I'd tend to agree with you. Much as with health insurance companies, there's often a much stronger disincentive to looking out for the best interests of people's health than incentive. There's certainly a strong monetary incentive to start kids on a costly regimen of drugs early in life.

In this particular case though there seems to be some possible misinterpretation of the term ADHD or the degree of severity of symptoms that term seems to be used for. I haven't looked at the source studies these various news items are referring to but the debate seems a bit clouded and apparently honestly so, at least in terms of prescribing drugs for severe disorders. The gist seems to be that ADHD isn't simply bad behaving kids. It's kids that few would consider even vaguely close to a "norm." ADHD is being used too broadly to describe behavior.

Anyway, I'm basing this tempering on this story -
http://warner.blogs.nytimes.com/2007/11/15/ritalin-wars/index.html

Discipline as a behavioral therapy can mean several things. Respect for authority is one kind of discipline while being taught the skills that allow one mastery over ones body and self is another.

You get a smart, fidgety, active kid, and eventually someone is going to get very tired of him. There will be meetings, and discussions, and, eventually there will be a doctor and drugs. The smart, fidgety, active kid won't be. He will be quieter on the days he takes his pills. He won't have a quick wit or any wit at all. He probably won't like the way they make him feel, but his teachers will be able to tell in a minute when he is not drugged up.

You should hear his teachers talk about how much better he is.

I think ritalin and its like *does* have the ability to be of genuine help to many children.

The issue is that, like most psychiatric drugs, it is simultaneously over and under-prescribed. Middle/some upper class parents and teachers tends to value their ability to control their children more than genuinely help them. As with most pschiatric drugs, the practical use in real life is more directed with someone wanting to pacify or control another person's behavior instead of sincerely seeking help for the actual patient. Also note: The number of people careing for, annoyed, or inconvenienced by people with psychiatric disorder is always going to be greater than the patients themselves, therefore, *much* of the advertising is directed at how convenient said pills are to apply (like long release pills, for example) because the non-patients form a bigger market.

Meanwhile, all the little children that it is safe to ignore, because of poverty, race, gender, or other circumstances, get no help at all...

We made the mistake of yielding to a teachers suggestion 5 years ago. The ADHD drugs worked as advertised for a while....

Although the schools are expressly prohibited from pushing these drugs now; once the child has on his or her record that they have been diagnosed and prescribed these drugs you definitely have to keep the therapy up to keep them in school. Otherwise the minute they blow their nose the wrong way in class or speak out of turn.. they'll be sent home immediately.

This fun tug of war with the schools continued forever forcing us to take Psychiatrists advice of increasingly potent drugs culminating to the point of having the kid on a drug cocktail for a short period of time.

This made him near insane and violent and neither the school officials nor the psychiatrist were willing to listen to me when I kept insisting that it was the drugs making him act out such a manner. He was was developing quite a thick folder of disciplinary actions for things he did and things other kids were having fun claiming he did.

Apparently I'm just the kids parent and don't know squat.

Summer before last; out of frustration I canceled all of his appointments and pulled him off of the drugs myself. Dangerous;I know, and it took a month and a half before he started acting like a fairly normal 12 year old. The first week back in school(Middle school now) he got into an argument with a kid who had been mercilessly picking on him in class. The teacher corroborated this and he was about to get off the hook until someone found out that he was supposed to be on medication.

After a pretty harsh committee scolding and a review of his previous disciplinary records the school determined that they didn't want to deal with his issues.. In spite of my insistence of the primary cause of the thick record. (again .. just a stupid parent) I was left with the choice of expulsion on his next incident or transfer to Lifestreams. (School for the bad kids. Criminals,druggies,and just plain exuberant kids all bunched together)

He managed to complete the program and and move up and out as fast as the program allowed, but now I've got him in a Lutheran school who's administration happens to agree with me after working with him and reviewing his history.

And yes.. I'm moonlighting to foot the bill.

My daughter has OCD, Tourettes and is Savant in some areas. With all these thorns in her side she has a high/average IQ, and is able to function within her high school classes without the administration or classmates knowing her disabilities.
Why? Because I never allowed her to be labeled or diagnosed by the education system. She has participated in studies and has received behaviour modification and talk therapy for many years. The end results, according to the studies which compared her group to subjects that were treated with meds, has been that her behaviours have improved more than participants that had taken medication. This proven with various diagnosis's including PET scans.

