POLITICS

 
Where Did Ritalin Come From?
A brief history of the controversial drug

Massachusetts News--March, 2000

By Ron Schneebaum, M.D.

March 2000--Some sixty years ago Ritalin was mostly used to treat narcolepsy, a condition characterized by brief involuntary attacks of sleep. 

A physician noticed certain very active and difficult-to-manage children and tried them on Ritalin and/or amphetamines, a family of drugs with chemical similarities to Ritalin, because of a calming effect seen in some patients who took Ritalin for other reasons. These active children were thought to have a "minimal brain dysfunction," as it was then termed. Medication seemed a better choice for this group of children than the long road of juvenile delinquency that awaited them.

Ritalin/amphetamines were then tried on children who were impulsive and hyperactive in school, but whose behavior wasn’t as extreme. 

These medications had the same effect – increased attention and decreased distractibility. Minimal brain dysfunction didn’t fit the picture of these kids, and a new name, Attention Deficit Disorder, was given to this group of kids whose performance responded to Ritalin/amphetamines. The name was later changed to its current ADHD (Attention Deficit Hyperactivity Disorder) to reflect the hyperactivity that can be seen as well as the attention deficits. The diagnosis was (and remains) descriptive in nature. It is made when a child has a prolonged history of decreased attention; and/or hyperactivity; and/or impulsivity that is not attributable to any other medical, psychiatric, or psychosocial problem.

Dramatic Increase In 1990s

A dramatic increase in the use of medication occurred in the early 1990s. At that time, a group of children who had ADHD without hyperactivity began to be regularly treated with medication. These children weren’t performing up to expectation in school. They were daydreamers. It was reasoned that they were inwardly, rather than outwardly, hyperactive. The use of Ritalin/amphetamines enhanced their school performance. The floodgates were thrown open. The number of prescriptions for Ritalin/amphetamines in this country continues to skyrocket.

The prevailing wisdom was that the condition resolved on its own by the end of the teenage years. This view also changed at this time. 

In 1995 Dr. Ned Hallowell wrote his first book, Driven to Distraction, and described in wonderful detail ADHD as it appears in adults. The book hit the bestseller charts across the country. Adults who functioned at a level less than expected who had the same features as children with ADHD began to be diagnosed and treated with Ritalin/amphetamines.

Science Searched for an Explanation 

It was reasoned that the brain has a central processing center that is dedicated to attention. Because of this well-working system, extraneous material can be ignored and attention may be focused. A pilot in a storm, for example, can land an airplane and ignore any distracting input. Neurotransmitters, chemical substances in the brain, were theorized to bring messages from one area of the brain to another. It was explained that the children and adults with ADD have a decrease in specific neurotransmitters. They have enough to focus on what appeals to them; they just don’t have enough for routine activity. The medication, though it’s not clear how, replaces the missing neurotransmitters. From this standpoint there is nothing wrong with medication. It simply makes these people equal to the others who don’t have the deficit. Doctors would liken giving the medication to giving someone eyeglasses. It doesn’t change who they are; it simply gives them back what should be their innate ability. Now there is a neat tidy package: a diagnosis with criteria for who fits and who doesn’t, a treatment plan and a scientific model that explains the cause and mechanism of treatment.

More Scientific Study

More scientific work is currently under way. Some researchers are trying to understand the genetics of the disease. Others are trying to find the place(s) in the brain of the specific defect(s). Huge efforts are being put into developing drugs that would increase neurotransmitter levels with fewer side effects. The financial reward for the makers of such a drug would be astounding, as some two million prescriptions are being written for Ritalin, alone, and the number continues to increase dramatically.

The scientific model generated it all: an observation, experimentation with medication, a hypothesis explaining the observed phenomenon and a path for further research. The only matter is to find and treat those with the disorder so that everyone will be on an equal level and will be performing maximally. Support groups abound. A battle is now being waged to recognize the disorder under the Americans with Disabilities Act so that the afflicted will get needed services. It is fully legitimized.

Complex questions arise, however, the more one examines this diagnosis and its treatment. The following questions/statements are meant to generate further thought:

• Current estimates are that ten percent of people are so affected, or one out of every six boys. This number is routinely accepted in the professional literature. If ten percent of the people in this country need drugs to function optimally, are we describing a disorder or making a statement about our society?

• Ritalin/amphetamines will help anyone concentrate, ADHD or not. This complicates the matter. For if everyone could have increased concentration by taking these medications, who should decide which students and athletes get prescriptions and which don’t? Further, if these drugs really are so benign why wouldn’t we want to make them more widely available? I believe it is because we instinctively feel that something about it is wrong.

• Thirty years ago amphetamines were a menace. The word was, "speed kills" Many became addicted. Now we are saying that it or its cousin should be prescribed routinely for children, often to ones who are as young as kindergartners. The long term effects of this approach on such a wide scale are unknown.

• We implore students to "Say no to drugs." At the same time we are prescribing Ritalin/amphetamines for children with ADHD so that certain social situations will be easier for them. What are we really telling them about the use of drugs? What will guide these children when they have to decide whether or not to, "Say no"? Will they have successfully learned that drugs that make social situations easier are okay?

• Imagine being told, as many children are, "We’re going to see grandma today. Take your Ritalin/amphetamines before we go. You know how upset she gets when you don’t behave." How might this make children feel about themselves?

• We are telling children from the youngest of ages that they must take medication to function normally without really examining the long term effects of this radically different approach to child psychology.
 
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