Almost 14 years ago, the inaugural issue of Policy Review under newly appointed editor Tod Lindberg ran an essay of mine called “Why Ritalin Rules.” It observed that American children were taking psychotropic drugs at (then-) record rates; that some doctors and other experts believed methylphenidate (the generic name for Ritalin) was being over-prescribed; that the disorder for which it and related stimulants were given — Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder — included a uniquely protean symptoms checklist; and that the line between science and advocacy was hard to find in the bustling pediatric zone of the psychotropic universe.
Alongside praise, the piece also drew flak — lots of it. Brickbats crossed the political aisle. From left to right, some readers hated it. At the time, that reaction seemed surprising. After all, unlike many pieces penned in those days about children and psychiatric drugs, “Why Ritalin Rules” rounded up some ten years’ worth of medical and other specialized literature. It wasn’t written to inflame, but to try and understand a potent and obvious development. Regardless, the conclusion drawn from all the emotional static was that the moment to have a reasonable conversation hadn’t yet arrived.
That was then. What a difference a decade-plus and millions more prescriptions can make.
Sunday, on the front and center of page one of the New York Times, author Alan Schwarz thoroughly if inadvertently ratifies the argument of “Why Ritalin Rules” in a long and absorbing story called “The Selling of Attention Deficit Disorder: The Number of Diagnoses Soared Amid a 20-Year Drug Marketing Campaign.”
A few highlights from his report: Prescriptions for stimulant drugs such as Ritalin and Adderall have more than quadrupled in the past ten years. According to data from the Centers for Disease Control, “ADHD is now the second most frequent long-term diagnosis in children, narrowly trailing asthma.” Citing the same CDC, a psychologist and professor emeritus at Duke University named Dr. Keith Conners — for 50 years a leader in the effort to medicate children exhibiting the symptoms of ADHD — is emblematic of the specialists now having second thoughts. The rising rate of diagnosis, he recently told an assembly of fellow experts, is “a national disaster of dangerous proportions.”
Apparently, these are now legitimate subjects for discussion. In fact much of what Schwarz relays, like Dr. Conner’s quote, is more alarming than anything in my earlier Policy Review piece. The Times story also does something else done first in “Why Ritalin Rules”: It administers a standard “Could you have ADHD?” quiz to a number of subjects. Just as uncanny, it reaches the same results that appeared in my more limited experiment back in 1999. Some half of those canvassed by such a quiz, in 1999 and today, appeared likely to have ADD/ADHD, i.e., they would probably qualify for stimulant drugs.