formulate a response in which you agree or disagree with his...

formulate a response in which you agree or disagree with his thesis. Use specific reasons and examples to support your stand.

PERSPECTIVES ON ATTENTION DEFICIT DISORDER / Would Tom Sawyer Have Been Prescribed Ritalin?

Lawrence Diller, Published 4:00 am PST, Thursday, March 18, 1999

IN 20 YEARS of practice as a behavioral pediatrician, I have seen some 2,000 children for their behavior and school problems. I've written many prescriptions for Ritalin, the stimulant used to treat Attention Deficit/Hyperactivity Disorder. ADHD is a condition of excessive inattention, distractibility, impulsivity and sometimes hyperactivity, primarily affecting children.

In the early 1990s, I began to see a new kind of ADHD candidate: younger than 6 years old, teenagers and adults. Many of the children seemed far less impaired by their personalities compared with the previous generation of patients. Nevertheless, their parents and teachers were concerned.

I wondered if Tom Sawyer or Huck Finn were brought to my office, would I, after reviewing their home and school environments, prescribe Ritalin.

I am not the only doctor writing more Ritalin prescriptions these days. The production and use of the drug has increased by 700 percent since 1990. In 1998, the United States used 84 percent of the world's Ritalin. What's behind this increase and why us?

Demands on children have grown while the strength of their social supports -- school and family -- has decreased. Today, there is a rampant educational paranoia that declares everyone must have a college degree to succeed. Children are expected to learn earlier and learn more, yet we have higher student-teacher ratios in the classroom. Parents are working harder and longer. That means less time for their children and more structured day- care and latchkey kids.

Parents are additionally handicapped by a "politically correct" parenting philosophy which appeals to conscience and conflict avoidance when disciplining Johnny. "If you know how to talk to Johnny he'll listen to you." Unfortunately, from my experience, if you try talking to attention-defict Johnny he's halfway down the street before you've finished your first sentence.

More managed health care means more "quick-fix" medication. Being "labeled" attention deficit gets you special services at school.

Children in England and Japan use one-tenth the Ritalin we do so it couldn't just be today's fast-paced life that makes us Ritalin-unique among nations. Unlike those countries, we prize individuality and self-expression yet demand conformity at school. Limitations of class and intelligence are more accepted in London and Tokyo.

Here we have the American Dream where anyone can be the next Bill Gates. We also believe in a "medical utopia," where all the problems of life can be solved by visiting the doctor and taking a pill. Performance enhancers like Ritalin, Prozac and Viagra are "in."

The cause of ADHD is increasingly viewed by experts as biological and genetic. ADHD is a heritable as height, studies conclude. Brain scans detect differences in the ADHD brain, headlines proclaim. Sure, personality is heritable, but these same studies indicated that a spectrum of personality is passed from one generation to the next. Each culture decides at what point an impulsive personality becomes a disorder.

Some experts compare impulsivity to having lower intelligence. I don't know how they can be so sure. That comparison depend on how one defines intelligence and makes a judgment on what kind of intelligence is more valued or "higher." Traditional IQ scores predict life contentment less well than "emotional intelligence." Unlike traditional definitions, theories of multiple intelligences include qualities like creativity, musical and artistic abilities in assessing intelligence.

Many of our most "successful" people played off their temperament or learning weaknesses in school and developed valuable skills that served them and others well -- once they left high school. Benjamin Franklin, Thomas Edison and Bill Clinton have all been described as "being ADHD." No doubt a core group of ADHD children will struggle in any environment. But there is an intolerance of temperamental diversity in our country that views present-day Tom Sawyers as nothing but genetic detritus. Human diversity in the past has contributed to the richness of our culture and civilization. I worry about a society where there's no place for an unmedicated Tom. He is so many of our sons and daughters.