Ritalin Not Always the Answer

Parents whose kids take the stimulant medication Ritalin for Attention Deficit Hyperactivity Disorder usually find themselves wondering about the value of using Ritalin. Anyone with doubts should read this thoughtful book by child psychiatrist Dr. Lawrence H. Diller.

He is not anti-Ritalin; he prescribes it for some children. But Diller raises many important issues about why Ritalin use has increased in the United States and whether it is the appropriate response to a child’s difficulties.

In 1997 alone, almost 5 million people were prescribed Ritalin, most of whom were children, some as young as 4. Use of the medication has increased by 700% since 1990. Yet 90% of the world’s use of Ritalin is in the U.S. Why is this?

Diller points out that the diagnosis for ADHD has expanded while the demands on kids and their parents have increased as well. It’s possible that we’re asking too much of children and, at the same time, giving them too little of what they really need in terms of attention and discipline. He argues that the popular way of viewing ADHD emphasizes the child’s brain chemistry and perhaps has de-emphasized the need for the family to learn effective parenting techniques.

Diller presents evidence that the diagnosis for ADHD is largely “in the eye of the beholder.” He advises parents whose children may be affected to seek a thorough evaluation for ADHD from someone specifically trained in the disorder. (Diagnostic criteria for the disorder, and its variations, are published in the American Psychiatric Assn.’s Diagnostic and Statistical Manual of Mental Disorders.)

Too many children may receive Ritalin who don’t clearly fit the manual’s criteria for ADHD or who may have other mental health problems, he says.

Diller does not dispute that Ritalin works beautifully for many children. But, aside from the value of a medication, he offers good advice for parents whose kids are difficult. For example, he rails against “politically correct parenting” in which some parents tend to parent according to society’s guidelines instead of their own instincts about how best to handle their children. These parents, he says, may be unable to deliver “the combination of affection and discipline that would work best with their child.”

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REAL BOYS: Rescuing Our Sons From the Myths of Boyhood

William Pollack

Random House

$24.95; 447 pages

This is the counterpart to the groundbreaking book on the psychological development of girls, “Reviving Ophelia,” by Mary Pipher. “Real Boys” author William Pollack similarly bemoans the cultural forces that impinge upon boys and influence their attitudes, behavior and upbringing.

Pollack, a well-known psychologist and researcher of men’s health, contends that boys today are struggling silently, with low self-esteem and loneliness, or are acting out aggressively because of pressure to “be masculine” when their intuition tells them to feel something other than stereotypical masculinity.

He bases his theories on decades of clinical work with boys and helps parents understand how they can break the masculine molds that stereotype boys and thwart their growth. Highly recommended for anyone raising a son.