More kids in North America are diagnosed with attention deficit hyperactivity disorder and given drugs to 'help' them behave than in the rest of the world combined, reports Richard DeGrandpre, author of Ritalin Nation.
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Although statistics are not available, the Hyperactive/Attention Deficit Disorder Support Group of South Africa believes that 10% of all South African children are affected.
Ritalin, long hailed as a wonder drug in the treatment of this disorder, also has its critics.
"Ritalin is little more than coke for kids," says DeGrandpre.
"Cocaine has pharmacological actions that are very similar to those of methylphenidate [Ritalin], which is the most commonly prescribed psycho-tropic medication for children in the United States," says a report by Nora Volkow and colleagues at Brookhaven National Laboratory, in the Archives of General Psychiatry in 1995.
Researchers are quick to point out that children prescribed Ritalin do not snort or inject it, which alters the drug-taking experience. Nevertheless they point to the fact that the continued use of cocaine and other stimulants causes brain changes. And the drug stops having the desired effect once the child goes off it.
Many experts question whether Ritalin is being over-prescribed and whether teachers, doctors and parents are too quick to diagnose a child as suffering from ADHD. And they worry that the recent move by drug companies to use print and television ads to sell their products directly to the public, will exacerbate this.
"I think it's a big mistake," said Lenny Winkler, an emergency room nurse and state representative in Connecticut . "I believe we are over-medicating our children.
"I think we're aiming the information to the wrong people. They should be targeted to the physician. The physician is the one that writes the prescription," explained Winkler.
Dr Peter Jensen, a child and adolescent psychiatrist at Columbia University, disagrees.
"I am actually very pleased that there are responsible, carefully prepared, factually based advertisements," he said. "They inform parents and others about the condition of ADHD. That it's a true medical disorder, that it has serious long-term consequences for children if they're not treated."
But Winkler says, in reality, too often it's the teacher who's making the diagnosis.
"In some situations, even parents were told if they didn't place their child on a psychotropic drug, their child wouldn't be able to attend school. And I just found this horrendous," she said.
She supports a Connecticut law that would, starting October 1, prohibit schools and teachers from recommending psychotropic medications. A teacher could recommend a visit to a doctor.
"If a child is appropriately diagnosed with ADD, ADHD, the child would definitely benefit from the medication, and I am not opposed to that at all," said Winkler. "But I am opposed to somebody making the recommendation to a parent (that) their child needs this drug and the physician sits down and writes it out without doing the necessary work on the child."
While much of the public debate has focused on over-diagnosis and over-medication of children, some doctors say a bigger problem is children being missed.
"Here in the United States, there is a tendency to over-prescribe in some instances. But it pales in comparison to the under-prescription or under-recognition of these problems in children," said Jensen. "We know from a variety of epidemiologic and other related studies, that as many as half of the children with conditions such as ADHD are not being treated at all."
Much of the stigma associated with psychotropic drugs for the treatment of ADHD comes from their potential for abuse. The introduction of new, less-addictive drugs over the next year could alter the Ritalin debate.
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