CROWN POINT, Ind.--In 1992, when Tim Griffin was three years old, his mother, Sharon, began to worry that he was "hyper," that he "never settled down." A teacher at Tim's preschool recommended that he be checked for attention deficit disorder. Mrs. Griffin took Tim to a nearby psychiatric clinic, and sure enough, he was diagnosed with attention deficit/hyperactivity disorder, a variant of ADD. The doctors prescribed Tim five milligrams of Ritalin twice a day.
Thus Tim joined millions of other children who share that diagnosis and that prescription. A visit to the Griffins' home in northwest Indiana reveals that today, at age eight, Tim is by no means a normal child--he's clearly afflicted with what one psychologist who's observed him calls "learned helplessness." But, tragically, this psychologist traces Tim's problem not to his "disorder," but rather to his treatment.
Phantom 'Disorders'That the line between cure and disease should be so blurry is no surprise, since there is no objective test for ADD or ADHD. In fact, despite countless attempts, no one has ever demonstrated that either disorder exists. But harried teachers and counselors have learned to recommend an ADD diagnosis to parents in order to get their more rambunctious students on Ritalin, an easy way to quiet them down. U.S. Ritalin prescriptions have increased to 11.3 million in 1996, up nearly 400% just since 1990.
Many doctors and parents are increasingly alarmed about this trend. For starters, Ritalin is a chemical cousin of methamphetamine, and its pharmacological effects and addiction patterns are similar to cocaine's. And no study has ever demonstrated that taking Ritalin can cause any lasting behavioral or educational benefits in ADD patients. Yet two national advocacy groups, the National Attention Deficit Disorder Association and Children and Adults With Attention Deficit Disorder, have grown large and powerful by feeding parents' concerns about this phantom disease.
What's gone largely unexamined, however, is the effect that the ADD diagnosis and "therapy" has on these kids' lives. Tim's experience demonstrates the dangers of this approach. Over the years, his Ritalin dosage was gradually increased to 60 milligrams a day from 10 milligrams. The drug was prescribed by doctors who agreed with Mrs. Griffin's conviction that Tim had to be medicated, rather than disciplined, in response to his "extreme whininess." Not all doctors share this view, but Mrs. Griffin, a nurse herself, is so devoted to the ADD diagnosis that she has sought out sympathetic physicians. When the family moved to Crown Point last year, for instance, Mrs. Griffin chose a new pediatrician because, she says, "she just had a lot of the philosophies that I had."
One of these "philosophies" was a willingness to disregard a warning in the Physicians Desk Reference that Ritalin users should stop taking the medication during regular "drug holidays" in order to avoid such side effects as insomnia and loss of appetite. Mrs. Griffin says Tim "never experienced a drug holiday, and I've not requested one, because of the severity of the condition. I can't imagine what life would be like if he had a drug holiday."
But perhaps because Tim didn't take any drug holidays, he has experienced one of Ritalin's many side effects, what the Physicians Desk Reference terms "toxic psychosis." One day in April 1994, after he'd been taking 60 milligrams of Ritalin per day for about seven months, Tim ran at his mother as she talked on the phone, jumped on her and screamed, "The bugs are going to get me!" Hundreds of bugs were falling on him from the ceiling, he told her. Tim had such hallucinations three times, moving Mrs. Griffin to find a new pediatrician who would reduce Tim's Ritalin dosage gradually to 25 milligrams per day. The hallucinations stopped and his behavior improved.
But that didn't shake the Griffins' devotion to Ritalin, nor their belief that his ADHD meant that he should be sheltered from even the smallest of life's trials. Soon after starting first grade, Tim developed a fear of large, open spaces. "He just doesn't do well in those situations," Mrs. Griffin says. He cried so much at the door to the school's cafeteria, and refused to go in so vehemently, that his mother eagerly arranged for him to eat his lunch in the school's office with the secretaries. Without the ADD diagnosis, a boy Tim's age would simply be told that we all have to do things we don't like--even eat in the school cafeteria.
The hold that the ADD label has on Tim and his mother became clearer yet when Tim was in second grade this past year. Mrs. Griffin asked his teacher to write her a note each day describing his behavior. On some days, Mrs. Griffin recalls, the note said that "Tim really, really tries, but he just can't help himself." Other days it said, "Clearly his medication wasn't working well today." Mrs. Griffin explains: "That's the result of the ADD, that's just the way he is--he's loud, he moves around." In other words, if Tim is behaving, his parents and teachers believe his Ritalin's working; if he's not behaving, the ADD is at work. Either way, the medication or the "disorder" is responsible; Tim's just along for the ride.
That's a corrosive lesson for a little boy to learn. James A. Tucker, a former director of Pennsylvania's Bureau of Special Education, is a psychologist at Michigan's Andrews University who's observed Tim (and spoke about him with the Griffins' permission). "My professional opinion," he says, "is that Tim is a brilliant little boy with a highly creative mind in a highly structured environment, and that creates a tension that's frustrating for him. I would suspect that a lot of the medication and medical experiences have led Tim to the belief that there's something wrong. His brain is active enough to rise above that, but also to use it as a way of manipulating his environment."
Indeed, there's plenty of evidence of Tim's braininess. As a first-grader, Tim saw a White House jigsaw puzzle in a store, and quickly became interested in the presidents' lives. Soon he knew their names in order, their causes of death, their wives' names, and much detailed information about the White House. In June 1995, a local television station news show featured Tim's prodigious recall, calling him a "presidential whiz."
Getting Off the HookSo why have Tim's mother and teachers remained convinced that he's plagued by an inability to pay attention? Tim has learned that he doesn't have to behave, or do anything else that he'd rather not--the lesson of a therapeutic culture that doctors and parents have allowed to run wild. Says Mr. Tucker: "Kids say to themselves, 'I have this problem, which I really don't believe, but it gets me off the hook. . . . If my temper tantrum is viewed as something I can't help, I'll learn very quickly that I can get away without doing things that I don't want to do, because you think that I have this disease.' We see this all the time."
In short, ADD kids are learning an early lesson in the mores of 1990s America: Don't take responsibility for your own conduct; instead, declare that you're in the grip of uncontrollable impulses, seek professional help, and start making excuses. Mrs. Griffin may be satisfied with the result--she's happy to shelter her son from all but the most innocuous aspects of life, and she thinks that Tim would be uncontrollable without Ritalin. But it makes an observer wonder: Aren't parents, teachers and doctors shirking responsibility for raising kids by substituting a phony therapeutic approach for old-fashioned discipline?
Mr. McGinnis is assistant features editor of the Journal's editorial page.
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