readin', ritin' and ritalin

Do psychoactive drugs really help children -- or just make them fit in?

By Arthur Allen

Published July 16, 1997 6:09PM (EDT)

Larry snapped after a weekend with his father. It was a
Tuesday morning, only days before the start of summer vacation,
after a pretty successful school year. He dashed through the
halls, throwing books and punching other kids and generally
disrupting the small school for the learning disabled he attends
in Silver Spring, Md. Larry got so wild, finally, that
Principal William Patterson called his mother to take him home.
It turned out that his father, an old-fashioned sort, had taken
Larry off Ritalin, the medication the 15-year-old takes for
hyperactivity. The mother was furious with her estranged husband,
but for Patterson, who has been teaching dyslexics for 35 years,
the episode was just a sad sign of the times. "This young man
was so upset, so ashamed that he couldn't behave,"
Patterson says. "But he is dependent on the drug. He has no inner
ability to control himself."

Patterson is an anomaly, and something of an embarrassment
to his staff at the Chelsea School. He has the nerve, in this era
of the biologization of everything, to think that giving children
psychoactive pills is a bad idea. Patterson actually believes he
can teach children to control their behavioral problems. At his
previous job as headmaster of a boarding school for dyslexics in
Massachusetts, he saw to it that Ritalin was banned from the
premises. A tall, William Holdenesque 60-year-old, Patterson has
enough perspective to view himself as a relic. "There's no way
that I or anybody else can stem the tide of drugs," he says. But
he can't help adding: "What are we telling the kids? Take a pill
and it will be all better? How about a little heroin?"

The prescription of psychoactive drugs for children has
increased roughly threefold in the past decade, a particularly
vivid demonstration of the shift in the national Zeitgeist vis-à-vis psychological health. The defiant message of "One Flew Over the Cuckoo's Nest" seems quaint now; Nurse Ratchet is here to
stay. Nearly 3 million American schoolchildren get amphetamines
to control their hyperactivity or cut through their lassitude;
600,000 get serotonin reuptake inhibitors like Prozac -- now available in a minty liquid for tots -- and
thousands more get lithium, the anti-psychotic-turned-wonder
drug. In some schools, a third of the boys are on Ritalin. There
is something paradoxical about teenagers lining up for their
noontime stimulant before filing into "Just Say No" lectures.
But of course, Ritalin and Prozac aren't exactly the drugs of choice for getting you high. Kids
do occasionally sell their extra Ritalin for $5 per pill behind
the local high school, but word is it doesn't provide much of a
buzz. The pills filing out of the pharmacy warehouses in metallic
phalanxes of green, blue and yellow aren't for fun. They're
intended to produce calm, well-adjusted citizens, their brains
chemically altered to fit the marketplace that awaits them.

The key that opened the doors of prescription for most of
these children is spelled A-D-D. That stands for Attention
Deficit Disorder, a peculiarly American malady that is diagnosed
roughly 10 times as often stateside as in Europe or Japan. If it
weren't for the enormous dimensions of the ADD phenomenon, one
might be tempted to suppose the syndrome was a huge hoax by the
pharmaceutical companies. The definition of ADD is vague and
complicated. In the DSM-IV, the most recent psychiatric
diagnostic manual, an ADD patient is so declared when he or she
consistently displays six or more symptoms of inattention or
hyperactivity. But if these all too common symptoms are markers
for ADD, maybe we ought to be putting Ritalin right into the
water supply, like fluoride. An ADD child, according to DSM-IV,
"often does not seem to listen ... does not follow through on
chores ... has difficulty organizing tasks ... often loses
things ... is easily distracted ... is often forgetful ... is often
'on the go' ... often talks excessively."

Still, add these symptoms together and you get a child who
can't read or pay attention, and is likely to be suffering in
class, and maybe at home. In therapeutic circles, the feeling is
that the attention being paid to the attention disorder is
society's way of showing it cares about children who once were
dubbed Fidgety Phils and plunked down in the corner with a dunce
cap until they dropped out of school and entered menial jobs,
skid row or prison. Today, an ADD diagnosis can open doors: not
only to medication but to federally guaranteed special education
facilities, computer chat rooms and parental support groups.
Today, particularly if you have enough clout or the cash to hire
a private consultant, your ADD kid will be placed in a special
classroom, and eventually get non-timed college admission tests --
about 40,000 SAT tests were administered this way last year.

