May 16, 2000 (Washington) -- At a hearing Tuesday before a House subcommittee, critics of Ritalin warned that the drug, widely used to treat attention deficit hyperactivity disorder (ADHD), may be dangerously overused and misunderstood.
The hearing, along with a discussion of the drug at a national gathering of psychiatrists in Chicago, focused further attention on a stimulant that has come under scrutiny from both medical experts and policy-makers.
"I hear reports that students are selling Ritalin at school and that schools are reporting thefts of Ritalin," said Rep. Michael Castle (R-Del.), chairman of the Subcommittee on Early Childhood, Youth, and Families.
Also of concern is a recent reportin the Journal of the American Medical Association that said Ritalin prescriptions to children ages of 2 to 4 had increased dramatically in recent years (see related WebMD story "More Preschoolers Receiving Psychiatric Medications"). That prompted the federal review of whether these youngsters, many of whom who have problems controlling their behavior and staying attentive in school, are getting appropriate treatment.
"From a layman?s perspective, [the prescribing trend] seems somewhat alarming to me," said Rep. Deborah Pryce (R-Ohio), appearing as a witness before the panel?s Tuesday afternoon session. It?s estimated that as many as 5 percent of American children have the mental disorder.
Lawrence Diller, MD, a behavioral pediatrician from Walnut, Creek, Calif., told those at the hearing that he treats children with ADHD with Ritalin, but only for the short term, since the long-term consequences are unknown.
He attacked what he called the belief in a "medical utopia," where taking a pill cures all ills -- even though the real issues may be family or school problems. "Yes, the kid is symptomatic, and these kids see often [that] when the problems between the parents resolve, their symptoms just fall away. In the meantime, they?ve been labeled bipolar, they?ve been labeled ADHD, they?ve tried three or four different medications," Diller tells WebMD.
An official with the Drug Enforcement Administration (DEA) told the lawmakers that Ritalin, known generically as methylphenidate, has seen a sevenfold increase in production in the U.S. during the 90?s. Because of its potential for abuse, the stimulant is classified as a controlled substance. The DEA says that in addition to being stolen at schools, Ritalin is being dealt on the street and distributed by drug rings.
"Adolescents don?t have to rob a pharmacy ... they have little difficulty obtaining it from a friend or classmate at school," said Terrance Woodworth, deputy director of the DEA. He also said that the abuse potential for Ritalin is in some ways similar to that for cocaine. However, experts say that Ritalin is extremely unlikely to lead to addiction in children.
Ritalin had its defenders at the hearing. Francisca Jorgensen, a special educator from Arlington, Va., described a child named "Joe" who struggled with attention and behavior problems for three years. Nothing helped until the family tried Ritalin with spectacular results. "Joe is and will be a success," said Jorgensen.
Mary Robertson told of the impulsive behavior of her son Anthony, which was finally controlled by Ritalin. "It was like watching a scene from ?Dr. Jekyll and Mr. Hyde.? The difference was unbelievable," says Robertson, a nurse and past president of the advocacy group Children and Adults with Attention-Deficit/Hyperactivity Disorder.
"Clearly, the Congress and the public need more information in order to weigh the benefits and harms of prescribing Ritalin," Castle says.
Ritalin was also a topic of discussion at the annual meeting of the American Psychiatric Association in Chicago, where experts said that the huge increase in stimulant and antidepressant prescriptions for children hides the fact that most kids with serious mental disorders are actually being under-treated.
"Drugs alone are not sufficient treatment," said David Fassler, MD, chair of the APA Council on Children, Adolescents, and Their Families. "The key is getting the child to a physician with sufficient experience and training to get the child the treatment he or she needs."
That too many children are being given strong psychoactive drugs without proper evaluation is becoming painfully obvious, according to the experts.
"The number of children being treated doesn't match the number being diagnosed," said Laurence Greenhill, MD, of the New York Psychiatric Institute. "We have to worry about getting the best [proven] medications to the children who need them."