Perhaps as much as 10% of American children are currently taking Ritalin. They are taking Ritalin not because they have a physical medical problem, but because they can’t concentrate in schools or are too “hyper” at home. But a growing body of evidence indicates that many of these children may suffer long-term health problems as a result of the drugs they are being prescribed. Maybe it’s time to ask whether giving children Ritalin is really any different to a pusher selling them amphetamines on the street.
What Is ADHD?
ADHD, or Attention Deficit Hyperactive Disorder, as we all know is characterized by a tendency to fidget “excessively”, an inability to concentrate and a general tendency to be too “hyper”. A century ago such children were likely to be physically punished or assigned tiring work until they calmed down, but today we live in a society where physical exercise is becoming a scarce commodity that one can obtain only by attending expensive gyms.
But how did ADHD come to be seen as a medical problem?
After the First World War, the world was struck by a massive influenza epidemic that killed more people than the war itself. Less well known today is that another, stranger epidemic followed in the heels of the influenza outbreak. Little is known about this second epidemic, and we still don’t know if it was caused by the ‘flu or was an entirely separate illness, but large numbers of people developed a strange affliction that, in the worst cases, left them alive but paralysed and inert, seemingly vegetative. This second illness has been called sleeping sickness, but it is unrelated to African sleeping sickness, an illness spread by a type of fly.
Decades later, neurologist Oliver Sacks was able to awaken some of these patients from their inert state by giving them L-Dopa, a Parkinson’s disease medication — an event that inspired the film Awakenings. But not all sleeping sickness sufferers were completely paralyzed by the illness; many appeared to largely recover. Yet some of these recovered victims were tragically left with permanent brain damage that ruined their ability to concentrate.
Many of these people were children who were left unable to concentrate on their schoolwork. Desperate for some kind of pharmacological fix for these unhappy kids, doctors turned to a relatively new class of drugs that were believed to be relatively free from side-effects and addiction potential: the amphetamines.
Amphetamines: Mad, Bad and Dangerous to KnowAmphetamines are a type of chemical stimulant, first marketed in 1932. Under the influence of a sufficient dose of amphetamines, a person can read a telephone book and find it interesting and engaging. Amphetamines have the power to turn boring activities into interesting ones, and for children suffering from the effects of sleeping sickness, initially they must have appeared to be a godsend.
We have a somewhat different view of amphetamines these days. As we now know, amphetamines are highly addictive; tolerance to their effects quickly builds up, necessitating ever-larger doses to achieve the same effect, and they can take a savage toll on your health. The Western world has been shocked in recent years by photographs of ‘meth’ users before and after they started abusing meth. Meth is nothing other than an amphetamine, and while the method of ingestion and pattern of use that meth users prefer renders it particularly destructive to their health, at root its effects are those common to all amphetamines. Meth can damage the brain and the heart, in children it retards growth, and it can cause outright death. The same is true of all amphetamines.
These considerations, however, didn’t stop both pharmaceutical companies and worried parents seizing on amphetamines as a possible way to get their hyperactive children to concentrate.
In the 1960s, “Hyperactive Child Syndrome” was invented — or described, depending on your perspective. Sufferers were treated with another newly-discovered drug, Ritalin. Ritalin is virtually identical in its effects to amphetamines; it is a stimulant and can also cause addiction, heart problems, retarded growth and death, but it has the great advantage of not having the word ‘amphetamine’ in its name. By the 1960s, people were well aware that amphetamines were dangerous, and few parents wanted to feed them to their children.
Roll forward a few decades, and Ritalin is now being prescribed to astonishingly-large numbers of children, most of whom probably do not have any kind of brain damage. Equally astonishing is the fact that amphetamines have made a come-back, with the drug Adderall (a mixture of amphetamines) now also widely prescribed.
Given that the side-effects of these drugs have now long since been known, how did they become so popular?
If It’s a Stimulant, How Come It Calms Them Down?
Perhaps one factor in the popularity of Ritalin is that many parents insist that ADHD is a “real” illness, like polio or tetanus, which can be “cured” by ADHD medication. For these parents, it’s hard to understand how a stimulant drug could calm their children down. Surely a stimulant would cause hyperactive children to become more hyper, not less?
But in fact, as the success of Adderall shows, drugs that are purely stimulant in their effect can indeed calm hyperactive children down. The reason is that hyperactive children generally want to sit down and concentrate in order to please their parents and teachers, but their state of mind makes it hard for them to do so. The stimulant effect of amphetamines enables them to more easily carry out their own wishes.
In exactly the same way, an adult who is assigned the task of reading the telephone directory from front to back might yawn, fidget and lose himself in daydreams. But if the same adult takes an amphetamine, it may become possible for him to read the telephone book with rapt attention, losing all signs of his previous “hyperactive” or “inattentive” behaviour.