A number of psychiatrists, educators and neurologists have
begun to describe ADD as a physiological ailment that arises
partly from a unique brain geography. Using the lingo of
evolutionary psychology -- the totalizing ideology of the '90s -- some
specialists describe the distracted or jumpy ADD child as an
evolutionary remnant, a hunter personality trapped in a culture
of desk jockeys. Such pseudo-scientific piffle is ubiquitous in
ADD circles -- particularly, it seems, among medical doctors. Edward Hallowell
and John Ratey, two Harvard Medical School psychiatrists who have done
as much as anyone to raise ADD's profile, claim in their book
"Answers to Distraction" that ADD diagnoses are prevalent in the
United States for genetic reasons: "Our forebears were restless
movers and shakers," they write. "This probably selected a gene
pool of people who are chronically curious and willing to risk
traveling down new pathways of exploration." And who, if they
were alive today, would presumably meet the elastic DSM-IV
definition of ADD.

"Two thousand years ago my son would have been roaming the
plains hunting," says Tony Meunier, an Arlington, Va.,
librarian. "Twenty years ago he would have dropped out of high
school. But kids can't afford to do that now." Meunier invites
me to a meeting of the local chapter of CHADD -- Children and
Adults with Attention Deficit Disorder -- a 40,000-member national
group created in 1987 with nearly $1 million in backing from the
makers of Ritalin. CHADD lobbies for ADD patients as a disability
group and provides shoulders to cry on for ADD parents. The
theme of the evening meeting, in the pastel conference room of an
Arlington hospital, is "How to Survive the Summer with Your
Teenager." Meunier, the chapter's coordinator, leads seven
other women in a talk about ways to get the kids focused on
something so the heat and boredom of summer don't
send them hurtling off the walls.

Meunier has explained to me that CHADD is no advocate of
blanket medication. "Most parents don't fool around with these
drugs," she says. "That's a myth that's overstated." Her 12-year-old, who has learning difficulties, went through a brief
trial of Ritalin but didn't improve; Meunier now spends hours
each night helping him organize his homework and his life. But
listening to the women at the CHADD meeting, I get the sense that
parents too overworked to put in the hours with their difficult
children tend to move toward the Ritalin solution.

"I've got a husband and three kids who are ADD, but they
refuse to take any medication," says an angry woman in a
business suit. "Hell, I'm ready to take Prozac at this point."

"Listen, I am taking it," says a woman in a plaid pant

"How do you get your kid to do his homework?" the angry
woman asks Tony.

"We work with him till he's finished," Tony says. "It's
been a lot of work."

"Is he on medication?"


"We give our daughter Ritalin to do her homework,"
interjects the woman in plaid, "but then she has trouble

If the ADD community includes parents who feel the need to
dull their children's roughest edges enough to squeeze them onto
the career track, the pharmaceutical industry is there to help.
Ritalin was administered to control wild kids in the 1970s, but
today's ADD child is just as likely to be the quiet, spacey type.
Children are younger, now, when they leave the home and enter the
structured, less tolerant worlds of day care and school. As
students, they are pressured to perform without as much support
from their frequently absent parents.

"The human gene pool
cannot change for cultural or economic reasons in 25 or 30
years," Lawrence Diller writes in a recent Hastings Center
Report. "Thus relatively greater numbers of children and adults
may be found wanting in their abilities to concentrate given the
current pressures of their academic and work environments."

solution is a pharmaceutical assault on inefficient personality
types -- Ritalin for the hyperactive, Prozac for the introverts.
Peter Kramer, author of "Listening to Prozac," remarked in a recent
interview about the "eerie confluence between what Prozac does
and what society demands." Vassar psychology professor Ken
Livingston describes the paradigm even more grimly in a recent
issue of the Public Interest: "In late twentieth-century
America, when it is difficult or inconvenient to change the
environment, we don't think twice about changing the brain of the
person who has to live in it."

It's all very well and good to make high-minded
pronouncements about the hypocrisy of American life. But if your
kid is the one who's struggling in school or making life
impossible at home, an inexpensive drug that doesn't seem to
cause any long-term damage can seem very appealing. "I don't want
to give her Ritalin if it's only because it would make everyone's
life easier, including mine," says Lynne, a suburban parent
whose 10-year-old daughter, Alissa, is ADD-diagnosed. But whatever
the justification, she does plan to go to Ritalin. Alissa's
grades are passable, but the girl is unhappy with her performance
and can't seem to do anything about it. The public school she
attends has budget problems and growing classrooms. "Life's
going to be so tough for her," Lynne says. "If Ritalin would
truly help, we owe it to her to give it a shot. Figuratively."