Unfortunately, it is a struggle to fight with the insurance company to maintain her talk therapy as they would prefer her to take medications for her 'disabilities'. So for part of the year I pay for her therapy and then insurance kicks in the other 'allowable' part. Shame.

If one advocated more for talk therapy and behaviour modification possibly medication use by children (and adults) would be lessened substantially. That along with healthy diets, exercise and creativity would go a long way in the USofA.

The only time that I almost totally lost it with school personnel was when I was working on my doctorate -- in educational leadership -- at UC: Santa Barbara. My very creative son, who went on to win acting awards as a juvenile and now has a degree from Cal Poly, was bored in the classroom and wasn't compliant. We knew he had special abilities, that he was very smart in some ways, and that he needed to be with the right teacher.
At the parent-teacher conference the school psychologist -- I still can't believe it -- said they wanted to put my son on Ritalin. I was seething, angry in a flash that such a thing could be suggested, and through clenched teeth proclaimed, "You will never, ever, ever suggest to me or anyone that my son should be put on Ritalin again in your life."
That settled it. They were ready to discuss alternatives. He was placed in a class for gifted and talented students and came home with all high marks.
There are few "world class" teachers and we need them all to be. That will never happen with the current salary schedules for teachers. Even where teachers are highly paid they are at a disadvantage because they are in school districts where they can never afford to buy a home unless they have high-income spouses.
The industrial classroom has learned to standardize behavior with drugs. I'm working on solving the problem. Stay tuned.
In the meantime, if you have children, practice the "You will never, ever...," line to you will be ready.

Channing
Ventura California USA

with concentration difficulties used sparingly and only when absolutely necessary at the smallest possible dose, not as an everyday regimen. It raises blood pressure, and does other kinds of great things to your body chemistry. when I was in college we used to use dexadrine for critical final exams- not wonderful, but boy were you alert/
I am not sure what drug tests are done on airline pilots- but I would not be suprised if ritalin did not slip in there once in a while- somewhat unsettling thought.

_{1."George Washington did not cross the Delaware for Capitalism," -Shmuley Boteach.
2.The Dems haven't punished the GOP enough, so you're going to reward the Republicans?}

Ritalin for kids has always seemed messed up to me, but I'd never say never. A low-tech alternative for some of the "ADHD" kids I taught was Mountain Dew. My understanding was that (like Ritalin) the extra stimulant actually allowed their mind to calm down/focus better--without the side effects (presumably). Some kids actually unintentionally self-medicated that way. Many of the kids I taught didn't have the funds or stability at home for something like talk therapy.

much of what is diagnosed as ADHD today is actually the result of parental neglect. in my work with kids at risk, many, many, many of the kids who lived in chaotic homes without limits, boundaries or discipline, exhibited the same symptoms evident in true ADHD kids.

that being said, i was diagnosed with ADD as an adult and the difference between my brain on its own and my brain aided by ritalin was one of the most astonishing things i've ever experienced.

would that i could take the drug, because it transformed my world. high test scores notwithstanding, my inability to focus and concentrate is a serious drag and something that plagues me to this day at 50. alas, ritalin = high blood pressure for me.

my coping mechanisms for projects including classical music, headphones, buckets of coffee. that doesn't work well for first graders, although one could make a case for changing the school environment and teaching methods to produce positive changes in the alarmingly overdiagnosed population of allegedly ADHD kids in schools these days. and yes, so many of them boys. a travesty.

("There's no indication that medication's better than nothing in the long run.")

ADHD in many children in time corrects itself; there a recent post on this, so it is borderline tautological to say the above.

What matters is the kid, who needs the meds to focus, when it is demanded of him that he focus and he cannot. Unfortunately, the school system does not wait for your kid to take the 4th grade until he is twenty. If yours is in that camp, he benefits. If he isn't, he doesn't.

Leave the drug companies out of it. They made the meds. It's your choice to use them or not, with the consultation of a professional, of course.

http://mauberly.blogspot.com/

Methylphenidate is a Schedule II controlled substance--just like cocaine, methamphetamine, opium, phenobarital, Demerol and a whole host of very potent or addictive pharmaceuticals.

To delude oneself into thinking that Ritalin is benign or nearly-harmless as many parents do is very dangerous.

that these drugs cannot be of benefit.

