Tuesday, October 03, 2006

Ritalin Requests Often Deemed Inappropriate

Joseph Biederman, M.D. full disclosure from the 2005 APA full disclosure list
Celltech Pharmaceuticals, Ltd ; Noven Pharmaceutical ; Johnson and Johnson PRD ; Janssen Pharmaceutica Products, LP ; Pfizer Inc. ; Sanofi-Synthelabo Pharmaceuticals, Inc. ; Cephalon Inc. ; Novartis Pharmaceuticals Corporation ; Shire US Inc. ; Eli Lilly and Company ; Ortho McNeil Pharmaceutical Inc. ; Stanley Foundation ; National Institute on Drug Abuse ; Wyeth Pharmaceuticals
Ritalin Requests Often Deemed Inappropriate

By Karla Gale

NEW YORK (Reuters Health) Sept 14 - Results of a survey of physicians suggest that parents often request a "behavioral drug," such as Ritalin, with the goal of enhancing their child's academic performance rather than treating an illness.

The survey was conducted by HCD Research and Muhlenberg College Institute of Public Opinion in Allentown, Pennsylvania, between the 8th and the 11th of September. Among the 634 physician respondents, about two thirds were primary care physicians and one third were pediatricians.

The survey results showed that, in the last year, physicians on average have seen 11 parents who requested Ritalin or other related drugs, even though their child was not diagnosed with attention deficit disorder/attention disorder hyperactivity syndrome for which the drugs are approved.

Moreover, respondents say that about 16% of parents to whom they have denied requests for behavioral drugs are obtaining them elsewhere.

Results of the survey also suggest that a third of the inappropriate requests are made by schools, and the rest by a parent. The physicians who were surveyed do acknowledge that 58% of the time, a prescribed behavioral drug does positively affect the child's academic performance.

However, Dr. Joseph Biederman, chief of pediatric psychopharmacology at Massachusetts General Hospital and a professor of Psychiatry at Harvard Medical School in Boston, scoffs at the notion that so many inappropriate requests are being made.

"That would be like parents inappropriately asking the eye doctor to fit their child with glasses so he'll have super vision," he told Reuters Health. "For a child who is not very intelligent, Ritalin will not make him intelligent."

He attributes part of the problem to misunderstanding how ADHD manifests in mild cases. "Some physicians will not consider an ADHD diagnosis unless there is a catastrophic educational situation." In less severe instances, for example, "if a child is brilliant but is doing just OK in school, that child may need treatment, which would result in their performing brilliantly at school."

"Some children may have mild symptoms, but in medicine, we treat mild symptoms such as hypertension or mild hypercholesterolemia," Dr. Bierderman continued, instead of sending patients home without any treatment "and asking them to come back after they've had a heart attack."

"In fact," he added, "most of the time, the problems that physicians have is with the absolute reluctance of parents. Research has shown that the average duration from the onset symptoms to treatment is about 7 years, because parents really struggle with this issue."

He added that physicians should pay even more attention when a school requests a behavioral drug, like Ritalin, "because they are with the child day in and day out. They are the ones who suspect ADHD because they see that the child is disruptive, fidgety, and talks a lot."

As to the notion that parents are obtaining the drugs elsewhere is "just ridiculous," the psychiatrist said. "These drugs are scheduled drugs and highly regulated, and physicians are quite careful in prescribing them."

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