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Biology 202
2000 Third Web Report
On Serendip

Usage of Ritalin in Treatment of Disruptive Behavior Disorders

Hajira Amjad

A great deal of controversy has arisen over the past few years over the increased prescription of Ritalin for the treatment of disruptive behavior disorders (DBD) in children. It has lead to questioning whether physicians are misdiagnosing DBDs and whether parents are looking for a quick fix for behavior that they deem as disruptive in children. The increasing use of Ritalin, especially by very young children, has alarmed the general public as well as doctors and health officials.

Disruptive behavior disorders are more commonly known as Attention-Deficit/Hyperactivity Disorder (ADHD) (1). Hyperactivity, impulsivity, and inattention categorize this disorder. While most individuals suffer from all three of the symptoms of ADHD, some individuals may only suffer from either inattention or hyperactivity-impulsivity. Individuals with this disorder have difficulty focusing attention on one thing, get easily bored, always seem to in motion, and have difficulty waiting(2). Although, individuals who suffer from ADHD do not have any physical problems, they face many social and emotional difficulties. These individuals face difficulties in their academic performance during their childhood, as well as later in their lives when they enter the work force (2) .

Diagnosing ADHD is extremely difficult and must be made cautiously. The American Psychiatric Association has come up with a list of fourteen signs, of which eight must be manifested by an individual to suffer from this disorder(3). The signs are as follows:

1. Fidgeting with hands and feet and constantly squirming

2. Difficulty remaining seated when required

3. Easily distractible

4. Difficulty awaiting turn in activities

5. Difficulty following directions

6. Blurting out answers before completion of question

7. Difficulty paying attention to a specific task

8. Shifting from one uncompleted task to another

9. Difficulty playing quietly

10. Talking excessively

11. Interrupting others

12. Not listening to what is being said

13. Forgetfulness

14. Taking part in physically dangerous activities without considering consequences

It is extremely difficult to diagnose children as having ADHD, when many of these signs may be apparent in most children. These signs are somewhat vague and it is often difficult to determine to what extent these symptoms must be apparent for an individual to be classified as having ADHD. Diagnosis of ADHD includes observation of the individual's activities by a doctor as well as input from parents and teachers about the child's behavior (2).

ADHD is mostly prevalent in children but can be found among adults as well. There is no cure for ADHD and for most children, it also carries on into their adult life. It is estimated that three to five percent of school-age children are afflicted by ADHD (2). It is approximated that between one to two million children suffer from ADHD (7). There is also a higher incidence of ADHD among boys, with almost three times as many boys suffering from ADHD than girls (2).

While some people feel that ADHD results from a lack of attention given to children by parents and teachers (1), new research has pointed to structural differences in the brains of children suffering from ADHD (4). These findings come from magnetic resonance imaging (MRI) of fifty-seven boys between the ages of five and eighteen classified as having ADHD as compared to a control group of fifty-five boys. The MRI's revealed that the boys afflicted with ADHD had more symmetrical brains than the boys in the control group. These boys also had smaller structures in the right hemisphere of the brain and this side of the brain was almost 5.2% smaller than that of the control group. It is not known exactly how this difference in brain structure size results in ADHD, but it is believed that inhibitory functions of the brain may be affected resulting in an inability to inhibit thoughts and actions (4).

Although there is no cure for this disorder, several methods of treatment are used to treat children with ADHD. Several different modes of treatment include nutritional therapy, behavioral therapy, and medication. Depending on the individual, one mode of treatment may be effective in treating ADHD, and for other individuals, a combination of different forms of treatment may be more effective.

A variety of different forms of nutritional therapy are used to treat ADHD. A former teacher who felt that nutritional deficiencies were to blame for student inattention formed a company that now produces blue-green algae as a nutritional supplement. Another example of nutritional therapy is the Feingold Diet, which is a diet free of artificial flavoring, artificial coloring, preservatives, and additives. This is also believed by some to improve the symptoms of ADHD (7). Another nutritional supplement, pycnogenol, may also help reduce the symptoms of ADHD (3). It has not been determined exactly how effective these forms of treatment are for individuals suffering from ADHD.

