The People's Perspective on Medicine

874 The Ritalin Controversy

Tune in to our radio show on your local public radio station, or sign up for the podcast and listen at your leisure. Here’s what it’s about:

As many as five million youngsters, or about 7% of school children, have been diagnosed with attention difficulties (ADD or ADHD). School is harder for them, not because of mental shortcomings, but because it is tough to sit quietly and pay attention. This, in turn, causes problems for their teachers and parents.

Stimulant drugs to help these kids focus better have gained tremendously in popularity over the last several decades. Methylphenidate (Metadate, Ritalin) is possibly the best known, but there are many others. Evaluating the long-term risks and benefits of such medications has become an emotionally laden topic. Some people are quite concerned about long-term effects and warn against their use, while others are convinced that children should not be deprived of these medicines. Our guests offer differing perspectives on this question.

Guests: Alan Sroufe, PhD, is professor emeritus of child psychology in the Institute of Child Development at the University of Minnesota. His article, Ritalin Gone Wrong, was published in The New York Times.

Edward (Ned) Hallowell, MD, is a child and adult psychiatrist and the founder of The Hallowell Center for Cognitive and Emotional Health in Sudbury, MA and New York City. He is the author of Driven to Distraction, Delivered from Distraction, and 16 other books. The website is The photo is of Dr. Hallowell.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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Very unhappy with this discussion. ADHD is NOT a Ritalin-deficiency disease. Why is there no discussion on cause? The fact is that ADHD people have irregular neurotransmitters in their brain. The fact is that there is evidence that certain food additives and food colors increase ADHD symptoms and that there are alternative ways to regulate neurotransmitters other than potentially toxic medications.
Would like to see a show that educated people to what ADHD is and how nutrition and holistic approaches show promise.

Thank you for your podcast on the subject of ADHD. My son’s second grade teacher recommended that he be tested for ADHD. I took him to our pediatrician and she said that it was hard at his age to tell, but did put him on ritalin for a month. He became very anxious, so we took him off and didn’t try anything else-she was not a fan of medicating for ADHD. Twelve years later, barely graduated from high school, and now in a drug rehab center, he has been tested, found to be ‘profound ADHD’, and now on concerta (basically a time-released ritalin) and doing well.
Should have, could have, would have, but now he’s finally ‘unwrapping his gift’. Thank you Dr. Hallowell for the enlightening discussion.

I was hoping for some discussion of Neurofeedback by either/both of the guests…certainly practitioners with that much experience would have a comment about that treatment modality?
◦Beau­re­gard, M., & Levesque, J. (2006). Func­tional mag­netic res­o­nance imag­ing inves­ti­ga­tion of the effects of neu­ro­feed­back train­ing on neural bases of selec­tive atten­tion and response inhi­bi­tion in chil­dren with attention-deficit/hyperactivity dis­or­der. Applied Psy­chol­ogy and Biofeed­back, 31, 3–20.
◦Gevensleben, H., Holl, B., Albrecht, B., Vogel, C., Schlamp, D., et al. (2009). Is neu­ro­feed­back an effi­ca­cious treat­ment for ADHD?: A ran­dom­ized con­trolled clin­i­cal trial. Jour­nal of Child Psy­chol­ogy and Psy­chi­a­try, 50, 780–789.
◦Levesque, J., Beau­re­gard, M., & Men­sour, B. (2006). Effect of neu­ro­feed­back train­ing on the neural sub­strates of selec­tive atten­tion in chil­dren with atten­tion deficit/hyperactivity dis­or­der: A func­tional mag­netic res­o­nance imag­ing study. Neu­ro­science Let­ters, 394, 216–221.
◦Omizo, M. M., & Michael, W. B. (1982). Biofeedback-induced relax­ation train­ing and impul­siv­ity, atten­tion to task, and locus of con­trol among hyper­ac­tive boys. Jour­nal of Learn­ing Dis­abil­i­ties, 15, 414–416.
Rivera, E., & Omizo, M. M. (1980). The effects of relax­ation and biofeed­back on atten­tion to task and impul­siv­ity among male hyper­ac­tive chil­dren. The Excep­tional Child, 27, 41–51.

I found this episode wanting. As is so often the case, the guest (here , Dr. Hallowell) sought to encourage the view that while he has an extensive understanding of the topic at hand, one’s own medical practitioners, whomever they might be, lack an understanding, and must be counseled by the patient based upon, you guessed it, Dr. Hallowell’s book. There is an element of hucksterism in this type of presentation I find a disservice to the listeners and one based on salesmanship rather than scientific study. The “buy my book to get the answer” approach makes the episode’s narrative less credible.
I did appreciate, though, that Dr. Hallowell did not reject medication as one extremely effective tool. In a time when too many voices on the media encourage one to eschew science for unverified claims about supplements or non-medicated approaches, Dr. Hallowell did present his approach in a more balanced light.
I enjoy the Peoples’ Pharmacy best when it presents what the data shows, and enjoy it least when its guests make statements that suggest that they, and pretty much only they, understand the issue at hand.

