized ADHD by the three dimensions listed above and included 18 symptoms under the three categories, which include some listed above. ADHD has undergone significant renaming and evaluation since the last publication of the Diagnostic Statistic Manual. Attention Deficit Hyperactivity, was referred to as ADD or sometimes ADD-H, Attention Deficit Disorder with hyperactivity. (www.journals.cup.org)
Who Advocates Ritalin?
Teachers, parents and doctors continue to advocate Ritalin despite the claims made by antagonists of the stimulant treatment. Although schools are looking more critically at Ritalin now, they seem to be a large regulator and proponent of the drug to induce calm behavior in an academic environment. Many people feel that parents and schools must work together to regulate the use and observe the effects of Ritalin. The majority of web sites advocating and discussing benefits of Ritalin appear to be school run or teacher-founded sites. Although Ritalin is not the answer for every child, most physicians use it as their first form of treatment. Pharmopsychology is the most widely used technique to treat ADHD. (Rief, 1998) Their support of Ritalin has foundation in some research.
Pros and Cons of Ritalin Use in Treatment
Although Ritalin appears to help children focus and regulate their attention levels, it is a highly controversial form of treatment. Ritalin alters the behavior of children and allows them to sit still and exhibit fewer symptoms of ADHD. It makes the children much more docile and easy to instruct. (Rief, 1998) According to studies on the drug, helps improve rates of negative behavior, academic productivity, and observation ratings. (www.medscape.com/server~java/MedI.i…cal_holdings_file=1&local_journals_only=0.htp)
Other studies attempting to study the long term effects of Ritalin were inconclusive, but they did reveal that cognitive and achievement scores were lower before taking Ritalin. The scores appeared to rise, as well as, the dosages of Ritalin. (Frankenberger, Cannon, 1999) In elementary schools, higher scores on certain standardized tests seem to indicate progress for the children using Ritalin (Murell, 1999); however, the main problem with this study is the lack of a control group diagnosed with ADHD. A few studies show that Ritalin only affects certain abilities to focus. In one study done on auditory testing, Ritalin did not have a significant effect on the child’s ability to focus on background noise, phonemic skills, or general speech. (Tillery, 1998) A great number of people take the middle ground with Ritalin realizing that it is not a cure only a treatment. Research done on parent-child dynamics shows that relationships and realistic guidelines and goals must also be integrated with the drug therapy. (Widener, 1998)
On the other hand, the side effects of Ritalin are very frightening. Great debate exists over whether or not Ritalin is a harmful substance to administer to children. The Physicians Desk Reference lists the possible side effects of taking Ritalin: anorexia, nausea, dizziness, heart palpitations, headache, dyskinesia, drowsiness, blood pressure and pulse changes, tachycardia(racing heart), angina, abdominal pain, restlessness, insomnia, loss of appetite and arrythmia. Hallucinations and toxic psychosis may also occur in patients taking Ritalin. This stimulant could have severe affects on past drug abusers or alcoholic patients because of the increased reports of abuse. The PDR also warns against "committing a child to a 10- or 15- year diet of stimulants." (http://natures-answer.com/ritalin.htm) Other issues with the drug Ritalin are the fact that it is not an effective treatment for all of the symptoms of ADHD and may only mask the problem. Researchers agree that this is not the way to solve the problems the child or patient with ADHD face. As a member of the same family as cocaine, another concern about Ritalin is the fact that it is a "gateway drug" that could lead to substance abuse. (http://pinesgift.com/msritalin.html) Researchers have embarked on a new road to study the rate of Ritalin abuse. According to the Washington Post, students can sell the pills for $1-$5 dollars a piece. People either swallow the pill of crush it and snort it. The street names for Ritalin are "Vitamin R", "R-ball" or "the smart drug." The DEA, Drug Enforcement Administration holds Ritalin responsible for a number of deaths. In 1994, over 1,171 people were admitted to the emergency room because of reaction to methylphenidate. (http://www.ndsn.org) According to Peter Breggin "[Ritalin] works by producing malfunctions in the brain, that is the only way it works." It causes the brain to atrophy, makes children lethargic, "robotic", and depressed. (Breggin, 1998) The US military has also put a ban on Ritalin use by not allowing people who have taken Ritalin to become coast guards, marines, or officers in the air force. "Unfortunately there is nothing we can do if a person has been using Ritalin," he said. "It is considered to be a mind altering drug." According to Sgt. Master Mike Torres, 1/50 men are turned away every month because of past or current Ritalin use. (http://www.restores-homepage.com/military_bans_ritalin.htm) In a study on the similarities between cocaine and Ritalin, researchers found that cocaine and Ritalin act in essentially the same fashion, but cocaine has a fast uptake where Ritalin has "slow clearance." (Volkow, Ding, Wang, 1995) Another downside to Ritalin is the temporary effects of it; 3-5 hours after the ingestion of the drug, the effects of "coming down" kick in. This displays part of the addictive quality of the drug, along with the increased tolerance to the drug. Doses must be increased with extended use of the drug.
Alternatives to Stimulant Therapy
Doctors use many different stimulant medications to treat ADHD; however, many of them have similar side effects to Ritalin and similar drawbacks. Many books are available to help parents and teachers cope with ADHD children by setting strategy and talking through a lot of the feeling associated with the disorder. Some books on the subject are listed below. Many herbal products and natural treatments also exist although the efficacy of these treatments is also controversial and probably ineffective. Many web sites have information on biofeedback, diet treatments and herbal treatments. (http://www.planetrx.com/condition/cond_detail/add_info/2_alternativecare.html)
Frankenberger, W., Cannon, C.(1999). Effects of Ritalin on
academic achievement from first to fifth grade. International Journal of Disability, Development, and Education,46. 199-221
Murrell, J. (1999). Behavior profile of children with attention
deficit disorder under treatment of ritalin in elementary schools. Dissertation Abstracts International,60.
Musser, C., Ahmann, P., Theye, F., (1998). Stimulant use and the
potential for abuse in Wisconsinas reported by school administrators and logintudinally followed children. Journal of Development and Behavioral Pediatrics,19. 187-192
Rief, S., (1998) The ADD/ADHD Checklist Prentice hall: Paramus,NJ
Tillery, K. (1998) A double-blind study of the central auditory Processing and auditory continuous test performances of children with attention deficit hyperactivity disorder and central auditory processing disorder under ritalin and placebo conditions. Humanties and Social Sciences, 58. 2536
Widener, A., (1998) Beyond ritalin: the importance of therapeutic work with parents and children diagnosed ADD/ADHD. Journal of Child Psychotherapy,24. 267-281
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