The question remains to be answered: why are ADHD diagnoses and Ritalin prescriptions increasing so rapidly? A few possibilities include:

• Dr. Sally Latel, a psychiatrist and AEI fellow, claims that "Today, children suffering from ADHD are simply less likely to slip through the cracks." (Fumento, 2003)
• There is now a fairly rigorous testing process in place (described in the Diagnosis section of this website) which, if used by a properly trained physician, should be able to differentiate between ADHD and non-ADHD children.
• Girls who display the Inattentive type ADHD are being diagnosed at a growing rate, probably because in many cases these symptoms went unnoticed in the past because they were not as pronounced as hyperactive symptoms, which are more prevalent in boys (Biederman, et al., 2003)

A recent study found that individual states are prescribing stimulants at varying rates, with more prescriptions being given in upper-class communities (Medical Letter on the CDC & FDA, 2003). Also, the United States consumes 90% of the world's supply of Ritalin, a rate that is five times that of the remainder of the world combined. (http://www.pbs.org/wgbh/pages/frontline/shows/medicating/backlash/un.html)

Pro-medication advocates interpret these statistics to mean that many children who would benefit from drug treatment, including those from poorer communities and countries with less-developed systems of medicine, are not getting the pharmaceutical treatment they need to help them control the symptoms of ADHD. Indeed, Ritalin effectively alleviates the symptoms of ADHD in 75 to 90 percent of ADHD cases according to several reports, (http://www.chadd.org, Fumento, 2003) which suggests that it is effective when needed, although medication coupled with cognitive-behavioral therapy is considered to be the most effective form of treatment.

However, evidence does not suggest that the increase in ADHD diagnoses is due entirely to improved diagnostic criteria and more appropriate diagnoses:

• The actual evaluations carried out by psychiatrists and physicians are, in many cases, widely divergent from those suggested by the American Academy of Pediatrics.
• One percent of doctors are responsible for a majority of methylphenidate prescriptions. (http://www.pbs.org/wgbh/pages/frontline/shows/medicating/backlash/un.html)
• According to Dr. Peter Williamson, many physicians diagnose ADHD after brief interviews of under 30 minutes in duration with the children, who then receive prescriptions for Ritalin or another medication.

It seems that, in many cases, the physician's attitude is "Let's try a drug therapy and see if it works; there's no sense withholding medication from someone who might benefit from it." This indiscriminate attitude is problematic for a number of reasons:

• The vast majority of people who use Ritalin respond positively in terms of ability to focus and concentrate, regardless of whether or not they demonstrate symptoms of ADHD. Thus, doctors may find that patients do indeed respond positively to Ritalin treatment though they may have been functioning in a healthy manner without the drug.
• According to Dr. Peter Williamson, the best form of treatment of ADHD, in general, is drug treatment to alleviate immediate symptoms coupled with cognitive and behavioral therapy to develop coping strategies. Emphasizing only the drug treatment serves to alleviate symptoms but may not be the best form of long-term treatment for those who suffer from ADHD.
• Indiscriminate prescriptions of Ritalin and other stimulants becomes an even greater concern when the issue of growing prescription stimulant abuse is taken into account, a problem with a myriad of associated issues. In 1996, the DEA stated in reference to Ritalin: "These drugs have been over-promoted, over-marketed and over-sold, resulting in profits of some $450 million annually. This constitutes a potential health threat to many children and has also created a new source of drug abuse and illicit traffic" (http://www.add-adhd.org/ritalin.html).

The DEA concluded that in many cases Ritalin prescriptions are a "quick-fix bogus medical practice." After reviewing the wealth of literature on the rise in Ritalin prescription, these fears seem well-founded.

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