As a behavioral pediatrician in Walnut Creek for the past twenty years I have evaluated and treated over two thousand children for their behavior and performance problems.
Over the years I've written many Ritalin prescriptions, the stimulant used to treat ADD (short for Attention Deficit Disorder or hyperactivity). Beginning in the early 1990s I began seeing a new kind of ADD candidate: younger than six years old, teenagers and adults. Many of the children seemed less impaired by their personalities compared to the previous generation of patients. Nevertheless, their parents or teachers were concerned.
I found myself reaching for my prescription triplicate form (Ritalin is a controlled substance) more and more frequently. I began to wonder what was behind this change. My own unease with my role led to an inquiry over the social, cultural and economic aspects of ADD and Ritalin. I learned that Ritalin production and use increased by 700% since 1990. The United States uses 90% of the world's Ritalin. Ritalin use is uneven in the United States with a six fold variation between states and twenty fold community variations within states. African and Asian American children are conspicuously missing in Ritalin statistics while areas of higher use seem located in white suburban rings around our cities.
In my own community of Walnut Creek I've seen changes that have led to increased pressures on children to perform while social supports for them, their families and schools decreased. Ritalin addresses this living imbalance as much as treating any purported chemical imbalance of ADD. When I first came to Walnut Creek I thought I had discovered the Shangrila of school systems. The needs of both average and special children were being met. As predicted Proposition 13, passed in 1978, took its toll on public education so that by the mid-1980s pupil teacher ratios were climbing and the criteria for special services had become tighter. In 1970 only a third of mothers worked out of the home. In the late 1990s, nearly 70% do, forcing more young children in full day structured day care and more latch-key elementary school age children doing homework on their own.
Economic globalization and downsizing have their parents working harder and longer at their jobs and paranoid. Paranoid about their own security and paranoid about their children's future without a higher education. Sesame Street showed that children as young as three can learn their alphabet and numbers so parents concluded all children at three or four should be similarly able. However, there is a range of abilities in normal children and some are more interested in playing than learning at this age. The push for performance continues through elementary school and accelerates into high school where Cs are no longer acceptable to most families in my area.
American psychiatry which used to blame Johnny's mother for his behavior problems now blames Johnny's brain. The theories of biological psychiatry in concert with the introduction of Prozac to America has made it quite acceptable for adults who weren't severely impaired to utilize a psychotropic medication. Now it's okay for kids too. Ritalin will allow anyone, child or adult, ADD or not, to perform better and become more methodical with tasks they find boring or difficult. ADD, which has no definitive biological (blood test or brain scan) or psychological marker, is ultimately an opinion, a diagnosis in the eye of the beholder. The line between treating a disorder and enhancing performance is blurred.
Meanwhile, as a physician after assessing the child, his family and school situation, I keep prescribing Ritalin. My job is to ease suffering and Ritalin will help round and octagonal peg kids fit into rather rigid square educational holes. But in my role as a citizen I must speak out about the social conditions that create the living imbalance. Otherwise I am complicitous with forces and values that I believe are bad for children. The 700% rise in Ritalin use is our canary in the mind shaft for the middle class warning us that we are not meeting the needs of all our children, not just those with ADD. It's time we rethought our priorities and expectations unless we want a nation of kids running on Ritalin.