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TIME: Almanac 1993
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1992-09-23
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BEHAVIOR, Page 65Worries About Overactive Kids
Are 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.