The most common and most controversial method of treatment is through the use of medication, specifically methylphenidate or Ritalin (6). Controversy surrounds the usage of this drug for treating children with ADHD, mainly because Ritalin is classified as being in the same family as cocaine (1). It is known that Ritalin does have a calming effect on children with ADHD, but the question arises of what may be the long run effects these kids might face.

As with most medications, Ritalin has adverse side effects, mainly nervousness, insomnia, and loss of appetite. These effects can be controlled by reducing dosage or omitting the drug in the evening (7). There are various other side effects that may not allow a child to take Ritalin and in these cases the child is either given a lower dosage or is put onto another medication. Another effect of this drug is that it can suppress growth. This can have a tremendous impact, considering that this drug is administered during the years that children grow. It may also have an effect on brain growth and development and since Ritalin is prescribed during the years that the brain of young children grows, it may have an adverse effect on brain development(1).

Another problem with Ritalin is that it is highly addictive. It has been classified as a schedule II drug, which is a category of highly addictive drugs and includes drugs such as morphine, opium, and amphetamines (1). Despite Ritalin being classified as an addictive drug, it has not been found to be addictive when given in low dosages to treat children with ADHD and it is uncertain whether exposure to Ritalin makes children more prone to substance abuse as adults (6).

The exact mechanism of how Ritalin works to decrease the symptoms of ADHD is not known. Some new research has given some insight as to how Ritalin may function. It had previously been believed that Ritalin regulated levels of dopamine, which is involved in the regulation of activity and locomotion. However, it has been found in recent studies that Ritalin affects levels of serotonin. This in turn increases the calming effect of serotonin on dopamine (8). With these new findings, it would be interesting to see if it is possible to treat ADHD through medication that specifically targets serotonin and would not have the same adverse effects as Ritalin.

Although health officials claim that there is no danger in using Ritalin, it cannot be determined what long term effects Ritalin may have on these children. Considering that Ritalin is placed in the same family of drugs such as cocaine and it is known that cocaine has harmful effects on individuals, it is possible that after years of taking Ritalin even at such low dosages it may have some damaging effects. It is difficult to determine what the long-term effects of this drug are going to be. It is also alarming that children younger than the age of six are being prescribed Ritalin. At such a young age, it is difficult to even determine whether or not the child is afflicted by ADHD. At this stage of life, many children may exhibit the symptoms of ADHD without actually having the disorder. The effects of Ritalin on children under the age of six are still unknown and prescribing these children Ritalin may be harmful to their health.

The symptoms that are described as being indicative of children with ADHD seem to be rather broad and vague as to what extent these symptoms have to manifest themselves in the children. It seems that there may be many children who are misdiagnosed as having ADHD and be put onto medication that is harmful to them. Although ADHD seems to be overdiagnosed, this is not to say that there are children for whom ADHD is a disorder that interferes with their lives. In order to avoid mistakenly diagnosing ADHD, a more stringent set of symptoms needs to be defined or the amount of time these symptoms are apparent in children should be lengthened.

WWW Sources

1) The Journal of College Student Psychotherapy , An article titled "The Hazards of Treating 'Attention-Deficit/Hyperactivity Disorder' with Methylphenidate (Ritalin)"

2) National Institute of Mental Health , Question & Answer about ADHD

3) Attention Deficit Disorder and Hyperactivity , Site about alternative treatment for ADHD

4) Subtle Brain Circuit Abnormalities Confirmed in ADHD , Site about structural brain differences in children with ADHD

5) Our Children on Ritalin , Site about alternative treatment for ADHD

6) National Institute of Mental Health , Consensus statement by NIH

7) Why to Avoid Ritalin , Information about Ritalin

8) Duke University Medical Center , Theory of mechanism of action of Ritalin

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