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IN A FRENZY OVER RITALIN

I have become the target of those who confuse the messenger with the message.

Two columns ago, I reviewed "Ritalin is Not the Answer" ($15, Jossey Bass), a book by professor and clinical psychologist David Stein. He presents not only a well-researched indictment of the use of stimulant medications (such as Ritalin) in the treatment of childhood attention deficit (hyperactivity) disorder (ADD or ADHD), but also a nonmedical treatment plan called the Caregiver Skills Program. Not surprisingly, the column ruffled the feathers of a number of mental health professionals.

The most common complaint was that I did not present a "balanced" view concerning the controversies surrounding ADD. Right. It was my intention to present Dr. Stein's view, which is not "balanced" but rather balances what professionals who constitute what I call the ADD Establishment have been telling the American public for more than 20 years, much of which, according to Stein, consists of misinformation.

For example, Stein maintains that ADD does not qualify as a disease. This was affirmed by a consensus of participants at the 1998 National Institute of Health Conference on ADHD, so he is hardly alone in this opinion. There is, to date, no convincing proof that the symptoms of ADHD result from a physiological dysfunction or are inherited.

Stein simply proposes what is logical and rational: If ADD is not a disease, then it is not appropriate to treat it as such, as with drugs. Furthermore, he says, the drugs in question are potentially dangerous to a child's health.

A good many professionals said Stein ignores the fact that many children have been "helped" by these drugs. He responds that while a dose of such medication will indeed relieve ADD symptoms for a period of hours, there is no reliable evidence that taking one of these drugs for years produces lasting benefit.

Furthermore, because these drugs produce "instant" (albeit temporary) improvement, parents and teachers often come to rely exclusively on them instead of employing remedial methods that will produce enduring gain. Stein doesn't think this qualifies as truly helpful.

He does not have a problem with short-term use of these drugs. Unfortunately, many if not most ADD children take them for several years or more.

Stein says it is unnecessary, even manipulative, for a professional to administer any tests to diagnose ADD. That raised the hackles of a fair number of professionals. Again, Stein is dead on. The diagnostic criteria presented in the latest Diagnostic and Statistical Manual make no mention of test data. If a professional even implies that such testing is necessary to make a diagnosis, he/she is not being forthright. If he/she presents these tests as necessary to developing a comprehensive treatment plan, that is another matter, but all too often these very expensive procedures are presented in the former light.

Finally, some professionals claimed Stein (and by association, myself) is preventing parents from seeking appropriate treatment for children with ADD.

Au contraire. Stein is encouraging parents to look at the full range of treatment options, presenting a viable alternative to the use of drugs, and trying to prevent parents from spending their hard-earned money on inappropriate diagnostic and treatment procedures.

Stein has plenty of evidence to back his claim that the Caregiver Skills Program, when employed conscientiously, works to the long-term advantage of parent and ADD child. Some professionals retorted that if a child does not need medication, he does not truly have ADD. This is circular reasoning of the sort Stein will address in his next book, as yet untitled, due out in the fall of 2001. He told me, "Anyone upset by 'Ritalin is Not the Answer' is going to be apoplectic over the next one."

You may not agree with everything Stein has to say. Then again, you may simply not want to even consider that he has something of value to say.

In any case, his iconoclasm is thought-provoking and, for some, refreshing. Oh, he also asked me to inform my readers that anyone who wants to contact him may do so at dstein@longwood.lwc.edu. That's called intellectual honesty.

John Rosemond is a family psychologist. Questions of general interest may be sent to him at Affirmative Parenting, 9247 N. Meridian, Indianapolis, Ind. 46260 and at his Web site: http://www.rosemond.com.
If you or someone you know has parenting problems, call the Parents Anonymous 24-hour confidential Help-Line at 892-2172.

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