Stimulant of Choice: The Myths and Reality of Ritalin

Excerpted from
Running on Ritalin: A Physician Reflects on Children, Society, and Performance in a Pill
By Lawrence H. Diller, M.D.

I didn't want to hear the word Ritalin, and I especially didn't want to hear it from my husband's first wife." A mother named Alice is describing a turning point in her family's struggle to cope with their son, Joe. Affectionately nicknamed "Rocket Boy" as a toddler, Joe had been "expelled" from preschool and was by this time several months into kindergarten and showing no signs of slowing down. To the contrary, being forced to spend hours in close proximity with his schoolmates seemed to obliterate whatever shreds of self-control he could muster around his parents. On a daily basis, Joe would literally flip out, hurling his body into a group of children, thrashing and screaming. The calls home from his kindergarten teacher, a kind and resourceful woman, came every night.

He'd been an intense challenge since infancy, Alice says, sleeping little, crying lots. As a toddler, he'd sabotaged countless shopping trips with his frequent and unpredictable tantrums. Alice recalls a sympathetic fellow shopper commiserating about the terrible twos: "Little did she know that this was the eighth episode that day!" Over the next few years Joe became kid non grata at other children's homes and birthday parties. Kindergarten caused his behavior to spike even more severely, and a bad cycle set in: In extremis, he would revert to baby talk, whereupon other kids would tease him by imitating it, which prompted him to flip out again.

Alice and her husband, Mark-caring, conscientious, well-educated parents with an "easy" younger daughter-tried all the standard techniques for coping with difficult children: time-outs, positive-reinforcement charts, frequent strategy conferences with the teacher. Joe seemed beyond reach. And his parents suffered the multiple agonies that come with such a struggle: seeing their child miserable and feeling helpless to help him; "losing it" when they got angry at him and then feeling guilty for that; blaming his misery on their own inadequacies as parents (and feeling sure that outsiders were doing the same); anxious about the effects on their younger child.

Finally someone-it happened to be Mark's ex, who worked in the health field-suggested that Joe fit the profile for ADD and that Ritalin might help him. Alice reacted defensively: Joe wasn't that bad, and besides, the idea of giving her child a psychoactive drug every day was repellent. Mark agreed, and they temporized for several more months as Joe continued to deteriorate in school and fell asleep in tears every night, curled in fetal position on the floor of his room. The scale was tipped when he came home with his kindergarten photo, showing his lost, haunted face amid a swarm of giggling five-year-olds.

When they took him to a pediatrician for an ADD evaluation, he was off the chart in most categories on the questionnaires they were asked to fill out. The doctor said some encouraging things about Joe's character and gifts, then sent them home with a mountain of ADD literature-and a bottle of small yellow Ritalin pills.

"My hand shook as I put the pill down next to Joe's cereal bowl that morning," recalls Alice. She didn't tell her son exactly what the pill was for, only that it would help him feel better. She and her husband didn't notice anything dramatically different in Joe's behavior for the first couple of days-but the calls from school stopped coming. Gradually his social life improved; other parents occasionally commented on how he had matured. He didn't turn into a different person, says Alice; he was still difficult and argumentative and hypersensitive. The difference seemed to be that he didn't lose himself in stressful situations. With the help of the drug and continued intensive behavioral work by the family, he could control his swirling energy.

Alice had heard a certain amount about Ritalin before it took its place at the family breakfast table. She knew it was a stimulant that was said "paradoxically" to have a calming effect on children. She had heard that it could suppress a child's appetite, stunt his growth, and interfere with his sleep. She was aware that the Church of Scientology had strongly and publicly opposed its use-which, if anything, led her to think maybe it wasn't so terrible after all. But she did wonder if the drug might alter Joe's personality permanently; she already missed his ebulliant, mischievous side a little. And she was truly worried that it might be addictive-or at least that it might predispose Joe to later problems with drugs.

All in all, Alice's knowledge of Ritalin was about on a par with that of most media-consuming Americans: she knew just enough to be confused and concerned about the drug. Once it was shown to be of significant help to Joe, however, she made it her business to learn more.

In doing so, she had to sort through a great deal of information, misinformation, and myth. Ritalin has been in use in the United States for half a century and has become the most widely used and accepted drag of its type-yet it remains in many ways misunderstood and controversial. Misunderstood because it is both a therapeutic tool and a drag of abuse, and because we don't know exactly why it produces the effects it does. Controversial because its use has been mainly in treating children, whose brains and personalities are still being formed and who do not themselves make the decision about taking the drag. Controversial, too, because there are more and more of these children as time goes by.