|Brent Shipley is one of four million American schoolchildren who take the stimulant Ritalin to treat attention deficit disorder.|
One afternoon last May, hundreds of schoolchildren in Peoria, Illinois, rallied against drug abuse at a park just outside of the city. Wearing scarlet "Dare To Say No To Drugs" T-shirts, they celebrated Drug Abuse Resistance Education day--DARE day--with volleyball, tug of war, and soda pop. Cars in the parking lot, watched over by cops on horseback, were plastered with DARE bumper stickers. In the schools during the year, each class had its own DARE police officer who regularly volunteered to teach lessons on the horrors of drugs. Yet, in this most conservative of Midwestern cities, somewhere between 5 percent and 8 percent of the schoolchildren take, with the school district's blessing, a powerful stimulant to help them get through each day.
Eleven-year-old Brent Shipley is one of them. At the age of 5, Brent was diagnosed with attention deficit disorder. Now, every morning, after a heaping bowl of cereal, he washes down with his milk a 20-milligram time-release tablet of Ritalin to keep him calm and focused at school.
|Are we too eager to prescribe a drug for something many experts say doesn't even exist?|
For the most part, it does the trick. Brent may throw around a ball of crumpled paper on the school bus or demonstrate a few moves from All-Star Wrestling, but such behavior is typical for a boy his age. Last year, he made the honor roll two out of four quarters at the Roosevelt School of the Arts, where he is now in the 6th grade. He performed at least satisfactorily in all his aca-demic subjects except music theory. In that class, he received a D minus despite the fact that he can play songs on the piano by ear. Sometimes he struggles at math, but his math tutor says he understands concepts easily once he takes the time to study them. Brent also plays the saxophone in the school band, sings in the school choir, and dances with a local troupe. A good-natured kid with a wide, toothy smile, he is generally well-liked, though he sometimes irritates classmates and friends with bursts of immaturity--rude noises, repetitive movements, foul language, and humor derivative of Dumb and Dumber.
But any annoyance Brent's peers might feel is fleeting, for most are accustomed to students who take Ritalin. According to Roosevelt principal Paul Phillips, almost 10 percent of the school's 720 students take the drug, the vast majority of them boys. Over the last few years, the use of Ritalin to treat ADD-diagnosed children has spread in Peoria and nationwide. Some 4.3 million youngsters now take the drug, more than twice the number that took it in 1990. The drug has become such a common part of schooling that the venerable New Yorker magazine listed it as one of the three R's--"Readin Ritin Ritalin"--on its September 9 cover.
Phillips does not find the trend alarming. In fact, he thinks more kids could benefit from the drug. "Without Ritalin, some kids couldn't focus at all," he says matter-of-factly.
Christina Brock-Lammers, who was Brent's 5th grade teacher and is admired within the school community for her skillful work with ADD children, takes a slightly different view. "We're overmedicating children," she says. "Some students need Ritalin, but others can do without it if they're in the right environment. I don't, for instance, have my students spend a lot of time sitting in their seats. I have an activity-centered classroom, and my students--ADD or not--find that a lot less constraining."
Yet strictness, she says, is also important. Students need the freedom to move about, but they also need, in a kind of educational yin-yang, lots of structure. "It's the little things," Brock-Lammers says. "Making sure at the end of the day that each child is going home with a book."
Still, Brock-Lammers acknowledges that for some kids like Brent classroom-management techniques do not suffice: They need Ritalin to succeed in the classroom. "If these kids miss taking their pill," she says, "you can tell almost right away. They simply cannot do their work."
Like Brent, virtually all Roosevelt students who take Ritalin have been diagnosed with ADD, which most experts suggest afflicts somewhere between 3 percent to 5 percent of the nation's school-age population. Estimates vary widely, though, with some putting the number as high as 20 percent and others denying the disorder exists at all.
|Psychologists, doctors, and other experts now break ADD into types and subtypes.|
The term "attention deficit disorder" is actually a broad catchall. Psychologists, doctors, and other experts now break ADD into types and subtypes. Brent's specific diagnosis, for example, is attention deficit hyperactivity disorder, or ADHD, which has as its central features inattentiveness, impulsiveness, and hyperactivity. The last trait, hyperactivity, is the one most associated with ADD, perhaps because it's so easy to spot. In fact, during the 1970s, "hyperactive" became the term most used to describe fidgety, overwound children who couldn't concentrate on their schoolwork. But in the late 1970s, "hyperactive" was deemed far too limiting a word. After all, many children lumped under this heading were chronically inattentive but not the least bit restless or impulsive. So when attention deficit disorder entered the medical textbooks in the early 1980s, it was divided into two major classifications: ADD with hyperactivity and ADD without. The more prevalent ADHD is diagnosed primarily in boys, while the other--sometimes referred to in popular literature as the "spacey" or "dreamy" type--is more frequently diagnosed in girls.
|An increasingly vocal group of critics charges that both labels and the disorders they describe are nothing more than fiction.|
And yet some experts don't buy any of it. An increasingly vocal group of critics charges that both labels and the disorders they describe are nothing more than fiction. These naysayers point out that there is no medical test that can pinpoint the supposed neurobiological disorder and that there is no obvious organic cause. They argue that if ADD is, as one best-selling book on the subject claims, "everywhere," and if it has an almost preternatural capacity to assume new forms--there's now a strand of ADD known as oppositional defiant disorder, or ODD--then it is so vague as to be nonexistent.
The Ritalin that Brent Shipley takes washes out of his body after eight hours, so when he arrives home from school at 4 p.m. he takes a smaller 5-milligram dose to get him through soccer practice and homework. Brent's mother, Cindy, says life would be "rough going" without Ritalin. Sometimes, life's rough going even with it.
Brent, for example, still cannot do his homework alone. He despises worksheets. Just can't sit still for them. So he walks around the table iterating answers--"adjective," "adverb," "pronoun," and the like--while his mother transcribes them into the blanks. Reading, on the other hand, Brent likes. But he can't concentrate on a book for more than a few minutes at a time. Consequently, he and his mother read in tandem, like two anchors delivering the evening news on television. First he reads a page, and then she reads a page. "I'm not always sure he's absorbing what he's reading," Cindy admits. "He's good at spelling but weak at comprehension. Everything is just going too fast."