Breuning was sentenced to prison for this fraud, and articles condemning his actions appeared in major medical journals. Yet many teachers, pediatricians, psychiatrists, and parents are still influenced by the pro-Ritalin wave that washed across the country during the years when his "research" was believed to be genuine.

In the years immediately following Breuning's exploits, there was an exponential increase in the use of medication for children diagnosed with ADHD. A 1987 study found that 6 percent of all schoolchildren in Baltimore were on medically prescribed stimulant drugs.'4 An outraged public response in that city caused Ritalin use there to decline in the following few years, but in the rest of the nation, the number of children being dosed with this and other medically prescribed stimulants continued to increase.

By 1995, more than 6 million psychiatric prescriptions were being written every year for Americans under the age of 18. 15 And in 1996, the World Health Organization estimated that nearly 5 percent of all elementary schoolchildren in the United States were on Ritalin.16

Which Kids are Put on Ritalin?
The assumption is that these children have a brain dysfunction or disease Yet doctors prescribing Ritalin rarely, if ever, perform neurological tests." Instead, they take the word of parents or teachers, whose judgments are invariably subjective. The scores that are obtained from the various scales used to diagnosis ADHD give the appearance of scientific precision, as though they were measuring something tangible, like blood sugar levels. But in reality, ADHD is defined entirely in behavioral, nonmedical terms. The numbers merely sum up a particular teacher or physician's subjective impressions. In fact, a number of studies have shown that when parents, teachers, and clinicians rate the same child, they frequently come up with wildly differing scores.18

Who, then, are the children who get diagnosed with ADHD?

Some, who may be so unruly that they can completely disrupt an entire class, or who are impossible for their parents to handle, may benefit from the drug, at least in the short term. But many are simply children who have a strong sense of their own inner rhythms and timing. These youngsters often feel frustrated in authoritarian situations, and conforming to the rules of a classroom or of autocratic parents can be difficult for them. Such children are potential recipients of an ADHD diagnosis, because the American Psychiatric Association's criteria for ADHD officially points the finger at children who "interrupt others, and have difficulty following instructions."

Children who are especially intelligent are often bored in today's schools, and will sometimes try to answer their teacher's questions as quickly as possible, in the manner of game show contestant "whiz kids" eager to display their knowledge. This behavior, while hardly evidence of pathological brain chemistry, may nevertheless lead to a diagnosis of ADHD, because another of the of ficial criteria targets kids who "often blu* out answers to questions before they have been completed."

Children who are assertive by nature may also receive the diagnosis. One of the scales that is most widely used by parents and teachers to assess for ADHD is the Revised Conner's Questionnaire.'9 According to this scale, children are suspected of being hyperactive if they are "sassy," and guilty of "wanting to run things."