Oct. 10, 1999 (Washington) -- "It's time we paid attention," Lawrence Diller, MD, told pediatricians here at the 69th Annual Meeting of the American Academy of Pediatrics. Diller, referring to the 4.8 million children with attention deficit hyperactivity disorder (ADHD) who are currently taking Ritalin (methylphenidate), called upon clinicians to become advocates for patients and their families.
"What we're seeing is the tip of the iceberg and the front of a storm for children with ADHD in the U.S.," says Diller, a behavioral pediatrician at the University of California, San Francisco, and author of the book Running on Ritalin: A Physician Reflects on Children, Society and Performance in a Pill.
The reasons for Diller's unease becomes clear in light of statistics: the U.S. currently uses 85% of the world's Ritalin, and recent data show that 4.8 million U.S. children are taking the drug. Between 1990 and 1997, Ritalin use increased 700%, according to Diller. "In some areas, especially the northern states, use is so high it's disturbing," he says.
Diller says problems with ADHD have more to do with a "living imbalance" for children than a chemical imbalance. "As children's needs have increased, attention to their needs have decreased. We're not blaming parents; Moms don't work because they want to, it's because they have to," says Diller. He cites several factors that intensify the problem, from pressures to exceed in school to media hype about the condition. "But the fact is, 20% of fifth grade Caucasian boys are on Ritalin," he says.
While Diller doesn't maintain that Ritalin is overprescribed or underprescribed, he says he has a problem with the concept that Ritalin is a first and only choice. "We know some children are suffering and need help getting through the day," he tells WebMD, "... but, Ritalin isn't the only answer." Diller suggests parents work closely with their child's physician to understand all of the issues, learn about the benefits and drawbacks of treatment, and above all, "demand adequate evaluations for your child."
Co-presenter Daniel Kessler, MD, says that because ADHD is associated with so many problematic outcomes -- divorce, sexually transmitted disease, accidents, incarceration -- consumer training is essential. It's a public health issue, he says, "every time parents pick up a magazine, they see an article that says ADHD isn't real. If parents don't think it's real, what's their motivation for seeking treatment?" Kessler is director of developmental and behavioral pediatrics at the Children's Health Center in Phoenix.
Kessler says that it's important for parents to remember that when it comes to ADHD, "no one is to blame. We need to focus on strengths and on what's working in the kid's life."