I listened to this show this morning and at first was frustrated with Dr. Sroufe’s distortions and inaccuracies. However, I was greatly relieved when Dr. Hallowell came on to bring some balance, science and fact to this issue.
I am a clinical psychologist specializing in the assessment and treatment of ADHD in children, adolescents and adults for the last 22 years. I have attended numerous conferences and workshops on this topic with Dr. Hallowell, Dr. Russell Barkley and others all over the country for the last two decades. Dr. Sroufe has done all of us a great disservice and has much to atone for.
Any given week I am in the midst of assessing 3-5 individuals for ADHD and related issues. Each year for the last 22 years I have assessed on average about 200 children, teens or adults with this and related conditions. Medication is safe and effective and in most cases extremely helpful in the short AND long term, despite Dr. Sroufe’s dismal appraisal. If you or someone you know has ADHD or you suspect they may have it, please do not allow Dr. Sroufe to frighten you.
As Dr. Hallowell so artfully stated, stimulant medication is not the only answer for everyone but what is? The best metaphor is a pair of prescription glasses. That pair of glasses does not cure a thing but so what? They help us see. The medicines we prescribe for ADHD help 80 percent of our patients. I challenge any psychologist or physician to achieve that level of success with a single therapy for a significant disorder.

As a mother of two boys, seriously. We have changed our schools to cater to girls even the math books are more reading and less mathematical reasoning. Girls are excelling and our boys are struggling. The world is “crazy busy” and why are we medicating our boys. Any study performed significantly correlates this disorder with boys. Sit and read, read, read, read and read some more. Reading and testosterone hummmm nature did not create boys to sit still and read. Our math and science scores are suffering in our country because of the changes in the 70’s to help girls excel-sit and read your math and science books we stopped doing. Schools want our boys to act like girls and sit still and be quiet and read. Take time for your boys maybe the problem has nothing to do with them and everything to do with unrealistic expectations of their genetic makeup.

I am 81 yrs. old; never heard of ADD/ADHD till about 25 years ago. I am of the uneducated opinion that it is the result of electronic games, TV, and related visual/electronic that did not exist in my growing-up generation. After school we played sandlot games, outdoor games at night by street lights, and listened to radio program. Have any of the researchers factored in these elements that have so affected the last generation or two?

Three points:
1) Having lived with both ADD and sleep apnea all my life, I know how much of a struggle both can be, so I feel for you.
2) You can’t “cure” ADHD, because it’s not a disease.
3) If all your child’s symptoms disappear when his or her sleep apnea is treated, GREAT! But it probably means they didn’t have ADHD to begin with.

Good show. The resources available to diagnose and treat children with atypical wiring or mental disease vary widely. School psychologists in the rural midwest are rare. Psychologists/Psychiatrists who will see the 50% of children on Medicaid are hours of travel away when they can be found.
The impetus for medication trials comes from teachers who do not have the time and resources to deal with the typical ADHD boy. Occasionally, the small dose of Ritalin works like a switch, there are no side effects, and with weekends and holidays off meds everybody is happy.
Ritalin will not help school performance if the symptoms are caused by sleep apnea, seizures, metabolic problems, dyslexic or autistic wiring problems, abuse and especially bipolar wiring. Interestingly, girls with ADD are overlooked because they don’t cause many problems in class, so they are under diagnosed and under treated.
Americans are losing good, committed teachers when class size is too large, “titled” children require excessive paperwork, and there is no assistance in helping other children with special needs. The middle part of the class loses out in the above situation – there just is not time for everything.

David Lynch Foundation advocates meditation as an effective therapy and funds university and medical school research to assess the effects of the program on academic performance, ADHD and other learning disorders, anxiety, depression, substance abuse, cardiovascular disease, post-traumatic stress disorder, and diabetes.

I am a 30 years experienced psychotherapist and in more recent years have had a number of 25-40 year old young men (not sure why this gender) come in individually or attend couple therapy with partners and one of the major issues is excessive use of alcohol or marijuana. With a little history taking I find they were formerly treated as children or youth for ADD of ADHA but in adulthood went off of their medication. So, it seems these folks are “self medicating” their cognitive issues. I find myself developing a cache of psychiatrists whom I trust to blend the behavioral and chemical treatment alternatives you mention. I would appreciate any additional ideas.

My daughter has ADD. We used medication very carefully. She is off medications now and is overall doing pretty well. However, what we had that a lot of other families don’t have was 1/ medical knowledge and 2/ resources.
Between private school and tutoring, we have spent about 100K on our daughter. Has it been worth it? Yes but most people can’t afford that so give the medication and hope for the best.

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