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Drug of Choice

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In 1937, a Providence, Rhode Island, physician named Charles Bradley discovered that he could calm "difficult" children by administering Benzedrine, an amphetamine that seemed to help them focus on schoolwork. Later, in the 1960s, doc-tors turned to another psychostimulant, Dexedrine, as a means of quelling misbehaving kids and inducing better concentration. Widespread use, however, was stymied by its association with the street drug "speed."

Ritalin, which had been approved by the Food and Drug Administration in 1955 as a way of controlling mild depression and senility in adults, was first administered to hyperactive children in 1961. While Ritalin was clearly an amphetamine-like drug, it carried none of Dexedrine's negative connotations. This, combined with Ritalin's obvious effectiveness in subduing wound-up children, made it the number one medication for treating "attention deficit disorder" when ADD was first listed in the Diagnostic and Statistical Manual of the American Psychiatric Association in 1980. By the late 1980s, more than 90 percent of all prescriptions for the treatment of behavioral problems in children were for Ritalin, making it a cash cow for its manufacturer, the pharmaceutical giant Ciba-Geigy.

Children can take either the generic methylphenidate or the brand-name Ritalin, but the great majority of doctors prescribe the latter, considering it slightly more effective. A typical monthly prescription of Ritalin--1,000 milligrams, usually administered in three 10-milligram doses daily--costs $45 to $50; the generic costs about $10 less. Most family health insurance policies pick up the cost of the medication once the ADD diagnosis is made.

The fact that a psychostimulant like Ritalin helps "hyper" children concentrate on schoolwork seems oddly paradoxical; intuitively, one would expect it to have the opposite effect. Some experts suggest that Ritalin's subduing nature stems from the fact that ADD-diagnosed children are restless because they are in fact understimulated. Ritalin, according to this view, stimulates children so they can finally bring their concentration to bear on specific tasks. In any case, Ritalin seems to calibrate, or "lasso," an ADD child's all-too-scattered energies.

Ritalin is a fast-acting medication: It takes effect within 15 or 20 minutes but washes out of the body after four or five hours. This means that most children who use the drug take a pill first thing in the morning, another at noon, and yet another at the end of the school day to help them concentrate on homework. Increasingly, parents are turning to a time-release tablet, which is effective for up to eight hours.

Effective with an estimated 70 percent to 80 percent of ADD-diagnosed children, Ritalin can cause side effects in some children, including the loss of appetite, stomachaches, and occasional nervousness and sleeplessness. Ritalin has also been known to trigger seizures and Tourette's syndrome, although such extreme side effects are rare.

—David Ruenzel

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