The Run on Ritalin: Attention Deficit Disorder and Stimulant Treatment in the 1990s

Article excerpt

Stimulants were first reported as a pharmacologic treatment for children's behavioral problems in 1937.[1] Methylphenidate, a derivative of piperidine, was synthesized in the 1940s and marketed as Ritalin in the 1960s.[2] It is structurally related to the older drug still used for the treatment of hyperactivity, d-amphetamine. Their pharmacological actions are essentially the same.

Stimulant treatment for children became more common in the 1960s when its short-term benefits for what was then called hyperactivity were documented in controlled trials. In 1970 it was estimated that 150,000 children were taking stimulant medication in the U.S.[3]

A furor over stimulants began in 1970. The reaction stemmed from an article in the popular press charging that 10 percent of the children in the Omaha school district in Nebraska were being medicated with Ritalin.[4] While ultimately shown to contain inaccuracies, the article spurred other reports of "mind control" over children and led to congressional hearings about stimulants that same year.[5] Numerous articles in newspapers and magazines and one book attacked Ritalin and the "myth" of the hyperactive child.[6] Subsequently it was found that some of the criticism appeared to be led by supporters of the Scientology movement, who have consistently challenged mainstream psychiatry's use of psychoactive medications.[7] Yet the negative publicity struck a nerve with the general public, which by the mid-1970s made it quite difficult to convince parents and teachers in many communities to attempt a trial of Ritalin.

The DEA began monitoring the amounts of medilyphenidate and amphetamine produced in this country in 1971. Both became Schedule II controlled drugs partly in -response to an epidemic of methylphenidate abuse occurring in Sweden and the illegal use of stimulants in this country. Estimates on the number of children using stimulants have varied widely. In 1980 it was estimated that from 270,000 to 541,000 elementary school children were receiving stimulants.[8] In 1987 a national estimate of 750,000 children was made.[9] Both estimates were guesses extrapolated from local surveys.

More precise than national estimates of children taking stimulants are the records of production quotas maintained by the DEA that show a steady output of approximately 1,700 kilograms of legal methylphenidate through the 1980s followed by a sharp increase in production in 1991.[10] From 1990 through May 1995, the annual U.S. production of methylphenidate has increased by 500 percent to 10,410 kilograms[11] (see figure), "an increase rarely seen for any other Schedule Il Controlled Substance," according to the DEA.[12] A national survey of physicians' diagnoses and practices based upon data collected in 1993 found that of the 1.8 million persons receiving medication for Attention Deficit-hyperactivity Disorder, 1.3 million were taking methylphenidate.[13] A comparison of 1993 Ritalin production with the latest figures available for 1995 suggests that 2.6 million people currently are taking Ritalin, the vast majority of whom are children ages five through twelve.

Who is taking all of this Ritalin, and why? To get at the answers to these questions, we need to look at changes in professional and lay attitudes regarding psychoactive drugs, the brain, and children's behavior. Six hypotheses are suggested to explain the sudden increase in the demand for this drug.

Changes in Diagnostic Criteria

As more children's behavior is viewed as abnormal, more treatment is offered. The American Psychiatric Association distinguishes deviancy from normalcy in its Diagnostic and Statistical Manual of Mental Disorder (DSM). With the introduction of the DSM HI in 1980, mainstream psychiatry officially changed its view from a diagnosis of hyperactivity, highlighting physical movement, to one where problems with attention, Attention Deficit Disorder, were of primary concern. …