The widespread view that Ritalin must genuinely and objectively cure an illness is further promoted through the unscrupulous and unthinking use of brain scans by scientists and pharmaceutical companies. Using technologies such as MRI, scientists can show that hyperactive children have discernibly different brain activity patterns to non-hyperactive children. A scientist can take a copy of an “abnormal” hyperactive brain scan and compare it with a brain scan of the same child after taking ADHD medication. The medication appears to make the pattern of activity in the brain more normal, to judge by the scans.
Why do I call this work “unscrupulous”? Because if you think about it for a minute, this research doesn’t tell us anything that we didn’t know to start with. All our thoughts and emotions correspond to activity in the brain, and indeed are regarded by most scientists as being generated by the brain itself. A person who is feeling sad will show a different pattern of brain activity to a person who is feeling happy. A person who is habitually nervous will have a visibly different pattern of brain activity to one who is habitually relaxed. And … a child who tends to be hyperactive or fidgety will have a different pattern of brain activity to one who is calm most of the time.
Take a child who is, for any reason, currently in a state of restlessness, give him amphetamines and – voilà – his brain scan starts to look more like that of a child who is not restless; because he is no longer restless. It is quite wrong to think that either an initial disease state or a subsequent cure have been proven by this kind of research. Except in the cases of the relative handful of children who who do have actual physical damage to their brains, ADHD continues to be purely a matter of definition.
How Severe Are the Long-Term Side-Effects of Ritalin?
The potential long term effects of Ritalin may include permanent damaging brain changes, heart damage and even death. As long ago as 2006, the UK’s Guardian newspaper reported that 51 children had died in the US as a result of being prescribed Ritalin. Yet there are those who believe that the real figure may be ten times higher than this, with many Ritalin-induced deaths being chalked up to genetic heart defects or unknown causes. While death is a rare side-effect of Ritalin, other side effects such as undesirable brain changes and growth retardation may be far more common.
Western society likes to draw a sharp line between drug “abuse” — where a drug is taken in a relatively uncontrolled fashion for recreational reasons — and the doctor-prescribed use of medications. Yet the side effects of drugs like Ritalin are largely the same whether they are prescribed by a doctor or taken for kicks. Indeed, a person may illegally use Ritalin recreationally once or twice and then stop, whereas children prescribed ADHD medication may take their drugs day after day, year after year during sensitive developmental periods.
OK – Ritalin Can Have Dangerous Side-Effects: But Does It Help Children To Concentrate?
If Ritalin really helped hyperactive children, those who feel that the importance of good school results overrides the necessity to maintain physical health may well decide to give their children Ritalin anyway. And yet, the hard truth is that Ritalin does not improve long-term school results.
In 1999, Professor William Pelham, a world authority on ADHD, helped author a study that showed that after one year, hyperactive children did much better in school when given Ritalin that unmedicated hyperactive children. It seemed that the old adage “drugs are never the answer” had been proven wrong in this case.
Scientific opinion for a while rested on the side of medicating hyperactive children using stimulant drugs. But then in 2007, Professor Pelham and his colleagues published the results of a longer-term study that had continued to follow the medicated children who were the subject of the first study. They discovered that after three years, the children were no longer doing any better than the unmedicated kids, and their health had suffered as a result of their Ritalin use: many of them were short and underweight compared to their peers.
Pelham’s study appears to confirm what our grandparents already knew: drugs are never the answer. Adults who turn to powerful stimulants to help them pass an exam or concentrate in their work are liable to find, several years down the line, that they have health problems and an addiction; children, it seems, fare no better when prescribed these drugs by a doctor. In fact the health effects of stimulants are worse for children than for adults, since children are still developing.
Why Are There So Many Hyperactive Children?
Perhaps we should have asked ourselves why one in ten of our children have trouble concentrating in school, instead of rushing to medicate them. Could it be — and I know this is a wild and crazy theory but bear with me for a second — could it be that allowing children to drink caffeinated beverages, watch endless amounts of TV and eat and sleep at irregular times, could in fact destroy their ability to concentrate? Recently a study showed that exposure to light near bedtime worsens the quality of sleep by interfering with the production of melatonin in the brain, and yet in the Western world, many children are daily glued to computer screens and TV sets even until late at night.
The same children are then expected, against all their instincts, to sit still for hours every day, attempting to absorb information from dull and ultimately often completely pointless school lessons. Children come out of school overweight, depressed and frequently nurturing the beginnings of a lifelong hatred of the subjects that they were supposed to be learning about.
Perhaps we should spend a little less time worrying about children who won’t conform to the demands our society places on them, and instead spend a little more time worrying about whether our society might have diverged so far from the basic needs of human beings that children can no longer fit into it without losing the very thing that ultimately really matters — their health.
As generations gone by used to say, as long as you’ve got your health, the world is your oyster. But lose your health and you’re in a whole different ballgame. The tragedy of giving Ritalin to children is that while it may make them easier to control and improve their exam results in the short term, in the long term it may damage them before they ever had a chance to find their own feet.