FEARS CALMING ABOUT RITALIN PRESCRIPTIONS

Five years ago, the prescription drug Ritalin was seen as a quick-fix solution for thousands of children who appeared inattentive at school, had behavior problems, or lacked the ability to concentrate and stay on task.

The drug came under fire amidst theories from health experts and concerned parents that the drug was overpromoted and had damaging side effects.

The outcry became so great that many parents refused to medicate their children, even when AD/HD was diagnosed, for fear of harming them children or being considered an inattentive parent.

"I went through it. That was a very serious decision to make," said Peggy Pruett, whose son began taking Ritalin in fourth grade. "I had the attitude that I'll try it and see what happens."

Pruett, who is a former Cape Girardeau coordinator of Children and Adults with Attention Deficit Disorder, said her son's improved grades, conduct and ability to concentrate were proof that the drug was needed and that it worked.

However, Pruett said there were inconsistencies in the diagnosis of AD/HD and the prescribing of Ritalin that fueled claims of overuse.

"The controversy very possibly kept some kids who had it and needed the medication from getting it," Pruett said. "The proper diagnosis is the key to the whole thing, and getting a physician who really is familiar with all the things associated with it."

Background

Ritalin is prescribed as part of the treatment of attention deficit/hyperactivity disorder, a neurobiological disability that affects 3 to 5 percent of school-age children and approximately 2 to 4 percent of adults. The disorder is characterized by inappropriate impulsiveness and inattention, and in some cases, hyperactivity.

A controlled substance in the same category as cocaine and methamphetamine, Ritalin has been used for more than four decades to treat AD/HD.

An overhaul in guidelines for diagnosing AD/HD, along with scientific studies that have heralded the positive effects of Ritalin when used correctly, have caused parents and others to feel more confident that Ritalin is a positive solution for children with AD/HD.

Local doctors said physicians everywhere have become much more discriminating in prescribing Ritalin, largely because of the number of children medicated in the past simply to control behavior and with questionable AD/HD diagnoses. They said many doctors are following guidelines developed by the Academy of Pediatrics in May which suggest doctors take extra time to talk with parents, teachers and others to probe for other possible reasons behind a child's problems prior to writing any prescriptions.

"We want to make sure to rule out any medical problems, neurological problems and learning disorders," said Dr. Beverly Brown, the physician consultant for Cape Girardeau public schools. "Chances are there might be other behavioral issues that need to be worked on first before you write a prescription."

Pleased with progress

Cape Girardeau resident Melea Hillstead has only good things to say about Ritalin. She became aware of the drug 13 years ago when her oldest son was diagnosed with AD/HD.

Since then, a younger son and daughter also have been diagnosed with AD/HD, and the family has run the gamut of drugs, including several varieties of Ritalin, used to treat the disorder.

"My decision was to put them on the medication to try and bring their focus closer to what is average," said Hillstead. "It was also to help them sleep, because without it they're up to 1 in the morning until they're so exhausted they can't help but to fall asleep. That's not healthy."

Hillstead said the controversy surrounding the use of Ritalin and possible over-diagnosis of AD/HD made her leery of the drugs, but it did not take long in each case for her to realize medication was needed to alleviate her children's problems.

"It's really sad when a child can't sit through a 10-minute cartoon, and my kids couldn't do that. They'd be bouncing in 50 different directions," she said.

In addition, Hillstead said her children had problems concentrating on homework and even sitting through meals. She frequently denied them sugar "because it sent them into orbit," and they never attending school holiday parties because their behavior would be disruptive.

"Halloween became torture. Christmas was -- God almighty," Hillstead said. "When my oldest son was finally diagnosed, it was almost a relief. All I could think was There is something wrong and they can give me something for it. It is fixable.'"

Not for everyone

Hillstead credited thorough exams by doctors with helping to diagnose her children's problems. Although she said there are some doctors who leap into a diagnosis of AD/HD and prescription of Ritalin to calm unruly children, there are many who will take the time to ensure no underlying problems exist.

"In my family it has done a world of good but for some people, they wouldn't give a plug nickel for Ritalin," said Hillstead. "It does depend on how good your pediatrician or family physician is at diagnosing it."

Doctors said when a child is suspected of having an attention disorder, they conduct evaluations to assess a child's behavior at school and in the home. Parents are encouraged to have their child tested for intelligence and learning disabilities and screened for vision and hearing problems that might negatively affect behavior.

If children exhibit problems at home and at school, and if there are no other medical problems affecting behavior, then doctors are able to make a diagnosis of AD/HD and consider prescribing Ritalin or another medication.

"It's easy to give medicine because kids are acting out or teachers are having problems with behavior in school without going through all the hoops you're supposed to, but you have to be sure you're making a real diagnosis," said Dr. Gary Olson, a local pediatrician who has prescribed Ritalin as well as other, nonmedication treatments for hyperactive children.

I think the diagnoses are more accurate now and people are coming more to doctors because of an increased awareness of the disorder and the success of the drugs used to treat it."