Debunking Ritalin

A recent article by L. Alan Sroufe, a researcher on Attention Deficit Disorder (ADD), concludes that Ritalin and similar stimulants have no long-term effects on improving children's performance. Furthermore, the drugs' well-documented short-term effects on improving attention and concentration are universal (e.g., for college students cramming for an exam) and are not specific to children or to people of any age with ADD.

The drugs have significant side effects (e.g., stunting growth); and like caffeine their effects diminish over time. The withdrawal symptoms associated with discontinuing use (e.g., as experienced by people who give up coffee) have been misinterpreted as a return of the behavior associated with their supposedly abnormal brains.

Research described in Sroufe's article revealed a variety of environmental factors leading to ADD, from poverty to family stressors to specific child-rearing practices. In contrast, measures at birth and in infancy related to the "abnormal brain" hypothesis did not predict the development of ADD.

The over-medication of our children is just one more example of the over-extension of the medical model into increasingly large areas of social behavior. Here is how the process works.

The spread of insurance companies and other third-party payers to virtually all of medicine has engulfed treatment for "mental disorders" as well. As a result, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders has become the official list of diagnoses--the key to unlocking third party payments. Not surprisingly, the list has grown dramatically over time, with each new edition containing many new "medical" conditions for which treatment can be reimbursed.

Why is it that there has been no corresponding burgeoning of non-psychiatric medical diagnoses? It would appear that the answer--artificially increasing demand--is to be found in economics rather than biology.

Because psychiatry is part of medicine, DSM diagnoses are considered medical conditions, so it is only natural to develop pills to treat them. Furthermore, since the total bill for diagnosing and treating problems with a pill is significantly lower than for psychological, social, and/or educational interventions (which require more professional time), third party payers also like pills.

Once a new mental disorder has been invented, the tail wags the dog. Researchers can do genetic studies to look for causes in DNA, people's brains can be scanned with MRIs and functional MRIs to look for identifying features, epidemiologists can track it in populations, and cross-cultural studies can be undertaken to find its distribution around the world.

The right way to go about matters--for the dog to wag its tail--is the reverse. Go around the world and see what kinds of behavior are considered abnormal everywhere, then see what clusters together into syndromes, and then do your biological and epidemiological studies.

Don't hold your breath for this to happen. It is an expensive approach, and it lacks the economic incentives of the current system. It might even lead us to rediscover Thoreau's "The mass of men lead lives of quiet desperation." That is, for the most part people are miserable because they find themselves in miserable circumstances (to which they may be significantly contributing).

Image Source:
United Nations Data Methylphenidate Consumption (Defined Daily Dose in millions).gif - Wikimedia Commons http://bit.ly/xjcrGF

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