Heritage Foundation Leadership for America

WASHINGTON, APRIL 12, 1999—Millions of Americans, most of them children, take Ritalin every day because they have been diagnosed with Attention Deficit Disorder (ADD), which prompts an important question: Why is such a powerful substance—one that shares many characteristics with cocaine and other amphetamines—so widely prescribed to young children?

In "Why Ritalin Rules," an article appearing in the April/May 1999 issue of Policy Review, consulting editor Mary Eberstadt draws on the past decade's professional and popular literature on the topic and uncovers four main reasons.

For one, the way Ritalin (clinically known as methylphenidate) works is widely misunderstood by the public. It improves attention span the same way amphetamines do—by stimulating the central nervous system—and has the same potential adverse effects, including weight loss and insomnia. Numerous medical studies, including laboratory tests with animals, have shown virtually no difference between cocaine and methylphenidate, she says. In fact, the Drug Enforcement Agency (DEA) classifies Ritalin as a Schedule II drug, subjecting it to the same strict controls as morphine.

Another reason for Ritalin's rise, Eberstadt says, is the "extraordinary political and medical clout" of the support group CHADD—Children and Adults with Attention Deficit Disorder. The group's history includes its 1995 petition to the DEA to reclassify Ritalin as a Schedule III drug, which would subject it to fewer controls and make it easier to obtain. It also includes the fact that CHADD accepted nearly $900,000 in donations during the early 1990s from the pharmaceuticals giant that manufactures Ritalin.

A third reason for Ritalin's popularity involves the ever-changing definition of ADD itself, Eberstadt says. Medical experts tend to rely on diagnostic tests that focus almost exclusively on behavior, but "the distinction between what is pathological and what is not remains unclear." As a result, many physicians use a positive response to Ritalin to confirm a diagnosis of ADD, even though almost anyone—child or adult—becomes more focused and less aggressive on the drug.

But the primary reason for all those prescriptions? "Compliance," Eberstadt says. "One day at a time, the drug continues to make children do what their parents and teachers either will not or cannot get them to do without it: Sit down, shut up, keep still, pay attention."