I state as fact, not as speculation, that they are overprescribed - even in situations where they can be of no use or can even be directly harmful. Whatever you believe the percentage of cases to be - whether .001% or 90% - that's not the same statement at all. I know there are cases where they are misprescribed because I am in direct contact with an alarming amount of situations where I know they are being misprescribed.

At the end of the day the relevant question isn't "are they of any use in a specific situation?" but "in what percentage of cases are they misprescribed or overprescribed or prescribed as a full solution when they're useless without being accompanied by other measures?".

And at least part of this comes from the way the inherent conflict of interest of pharmaceutical companies (between "the good of the patient" and "the bottom line") is resolved.

Look at the rapidity with which these products turn over and evolve in the marketplace. Look at the talk of "next generation" antidepressants introduced in a single human generation - before we've had time to fully assess the long-term impact of the first.

They aren't even certain today about how the relationships amongst the biological underpinnings of depression work - for example, exactly how the mechanisms surrounding seratonin function - but they had a drug to influence it four generations ago?

Danger Will Robinson. Underneath that talk of "generations" lies a very disturbing reality - whatever the motivations, we need to be clear that this is effectively an experiment writ large, part of a testing process. It is the part of the testing process that fiscal concerns ("market realities") dictated be curtailed.

I'm not saying that if the need were dire enough I might not turn to an experimental process in the hope of aiding my child. I'm saying that I would first take into account its clear nature as part of an experimental process if it were ever proposed. The need would have to be dire indeed.

-if no one is pressured to pay up for "real" comparative testing - not just against placebo and some 50 year old drug (such as a tricyclic in anti-depressant trials ), e.g. a study trying to determine the comparative effectiveness/side effects of, say, paxil and prozac - and

-if there is no time or no "great scientist" or no luck or no social payback in finding an "ultimate cause" to render many intermediate intervention drugs like Ritalin unnecessary.

then people either have to get used to the current unpleasant reality of being their own "trial subjects" or stay in the "burning building" of their own or their family's symptoms.

Most people do choose to jump fairly quickly onto the drug ladder if they think they might survive rather than just wait for the flames to get them in a medical or psychiatric emergency. What might not be an emergency for a family with many resources may well be one for a single mother with a child in trouble at school.

Whom can you count on to protect you, not only from a directly harmful product, but from an ineffective one with bad side-effects, when many of these are medications where it is the case(and/or a patient is told it is ) that it will take some time to determine whether the drug works or not?

Not the pharmaceutical companies, not the FDA, not your doctors, not your friends, even though they may have the best (or not) intentions and some current information available to them.

The lack of knowledge sharing on different psychopharmaceuticals (my particular hobby horse) is very real among physicians. Why this is far more the case than for purely physical conditions is a matter for speculation. Why comparative result studies are more common in detergents than mind drugs is that they are simpler and cost less for the companies.

There is still (I believe )no database showing which type of antidepressant if any works best for what type of person with which symptoms. Someone who goes even to a specialist in pharmacology is still likely to get a "favorite" based on anecdotal evidence shared within a small circle of physicians who happen to talk to each other- unless a "promising" drug is a universal flop- or worse.

My mother, who was dangerously depressed after a botched operation many years ago, had three options- tricyclics, shock therapy or nothing(talk and prayer). Tricyclics didn't work, shock therapy did- though with some lasting side effects. "nothing" had not only made her a danger to herself but the rest of us- though perhaps in some other life scenario it might have been effective.

As someone who has had the dubious distinction of being diagnosed 7 years ago with a progressive malady that now has a name ("mild cognitive impairment"), but no cure(none of the "almost ready" eagerly awaited reversals, or slowdowns as yet surviving even "Phase 3" testing), I find a certain humor in reading the posts in this thread, with their different hobby horses based on different or better/worse experiences....

One final rant- the flow of competing pop med MSM articles touting x or y to lessen the chance of "catching" a whole cluster of different dementias or other real abnormalities (not "alternative functionalities")-these are articles with such sparse evidence - it's amazingly bad medical journalism but at least it's good news compared to politics, so up the "most read" charts they go:-)

-mole

_{1."George Washington did not cross the Delaware for Capitalism," -Shmuley Boteach.
2.The Dems haven't punished the GOP enough, so you're going to reward the Republicans?}