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Ritalin, the immensely popular drug of choice for treating childhood
Attention Deficit / Hyperactivity Disorder, is getting a nervous second
look by medical groups and pediatricians due to potential long-term
health effects — a concern highlighted by the recent death of a
14-year-old Michigan boy that was reportedly caused by the drug.

Last week, the

Asheville Tribune
reported that Matthew Smith of Oakland County, Mich., collapsed March 14 in cardiac arrest while skateboarding. He was a victim of steady cardiovascular decay after a decade of Ritalin use, according to Dr. Ljubisa Dragovic, chief pathologist at the Oakland County medical examiner’s office.

“There was a chronic change of the heart muscle and the small blood vessels in the heart,” he said. “This comes from long-term exposure. This kid was on (Ritalin) repeatedly for 10 years.”

Dragovic said that after a thorough analysis he found the boy’s small blood vessels manifesting scarring and tissue growth consistent with chronic stimulant use. And, he said, witnesses stated that Matthew had earlier complained of chest pains before he collapsed while playing on a skateboard. He also found that the drug affected pathways throughout the nervous system over time, causing “gradual, low-level” damage.

Michigan ranks third in the nation in Ritalin prescriptions. Physicians there prescribe 334 grams for every 10,000 people, a figure that is 50 percent higher than the national average.

The pathologist’s findings, which he forwarded to the federal

Food
and Drug Administration,
caused the agency to launch an investigation into the effects of Ritalin, in general, and in the Smith boy’s case, in particular. Also, the boy’s parents have indicated their intention to file suit against the drug’s maker, Novartis.

“Although we continue to be confident in the safety of our product, we cannot make any additional comments on a matter that will be before the courts,” Novartis company spokesman Harry Rohme told WebMD last month.

Ritalin — a stimulant that is also called methylphenidate — is prescribed for about 4 million American children every year, most diagnosed with ADHD. The most common side effects include an increased heart rate, high blood pressure, dizziness, drowsiness and changes in vision. Lesser effects include chest pain, fever, joint pain, skin rash or hives, and uncontrolled movements of the body.

However, Dr. Keith Connors, PhD, director of the ADHD Program at Duke University Medical Center, said he doubts Ritalin killed Matthew Smith.

“With the millions of children, adolescents and adults who are taking Ritalin, there are going to be a lot of people who die from a lot of different causes … but that has nothing to do with any causal explanation or proof,” he said April 18.

Nevertheless, on Tuesday, the

American Academy of Pediatrics
issued a

statement
on ADHD, providing

new recommendations
for the diagnosis and treatment of children with suspected behavioral disorders.

The recommendations, developed by the AAP’s Committee on Quality Improvement, include:

  • In a child 6 to 12 years of age with inattention, hyperactivity, impulsivity, academic underachievement or behavior problems, primary care clinicians should initiate an evaluation for ADHD.

  • The assessment of ADHD requires evidence directly obtained from parents or caregivers regarding the core symptoms of ADHD in various settings, the age of onset, duration of symptoms and degree of functional impairment.

  • The assessment of ADHD requires evidence directly obtained from the classroom teacher (or other school professional) regarding the core symptoms of ADHD, duration of symptoms, degree of functional impairment, and associated conditions.

The panel said its recommendations are “not intended as a sole source of guidance in the evaluation of children with ADHD,” but rather are “designed to assist primary care clinicians by providing a framework for diagnostic decision making.”

Adding to the controversy over Ritalin is the fact that recent research has shown a dramatic increase in the amount of the drug prescribed to children, which suggests to some analysts that more children are being afflicted with ADHD — or that the condition is being over-diagnosed.

Academy officials said they weren’t sure if over-diagnosis was a problem yet since physicians and pediatricians often differ on diagnosis and treatment regimens.

Between 4 to 12 percent of school-age children — or an average of about 2.5 million, most of them boys — are believed to have ADHD. Symptoms include short attention span, impulsive behavior and difficulty focusing and sitting still.

The

Family Research Council
reports that the number of children taking Ritalin since 1990 has more than doubled. Worse, according to FRC’s Janet Parshall, even schools are handing out the drug — often without parental consent — more often to control what school officials call inappropriate behavior by some students.

FRC said a survey of a Boston school district last year found that its 86 nurses gave out nearly 200,000 doses of Ritalin and school officials said the actual number was probably higher.

“Giggling, squirming and loud talk among happy, healthy children is now being used as an excuse to give them Ritalin, a drug designed to help kids with real attention disorders,” Parshall said. “A study of two groups of English schoolchildren found little difference between the amount of giggling and squirming among normal kids and those who really had attention deficit disorders.”

She added, “What a shame for our normal, active, healthy, giggling, squirmy children.”

Dr. John Taylor, a nationally recognized psychologist specializing in ADHD, says most kids taking Ritalin are being diagnosed correctly. He believes rising levels of noxious chemicals in the environment and the food supply are causing more people to contract ADHD.

“There are more of them because of the exposure to so many chemical irritants,” Taylor told the

Detroit News
in 1998.

“There are over 4,000 chemicals lacing the food and beverage supply in the U.S. None has been evaluated by FDA for behavioral effects on human beings. Many people are sensitive to them — many of whom have ADHD,” he added.

Money also seems to play a role in the dramatic increase in Ritalin prescriptions. Until 1991, according to

IMS America
— the world’s largest provider of health information services, with data collection activities in over 80 countries — Ritalin use had been steady for a number of years. In 1989, children with some form of ADHD amounted to just five percent of the federal Supplementary Security Income program. Six years later, they made up 25 percent.

Also, some doctors say insurance companies are pushing them to prescribe it because it is cheaper than long-term behavioral counseling and treatment.


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