Douglas Brunson
Professor Christine Boese
English 102 – 101
April 18, 1999
RITALIN PRESCRIBED TO CHILDREN DIAGNOSED WITH ADD / ADHD
In recent years there has been an increase in the awareness of children suffering from Attention Deficit Disorder (ADD) and Attention Deficit
Hyperactivity Disorder (ADHD). The awareness of the etiology and conduct of children with these two disorders can not help but to bring into questioning the disciplinary actions for dealing with such afflictions. The courses of action being taken to modify the disruptive behavioral problems of children with ADD and
ADHD are numerous, but the use of methylphenidate (Ritalin) and other drugs that sedate children remains controversial as many doctors, teachers, and parents contend there must be better ways.
ADD, Attention Deficit Disorder, “is now recognized as the most common neurobehavioral disorder of childhood” (Shaywitz 1). It is thought that somewhere between ten to twenty percent of all school aged children are suffering from this disorder and the frequency of diagnosis has been increasing over the last decade (Shaywitz 1). Although it is agreed that ADD is one of the most prevalent Brunson 2
neurobehavioral disorders in children it has been very difficult to set a definition or identify all of the attributes of the disorder (Shaywitz 1). The problems that arise when distinguishing and clarifying the components of ADD are many times the results of other problems that have not yet been resolved (Shaywitz 2). “The
Basic parameters of the disorder, including its definition, nature, relation to other behavioral and cognitive disorders, and underlying neurobiology, have yet to be satisfactorily resolved” (Shaywitz 2).
Attention Deficit Disorder, even though still a controversial diagnosis due to its variety of neurological and behavioral characteristics, does have certain patterns of hyperactivity that usually comprise its classification. Some of these behaviors include: fidgetiness, compulsive aggression, unpredictable behavior
(impulsive), low tolerance to failure and frustration, short attention span, awkward physical coordination, and poor sleeping habits (Feingold 49-50). Most children diagnosed with ADD are of normal to high intelligence, but often fail in school due to their inability to sit still and concentrate on the material.
“Aggressive, demanding, impulsive, academically deficient, learning disabled, and hyperactive are labels often given to children with problems of aggression and hyperactivity” (O’Leary 17). Boys tend to be diagnosed with ADD nine times more than girls are. Rarely is there more than one child with ADD in a family. Not all characteristics of ADD will be found in all children, therefore the Brunson 3
classification requires information gained from rating scales, clinical interviews, and psychological tests.
ADHD, Attention-deficit Hyperactivity Disorder, “is the most recent diagnostic label for children presenting with significant problems with attention, impulse control, and overactivity” (Barkley 3). ADHD is just ADD with marked hyperactivity. The children that suffer from ADHD are of a multifarious bunch.
It is very difficult to categorize the group based on the “degree of their symptoms, the pervasiveness across situations of these problems, and the extent to which other disorders occur in association with it” (Barkley 3). Since ADHD has become a common diagnoses for children with these behavior problems, ADHD has also been one of the most common reasons for admitting children to mental health practitioners in the United States, and ADHD has become the largest childhood psychiatric disorder (Barkley 3).
Awareness of attention disorders as a separate diagnostic category has brought with it a need for appropriate assessment tools to ensure that the diagnosis is reliable and valid. One tool, the Yale Children’s Inventory (YCI), filled out by parents, was developed by clinicians to determine the extent of the behavior, cognitive, and attention problems of the children being studied. The purpose of the rating scale is to assist with comparing deviant behavior with normal behavior at home and in the classroom. The YCI consists of eleven areas grouped into either behavioral or cognitive behaviors. These eleven behaviors are Brunson 4
academic, fine motor, language, attention, activity, impulsivity, habituation
(adaptability), tractability (manageability), negative affect, social conduct disorder, and aggressive conduct disorder. This tool has been found to be helpful in diagnosis as it evaluates both the behavioral and cognitive components of ADD
(Shaywitz 30-65). Most tools used for diagnosis use one some of these same components, but the YCI is the most comprehensive.
No matter what tool is used, once a diagnosis is made, the medical clinicians, teachers, and parents must agree on the mode of treatment that is best suited for the management of each individual child. Physicians often prescribe psychostimulant medications for hyperactivity. Psychotherapy and behavior modification are also methods used to “treat” the child in order that their symptoms can be decreased and less problematic for the family, the school, and the community.
The use of psychosyemulant medications for the treatment of hyperactivity began in Providence, Rhode Island in 1937 when Dr. Charles
Bradley discovered that by prescribing Benedrine to children with behavior problems they were better able to concentrate and complete their school assignments (O’Leary 77). These psychostimulant medications were known to increase heart rate, blood pressure, and central nervous system response, but were soon found to decrease restlessness while increasing attention span in hyperactive children. However, it was not until the 1960’s and 1970’s that additional studies Brunson 5
were performed in order to find the most effective medication for children with psychological problems. “By the mid-70’s, psychostimulant medication became the most frequent treatment for hyperactivity in the United States” (O’Leary 78).
