By Lawrence H. Diller Bantam Doubleday Dell, 1998 Review by Christian Perring, Ph.D. on Oct 3rd 2000
Lawrence Diller is one of the most eloquent and thoughtful doctors writing for a general readership on the issue of the use of medication for children. His book Running on Ritalin was originally published two years ago. Since then he has written a number of articles for Salon magazine, following up on the latest news concerning Ritalin and the treatment of Attention Deficit Hyperactivity Disorder. Although there are news items almost every week concerning Ritalin and ADHD, Diller's book remains highly relevant to the debate, and I recommend it highly.
In the thirteen chapters, Diller sets out the clinical, emotional, scientific, economic, legal and social issues relevant to understanding the rise in the use of Ritalin. Diller's discussion of these issues is both clear and thorough. At the end of the book are 33 pages of notes and references for those who want to research more into the issues raised.
Although there are many complexities in understanding the issues of medicating children, Diller's position is straightforward and plausible. He argues that while he himself often prescribes Ritalin and agrees that it is often appropriate, all too often Ritalin in prescribed without first exploring other options. Often parents, doctors, and teachers talk as if ADHD were simply a brain dysfunction and they prefer to ignore the emotional issues that family members are facing.
There has to be some explanation for the massive rise in the diagnosis of attention deficit and in the use or Ritalin in the last decade. Maybe now more than ever, families face many pressures; children often experience those pressures as much as their parents. But Diller's hypothesis is that more important was the rise in the concept of learning disabilities and the accommodation provided to students labeled as having such disabilities. The Americans with Disabilities Act has been ruled applicable to ADHD, and also important is Section 504 of the Vocational Rehabilitation Act of 1973. But probably more important is the Individuals with Disabilities Education Act (IDEA). This act, passed in 1990, mandates that "eligible children receive access to special education and/or related services, and that this education be designed to meet each child's each unique educational needs through and individualized education program, or IEP." (148). Also important was Section 504 of the Vocational Rehabilitation Act of 1973. Of course, giving people an incentive to be labeled with a disability often means that the rates of diagnosis increase, and it seems this is one reason the rates of ADHD diagnosis have sky-rocketed in the USA.
Of course, every expert will find some details with which to quibble in Diller's book. As an ethicist, I found his discussion of the medical ethics literature on the topic the least satisfying part of the book, but that's because I am already familiar with those issues. With the vast area of other aspects of the Ritalin debate where I am on less familiar ground, Diller is a sure-footed guide. His ability to combine different aspects of the issues, such as the social, medical, and personal, is impressive, and is what gives Running On Ritalin its coherence.
Currently the USA is the main country facing these problem, but other nations are likely to follow. Furthermore, as pharmaceutical companies develop new drugs which can enhance our intellectual and emotional lives, and which can even mold our personalities, we are going to have to look long and hard at what we want to label as disabilities and how much we should use such drugs. Lawrence Diller is one of the best thinkers we have available to encourage and guide the debate.