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For adults, the results can be just as striking. "Helen," a 43-year-old | mother of three in northern Virginia, began taking the drug after being diagnosed with ADD in 1983. "The very first day, I noticed a difference," she marvels. For the first time ever, "I was able to sit down and listen to what my husband had done at work. Shortly after, I was able to sit in bed and read while my husband watched TV."
Given such outcomes, doctors can be tempted to throw a little Ritalin at any problem. Some even use it as a diagnostic tool, believing -- wrongly -- that if the child's concentration improves with Ritalin, then he or she must have add. In fact, you don't have to have an attention problem to get a boost from Ritalin. By the late 1980s, over-prescription became a big issue, raised in large measure by the Church of Scientology, which opposes psychiatry in general and launched a vigorous campaign against Ritalin. After a brief decline fostered by the scare, the drug is now hot once again. Swanson has heard of some classrooms where 20% to 30% of the boys are on Ritalin. "That's just ridiculous!"' he says.
Ritalin use varies from state to state, town to town, depending largely on the attitude of the doctors and local schools. Idaho is the No. 1 consumer of the drug. A study of Ritalin consumption in Michigan, which ranks just behind Idaho, found that use ranged from less than 1% of boys in one county to as high as 10% in another, with no correlation to affluence.
Patients who are taking Ritalin must be closely monitored, since the drug can cause loss of appetite, insomnia and occasionally tics. Doctors often recommend "drug holidays" during school vacations. Medication is frequently combined with other treatments, including psychotherapy, special education and cognitive training, although the benefits of such expensive measures are unclear. "We really haven't known which treatment to use for which child and how to combine treatments," says Dr. Peter Jensen, chief of nimh's Child and Adolescent Disorders Research Branch. His group has embarked on a study involving 600 children in six cities. By 1998 they hope to have learned how medication alone compares to medication with psychological intervention and other approaches.
BEYOND DRUGS
A rough consensus has emerged among ADHD specialists that whether or not drugs are used, it is best to teach kids -- often through behavior modification -- how to gain more control over their impulses and restless energy. Also recommended is training in the fine art of being organized: establishing a predictable schedule of activities, learning to use a date book, assigning a location for possessions at school and at home. This takes considerable effort on the part of teachers and parents as well as the kids themselves. Praise, most agree, is vitally important.
Within the classroom "some simple, practical things work well," says Reid. Let hyperactive kids move around. Give them stand-up desks, for instance. "I've seen kids who from the chest up were very diligently working on a math problem, but from the chest down, they're dancing like Fred Astaire." To minimize distractions, ADHD kids should sit very close to the teacher and be permitted to take important tests in a quiet area. "Unfortunately," Reid observes, "not many teachers are trained in behavior management. It is a historic shortfall in American education."