Economic and Cultural Factors Revealed in Ritalin Usage Patterns

Ritalin is the most popular drug in the methylphenidate family of pharmaceuticals prescribed to treat ADHD in children. Ritalin usage began to take off around 1990 and was clearly increasing at the time of this article from 2002. Its usage varies widely from country to country and region to region. Estimates on the actual number of children taking stimulants are difficult to determine; however, in 1999, the United States consumed 80% of the world's stimulants, down slightly from its peak of 90% in 1996.

Ritalin use varies widely within the U.S. as well. “Hawaii typically uses one fifth per capita of Ritalin compared with that of the highest-using states, which tend to be among the mid-Atlantic or Midwest states.” In some areas up to 20% percent of young boys take the drug, with the highest rates found in white middle- and upper middle-class suburbs. African-American families have rates of Ritalin use one-half those of white families (after controlling for socioeconomic status). These usage patterns reveal economic and cultural factors, as opposed to simply neurobiological ones, are largely involved in the diagnosis of ADHD and its treatment using Ritalin.

Throughout the 1990s, psychiatric academia increasingly moved toward a biological model of ADHD, a view obviously favored by the pharmaceutical industry and its enormous economic clout. Lawrence further contends, “The major ADHD self-help groups were firmly aligned in the biological camp dependent on the current expert opinion and committed to develop ADHD as a legitimate disorder to qualify it for disability status.” This trend came into question when the Journal of the American Medical Association (JAMA) published an article on the use of Ritalin in toddlers as young as three years old, which was followed by extensive popular media coverage and public outcry.

Lawrence describes how “demands on children have increased, whereas supports for children, families, and schools have decreased.” Our society is making educational demands on children as young as three, and demanding increased performance from both students and teachers, yet there has been no corresponding increase in educational funding and resources. Parents and families, facing their own increasing economic pressures, have less time to spend with their children. The economics of our health care system, including increased tendency toward managed care, favor prescription usage over labor-intensive alternative treatments such as behavioral management training. Finally, American culture promotes and values independence, spontaneity, and freedom of expression in our children while simultaneously demanding conformity at school. But children with ADHD and other learning disabilities need consistency of message and are set up for problems if not diagnosed and provided special care in their educational placement.

Widely-varied usage patterns suggest socioeconomic factors contribute greatly to the prescription of Ritalin and other stimulants in the treatment of ADHD. The economics of the medical and pharmaceutical communities, our education systems, and family economic realities contribute to the unevenness seen in the Ritalin usage data.

Diller, Lawrence H. M.D. Lessons from Three Year Olds. Journal of Developmental and Behavioral Pediatrics. Volume 23(0). February, 2002. pp. S10-S12.


Added by Bob Jarvis