Ritalin, also known as methylphenidate, is the most commonly known and used form of psychostimulant medication for hyperactivity. Also frequently prescribed are Dexedrine and Cylert. When physicians are determining the ideal course of treatment they are hoping to “control hyperactivity, increase attention span, reduce impulsive and aggressive behavior, and have measurable beneficial effects on visual and auditory perception, reading ability, and coordination, without inducing insomnia, anorexia, drowsiness, or other more serious toxic effects” (Feingold 64). Ritalin is the most frequently used because it is almost immediately effective and the negative side effects of sleeping and eating disorders are less than with the other medications (O’Leary 80).
Through additional studies it has become evident that certain foods, artificial colors, and salicylates also have a profound adverse effect on children with hyperactivity. However, elimination of chicken, beef, oats, and rye from the child’s diet, despite allergic reactions observed in testing, do not produce reductions in hyperactive behavior. However, reduction of sugar ingestion, does directly relate to both aggression and hyperactivity.
Psychological therapies for aggressive and hyperactive children that combine consultation and education for both the child and the parents have Brunson 6
proven to be quite effective since the mid 1960’s with the inception of a treatment program developed by Dr. Gerald Patterson in Eugene, Oregon (O’Leary 100).
His treatment program combines the use of discussion and insight in the treatment with the application of learning principles in the treatment of psychological, educational, and social problems. With younger children he recommends rewarding desired behavior and ignoring or punishing undesired behavior with consistent consequences. For adolescents he recommends more discussion and problem-solving skills. This has been found to be more effective in developing more constructive communication and in decreasing conflict in the home. Better communication and better use of rewards, punishments, and reasoning can lead to a decrease in undesired behavior and an increase in desired behavior.
Because of the serious social and academic problems that hyperactive and aggressive children have in school, behavior therapy can also be beneficial in the classroom. Interventions are similar to those in the home. Praise of appropriate behavior, soft reprimand, posting goals, and daily feedback to parents have been found quite effective. One-on-one tutoring is often also necessary due to the academic deficiencies of children with ADD and ADHD. The child, the teacher, and the parents need to be willing to work together along with a professional counselor and doctor in order to best obtain a change in the child’s behavior, as psychotherapy in itself cannot “cure” ADD or ADHD. Brunson 7
The use of psychostimulant medications, mainly Ritalin, remains one of the most effective therapies for ADD and ADHD. There was a time, however, when doctors assumed that if they selected the proper drug for any ailment and if prescribed in the proper dosage, healing would take place without significant harm. It is now well known that this simplistic concept is not the case as some drugs have an adverse effect on some individuals and caon be completely ineffective on others. There is no hard evidence that Ritalin can lead to addiction, but there is evidence that it can become psychological “crutches.” Far too often, drugs are prescribed as a first measure. Some physicians, however, do prescribe them as a last resort as not one drug is without its side effects (O’Leary 80-86).
Physicians who subscribe wholeheartedly to the use of Ritalin are often abetted by educators who find medication the simplest route to classroom quiet.
However, studies have also recently found that not only does Ritalin improve classroom manageability, but that academic productivity has also increased.
Adversely, teachers have found children on Ritalin become isolated, withdrawn, and over focused, and this may impair rather than improve learning. Studies have found that these adverse effects are dose-related, and that if the doses of Ritalin are closely monitored favorable effects on learning can be expected. Children treated with correct doses of Ritalin become indistinguishable from their non- hyperactive classmates in rates of noncompliance, interference, and solicitation of teacher attention. (Shaywitz 296). Brunson 8
Families will readily attest to the fact that the majority of children with
ADD and ADHD have serious social problems and that the usage of Ritalin has greatly improved home life. When taking medication hyperactive children become more focused and compliant with their parents, better able to play and do chores independently, and are less controlling and domineering with siblings. As the behavior of the child treated with medication changes, so are positive changes noted in the parents. There is decreased criticism, and increased warmth and acceptance.
Children with ADD and ADHD have difficulties with social interaction, attention span in the classroom, and coordination of their bodies. Conventional approaches involve psychostimulant medication, most frequently Ritalin in that the vast majority of these children show medication-related improvements. It has been found that cognitive performance and academic functioning are positively affected. As a result interpersonal harmony in the classroom and in the family is enhanced. Brunson 9
WORKS CITED
1. Barkley, Russell A. Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. New York: The Guilford Press, 1990. 2. Dudley, Gary E. Attention-Deficit Disorder (ADD) and Attention-Deficit Hyperactivity Disorder (ADHD). 1996. Atlanta Area Psychological Associates, P.C. 09 April 1999