Like birth, menstruation, and menopause, the unfolding of childhood is an inherently natural process. Nevertheless, every morning before going to school, 3 to 5 percent of American schoolchildren take a mind- and behavior-altering prescription drug called Ritalin (methylphenidate).1 They do so because they have been diagnosed as having a "disease," called "Attention Deficit Hyperactivity Disorder" (ADHD).

It may seem paradoxical to give stimulants to children who are hyperactive in order to calm them down. But this is done because these drugs often have the reverse effect on children than they do on adults. Although the actual impact of Ritalin and similar substances on the brain and mind of young people is poorly understood, children diagnosed with ADHD often continue to take it for years.

What happens to the youngsters who take this medication? Their actions tend to be more goal-directed and "on task" than before. They often become less distracted by things going on around them, and better able to stay focused on their schoolwork. They tend to become less aggressive, less apt to get into trouble, and generally more docile and compliant. They follow rules better.

These changes make them easier for adults to manage. Psychiatrists, parents, and teachers are often pleased with the changes they see in a child who is put on Ritalin, who may appear to be "finally settling down."

I have been dismayed to learn, however, that the drug usually does nothing to enhance learning or improve actual academic achievement beyond the short term.2 Actively seeking to find evidence for enhanced learning in children on Ritalin, psychiatrists Russell Barkley and Charles Cunningham analyzed 17 studies on the subject, and called the results "uniformly discouraging."

In 1995, a school board member from Litchfield City, Connecticut named Patrice Fitch publicly described her daughter's response to Ritalin: "In the classroom, she became more likely to pay attention or do what the teacher instructed. Yet, while she may have had her pencil poised over the work assignment, closer inspection revealed that she was not actually forming the answers but instead imitating the stance. While Ritalin made it possible for Amanda to sit more or less calmly in her chair, it did not help her to learn."4

Conequences
Approximately one-third of the children diagnosed as hyperactive do not become less restless on Ritalin. Some actually become more agitated. At best, the drug can help those children who have been accurately diagnosed to focus their minds so they can temporarily absorb information better. But others become withdrawn and stare off into space, not responding to much of anything. While these children no longer make trouble for their teachers or get into fights, they begin to exist in a state of disconnected social isolation.5

Even for those children whose behavior does respond as intended, the effect is only a temporary suppression of symptoms, not a cure. When children stop taking Ritalin, they are back where they started, only now they may also have to deal with a rebound effect from the medication, which may make them more distraught than ever.

And then, as with any drug, there are inevitably adverse side effects.6 Many children crash when their dose wears off, behaving even more uncontrollably than they did before. The Physicians' Desk Reference lists more than 25 symptoms-ranging from anxiety to hair loss to convulsions-that have been observed in Ritalin users having no preexisting conditions. Reactions include nausea, insomnia, headaches, weight loss, and a slowing of growth. Some children develop bizarre compulsive behaviors, such as insistent biting of their fingers and nails until they bleed. Other reactions include elevated heart rate, increased blood pressure, and a serious disorder known as Tourette's Syndrome, characterized by repetitive involuntary movements or tics.