A conscientious parent, lacking a firm conviction one way or
another about medication, may feel cornered into choosing it. And
it may be the right choice. But on a broader social level, the
drift toward fiddling with brain chemistry is deeply alarming. In
John Ratey's recent book, "Shadow Syndromes," he lumps almost
everyone into one or more chemical or physical brain types, and
urges us all to make use of the growing psychopharmacopia, even
if we don't make the cut of a DSM disease. "The negative
emotions that accompany subtle differences in the brain may not
be so harmless as we have long assumed," Ratey writes. Taking a
pill to modulate depression or anger "is not an 'escape' or a
'quick fix,' but can be a gesture of responsibility toward the
family." In other words, Ratey seems to suggest, the responsible
citizen, like the epsilon of Huxley's "Brave New World," has the
duty to take pills to combat inappropriate behaviors and

But guess what? A lot of kids don't want to take their
medicine. For four juniors I found hanging out near Bethesda-Chevy Chase High School in an affluent suburb of Washington,
refusal is rebellion. "People should talk to their kids, not
just give them pills," says David, 16, who says he was urged to
take antidepressants because he was staying in his room all the
time after his alcoholic mother left the family. "They thought I
was depressed or gothic or something," he says. "I think I was
just unhappy."

Mary -- a thin, pale, heavily made-up girl with dark hair and
plucked eyebrows -- took Prozac and then Zoloft for depression but
says neither worked. She understood the logic behind the drugs:
"When something happens to me, I take it harder than other people
because, like, they have more serotonin circulating in their
brains." But "it was so annoying to take them every day. They
made me feel shaky. Zoloft made my head twitch."

Jacqui Barron, student services administrator at the Chelsea
School, finds herself fighting the resistance of children every
day as she makes the rounds distributing the blue and yellow
Ritalin pills. "Being hyper with your mind rolling around the
room is kind of a high," says Barron. "The children feel the
drug subduing their minds, and it's less fun." Still, "most of
them accept it. They know they couldn't participate in class
without their medicine."

Patterson is forced to agree, sort of. "Ritalin improves
the learning environment for other kids because the child is no
longer tapping a pencil or looking out the window or pulling the
hair of the child in front of him. But I don't know of any
studies that have shown a real improvement in performance. Do
they act better? Yes, because they're drugged." At Chelsea, a
publicly funded independent school for children from D.C. and
suburban Maryland, Patterson can't control Ritalin intake --
indeed, he has clashed with parents who told him to mind his own
business. At his previous job at the Linden Hill School in
Massachusetts, which he left after 11 years in 1993, Patterson
took an incoming student body that was 90 percent amphetamine-reliant and banned the drugs altogether, engaging the children
instead in a highly structured program of instruction and
athletics. "As far as I know, only one of them went back on
Ritalin after he left," Patterson says. At Chelsea, Patterson
works around the drug, focusing on developing mental discipline
in his charges. "A muscular grooving of the stroke" is how he
describes the learning process for dyslexics. As for his anti-drug message, it falls on deaf ears. "If you don't want to seem
ridiculous," he says when we part, "I wouldn't quote me too

Of all the creatures in my childhood menagerie, the wildest
was a skinny, stuttering kid named Billy. I don't doubt that today he would have been considered an ADD patient, though I think of him more as a hummingbird than a hunter. Billy's face,
as I recall it, was always beet red; he was either laughing
hysterically at one of his inane pranks or crying because one of
us slugged him in exasperation. By age 12, when my friends and I
had reached the age of feigned sexual sophistication, Billy was
still into fart jokes. He had a certain asinine genuineness that
I'll always remember, and cherish, in a way. If Billy were a kid
today, both of his parents would probably be working full time, and his
nanny would be feeding him Ritalin for an after-school snack.
Picturing Billy's mother, a friendly, tired-looking lady with
worried blue eyes, I understand why so many of today's choosy
mothers choose mind control drugs. Still, I mourn the clown
terror Billy, source of so much aggravation and fun. The
playground is a poorer place without him.

Arthur Allen

Arthur Allen writes on health, science and other issues for Salon. He lives in Washington.

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