- The Washington Times - Tuesday, May 30, 2000

FARMVILLE, Va. David Stein says he sees it all the time desperate parents advised to put their out-of-control children on Ritalin to cure attention-deficit disorder.

Mr. Stein, a Longwood College professor and psychologist, tells the parents something altogether different: There's nothing wrong with their child that will be cured with drugs.

"It's a disposition," Mr. Stein said. "It's not a disease."

Mr. Stein advocates a strict program of behavioral therapy, rewards and punishments to bring a child's behavior in line. His ideas go to the heart of the controversy that surrounds attention-deficit disorder and drug therapy.

Many psychiatrists point to a body of research that shows Ritalin is a safe and effective treatment. A panel of experts convened two years ago by the National Institutes of Health determined that drug therapy works better than behavioral therapy at least in the short term and that the best option is a combination of the two.

But Mr. Stein and others say the research on which the panel based its conclusions is flawed and fails to address several important issues.

Increasing numbers of children are on Ritalin or some other drug to manage attention-deficit disorder (ADD), also known as attention-deficit hyperactivity disorder (ADHD). Some studies have shown that as many as 10 percent of grade-school children routinely take medication, and 90 percent of those students take Ritalin.

While the drug has long been controversial, some recent events have raised even more questions. A study released in February shows that the number of 2- to 4-year-olds on psychiatric drugs like Ritalin soared 50 percent between 1991 and 1995, even though the makers of Ritalin warn that it should not be given to children under age 6.

Last month, a medical examiner in Michigan ruled that long-term use of Ritalin led to the death of a 14-year-old boy. Two weeks ago, the American Academy of Pediatrics issued guidelines on ADHD diagnosis to prevent overdiagnosis and overmedication.

First lady Hillary Rodham Clinton has formed a task force to study the drug's use. Congress has taken up the issue as well, and has sought Mr. Stein's consultation in drafting legislation.

Peter Jensen, a psychiatrist and researcher at the Center for Advancement of Children's Mental Health at Columbia University, says Ritalin is unfairly criticized and that behavioral therapy alone works well in only 25 percent of the cases.

"Some children will have a superb response to behavioral therapy. If you bring together the school, the family, all the necessary wherewithal, that's the way to go," Dr. Jensen said. "But if you were to eliminate drug therapy, you'd have to say to three-quarters of the families, 'We don't have anything to offer you.' "

Mr. Stein agreed that most studies show Ritalin is more effective, but said that only tells half the story.

"Drugs are the quickest, easiest solution, and also the least healthy," Mr. Stein said.

Mr. Stein and others say the studies touting Ritalin as safe and effective don't evaluate Ritalin's long-term effects. He said stimulants like Ritalin can be addictive and can stunt a child's growth.

And while he doesn't doubt the drug is effective in reducing outbursts, he worries that children essentially become stupefied and zombielike.

Dr. Jensen acknowledged that studies show about 10 percent of children who go on Ritalin will exhibit a dulled personality. But those cases usually occur at higher doses, and a doctor can simply adjust the dose or try a different medication.

He said that leaving ADD untreated can have an even worse effect on a child's personality.

"What does it do to you as a child when for five years people tell you you're a pain in the neck?" Dr. Jensen asked.

Mr. Stein also believes that behavioral therapy stacks up poorly in scientific studies because most of the approaches in vogue are poorly crafted. One prevalent method tells parents to give a child three warnings before sending him to time out. Mr. Stein said that simply teaches a child to test the limits.

Mr. Stein, who outlines his program in a book called "Ritalin Is Not the Answer," tells parents to give no warning and immediately send a misbehaving child to time out.

An important aspect of Mr. Stein's philosophy is simply spending a lot of time with children. He said most day care centers are "chaos," and that too may children spend too much time watching television.

"Have you seen what they put on MTV? It's garbage. This is what influences their minds," Mr. Stein said. "Turn off the TV. Have a family dinner. Have family reading time."

Gary Watts, who lives outside Farmville, said a doctor had written a Ritalin prescription for his son, but Mr. Watts had reservations about medication so he went to see Mr. Stein.

"It seems strict at first, but when you apply his methods, you start getting some positive results pretty quickly," Mr. Watts said. "So instead of being strict, you end up rewarding [the child] for all the positive things.

"I'm not saying it's a miracle cure, and I'm not saying it will work for everybody," Mr. Watts said. "But it's kept my son from having to go on drugs."

Mr. Stein claims he has had 95 percent success with his methods, but he acknowledged that the parents who see him are highly motivated and willing to put in a lot of time with their children.

He hopes that independent researchers will study his program to see if it produces better results, but he's worried that "there's no interest in research into a therapy that works without medication."

Still, he's optimistic that the recent attention on Ritalin will cause doctors to re-examine its use.

"I've been doing this over 20 years … I've been talking about this for years," Mr. Stein said. "I think now the physicians are listening."

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