Are there long-term side effects from the drug? This is an important question' because children are often placed on this medication for many years. It is also a frightening question, because to date no adequate longterm studies have been performed.7

Although more difficult to quantify than physical side effects, there are emotional and psychological consequences to labeling a child as having ADHD and putting the youngster on drugs. Having this kind of a diagnosis and treatment become a permanent part of a child's health files and educational records hardly helps her or him build self-esteem and selfrespect. In 1993, pediatric neurologist Fred Baughman, M.D., asked in the AMA journal, "What is the danger of having these children believe they have something wrong with their brains that makes it impossible for them to control themselves without a pill? What is the danger of having the most important adults in their lives, their parents and teachers, believe this as well?"8

Others have asked what the implications are of telling a child, "Say no to drugs, but don't forget to take your behavior-controlling, consciousness-altering medication before lunch." What happens to children when the full weight and authority of the medical profession tells them to take drugs to control their behavior? How will children learn to understand their emotions and deal with them constructively if they are told to take a drug to make them go away?9

When Clinical Psychiatry News discussed the heavy use of illicit drugs among adolescents, the journal lamented the increasing numbers of young people falling prey to substance abuse. Ironically, right next to the article, and visually overpowering it, was a prominent ad for Ritalin.'°

Ciba-Geigy, the company which manufactures Ritalin, says that the drug is not addictive if used as directed. But like cocaine and amphetamines, it is classified by the Drug Enforcement Agency as a Schedule II drug, meaning that among those substances regarded as having medical use, it is considered to have the highest potential for abuse. And even CibaGeigy acknowledges that some youngsters buy or steal the drug from classmates' sniffing and injecting it to get high.

In England, physicians simply do not prescribe Ritalin or other stimulant medications for children." They are far more cautious than we are about drug use in children to begin with, and particularly so for drugs with pervasive central nervous system effects. Throughout western Europe children almost never receive medication for hyperactivity.

In the United States, however, it's a different story. Although the Physicians' Desk Reference specifically states Ritalin "should not be used in children under six years [of age]," that did not stop U.S. physicians from writing 200,000 prescriptions for Ritalin and similar stimulants in 1993 for children ages five and younger.'2In the U.S., Ritalin has been prescribed to children as young as 18 months old.

The 1980s saw a dramatic increase in Ritalin use among children in the United States which coincided with publication of influential work by the University of Pittsburgh's Stephen Breuning. His research was believed to have proven that stimulants such as Ritalin were effective answers to hyperactivity. But evidently Dr. Breuning was somewhat lacking in the noble spirit of open-minded scientific inquiry. In 1988, it was discovered that much of his data had been completely fabricated. It turned out that he had reported studies that had never been performed.'3