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TIME: Almanac 1990
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1990 Time Magazine Compact Almanac, The (1991)(Time).iso
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011689
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01168900.076
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1990-09-17
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BEHAVIOR, Page 65Worries About Overactive KidsAre too many youngsters being misdiagnosed and medicated?
They are Dennis the Menace come to life, half-pint hellions
who drive parents and teachers to distraction with their disruptive
antics. At home they clamber on kitchen counters, unscrew light
bulbs and mess up the simplest tasks, from hanging up their clothes
to making the bed. In school they throw erasers, kick desks, shove
classmates and are so busy making nuisances of themselves that they
fail to absorb their lessons. One bedeviled mother speaks for many
when she says, "I would have given the kid away."
Such hyperactivity has emerged within the past decade as the
most common -- and controversial -- childhood behavioral disorder.
According to the National Institutes of Health, as many as 1 out
of 10 U.S. youngsters -- mostly boys -- may suffer from the
baffling syndrome. Doctors disagree about what causes
hyperactivity, or attention deficit hyperactivity disorder (ADHD),
as it is now known. Everything from brain damage to stress, food
allergies or radiation from TV sets has been suggested. The NIH
says the problem is probably a combination of as yet elusive
genetic, environmental, neurological or biochemical factors.
Diagnosis is difficult, since there is no laboratory test for the
disorder, and the symptoms are vague and confusing. "Hyperactivity
is in the eyes of the beholder," notes James Kavanagh, an NIH
behavioral scientist.
Treatment for hyperactivity includes psychological counseling,
special diets that restrict artificial flavorings and preservatives
and, most typically, medication with such amphetamines as Ritalin
and Dexedrine. For unexplained reasons, these drugs, which usually
act as stimulants, dampen impulsive behavior in hyperactive
youngsters and enable them to concentrate longer. Up to 750,000
American children now take drugs to control ADHD; that figure is
expected to reach 1 million by the early 1990s.
But within the medical field and among parents concern is
growing that too many youngsters are being incorrectly labeled and
improperly medicated. Hyperactivity has become a convenient
diagnostic wastebasket into which doctors and impatient parents,
teachers and school administrators toss too many hard-to-handle
children. Says pediatrician Martin Baren of Orange, Calif.: "Kids
get diagnosed with this when the problem is something else, like
a language or learning disability." Or they may be simply
rambunctious. A recent study revealed that of 200 children brought
to the University of Chicago's ADHD clinic, 40% did not suffer from
hyperactivity.
The alarming fact is that many children whose symptoms have
been misdiagnosed are being given Ritalin and other powerful drugs.
Since 1987, parents around the country have filed more than a dozen
Ritalin-related lawsuits against doctors, teachers and school
districts. In one such suit, a Washington woman claimed that the
drug led her six-year-old son to attempt suicide. Complaints about
depression, listlessness and insomnia in medicated children are
common. Valerie Jesson, of Derry, N.H., says her son Casey, 10,
became a zombie while on Ritalin: "It knocked him into next week.
His eyes would glaze, and he would just sit staring." Jesson is
currently locked in a legal battle with New Hampshire's department
of education over whether her son's public school can demand that
he take Ritalin to attend regular classes.
Many physicians defend the use of Ritalin, citing studies
indicating that the drug is generally safe and is effective in
about 80% of cases of hyperactive children. Adverse effects are
usually limited to temporary appetite loss and insomnia. "Ritalin
is not a panacea," says researcher Howard Abikoff of the Long
Island Jewish Medical Center, "but without medication we'd be up
against the wall."
Yet some medical experts acknowledge that Ritalin is being
overprescribed. In Georgia, Michigan, Utah and Maryland use of the
drug is two or three times the national average. Says Andrew Watry,
executive director of Georgia's medical board: "It's seen by some
as a quick fix for behavior problems." The blame belongs not only
to doctors, who sometimes give little more than cursory
examinations before reaching for the prescription pad, and
teachers, who want their classrooms to be peaceful. It also rests
on parents, who often expect their children to be stellar
performers. ADHD is most commonly diagnosed in prosperous suburbs,
where the pressures to achieve are frequently greatest.
Doctors emphasize that drugs should be a last, not a first,
resort. Minor interventions, such as moving a child to the front
row in class or allowing him more time to complete tasks, can lead
to improvement. Rewards -- extra television or a favorite snack --
can help reinforce good behavior. And psychological therapy can
bolster a child's flagging self-esteem and aaddress social
problems, like a lack of friends, that contribute to his distress.
Only when these remedies fail should parents try medication on
their overly active youngsters.