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“With the demand for Ritalin growing, we must be increasingly wary about doling out a drug that can be beneficial but is more often useless or even harmful.”
“Psychiatry has devised careful guidelines for prescribing and monitoring this sometimes-useful drug,” observes Harvard Medical School faculty member Richard Bromfield. Writing in the current issue of Priorities, a publication of the American Council on Science and Health, Bromfield warns that “the dramatic jump in Ritalin use in the past five years clearly suggests that these guidelines are being ignored and that Ritalin is being vastly overprescribed.”

Why is this happening? “Under the pressure of managed care,” Bromfield contends, “physicians are diagnosing attention-deficit/hyperactive disorder in patients and prescribing them Ritalin after interviews as short as 15 minutes. And given Ritalin’s quick action,” he adds, “some doctors even rely on the drug as a diagnostic tool, interpreting improvements in behavior or attention as proof of an underlying ADHD — and justification for continued drug use.”

Bromfield reports that “Ritalin prescribing fluctuates dramatically depending on how parents and teachers perceive ‘misbehavior’ and how tolerant they are of it. When a drug can be prescribed because one person is bothering another — a disruptive child upsetting a teacher, for example — there is clearly a danger that the drug will be abused,” he warns. “That danger only increases when the problem being treated is so vaguely defined.”

What exactly is attention-deficit/hyperactive disorder? Bromfield asserts that “ADHD exists as a disorder primarily because a committee of psychiatrists voted it so. In a valiant effort, they squeezed a laundry list of disparate symptoms into a neat package that can be handled and treated,” he observes. “Certainly, some people diagnosed with ADHD are neurologically impaired and need medication,” Bromfield concedes. “Many more people have ADHD symptoms that have nothing to do with their nervous systems and result instead from emotional distress, depression, anxiety, obsessions, or learning disabilities. For these people,” he contends, “Ritalin will likely be useless as a treatment. Taking it may post-pone more effective treatment. And it may even be harmful.” The Harvard Medical School professor warns that Ritalin “can worsen underlying anxiety, depression, psychosis, and seizures. More common but milder side effects include nervousness and sleeplessness.”

Richard Bromfield views the rush on Ritalin as symptomatic of a larger problem. “The surge in both ADHD diagnoses and Ritalin prescriptions is yet another sign of a society suffering from a colossal lack of personal responsibility,” he argues. “By telling patients that their failures, misbehavior, and unhappiness are caused by a disorder, we risk colluding with their all-too-human belief that their actions are beyond their control, and we weaken their motivation to change on their own. And, in the many cases where ADHD is misdiagnosed,” Bromfield concludes, “we give parents the illusion that their child’s problems have nothing to do with the home environment or with their performance as parents.”