The Ritalin Puzzle
It looks as though I am going to be revising my Future Imperfect manuscript for publication, and one thing I plan to add is a chapter on mind drugs: Recreational, performance enhancing, and controlling. I have accordingly started looking into the current controversy over Ritalin and related drugs for controlling ADHD. In doing so, I was struck by a puzzle which nothing I have so far come across seems to deal with.
Currently, something like five to twenty percent of children are diagnosed with ADHD and those so diagnosed are widely claimed to be unable to function in a classroom without medication. Fifty years ago, neither Ritalin nor ADHD diagnoses existed—and classrooms functioned, judging by results, at least as well as they do now. That raises an obvious puzzle, to which I can see at least four possible solutions:
1. The rate of ADHD has drastically increased. While that is not impossible, there seems to be no plausible explanation for such an increase. The only clear evidence on causation is that ADHD is in part genetic.
2. ADHD is in large part a bogus problem—the view of many of the critics of Ritalin use. Teachers get parents to drug their kids because it's less trouble than dealing with normal kids undrugged. This seems to contradict the anecdotal evidence from lots of parents, who report large improvements in their children's behavior as a result of the drugs—but that might mean that one percent of children really have the problem and the rest don't.
3. What has changed is not the prevalence of ADHD but the environmental requirements on kids. The same child who is functional in many other environments may be a serious problem if he asked to sit still and be quiet for most of five hours a day—as many of us would be. The point was made by one mother who commented that it was odd that her child only seemed to have ADHD nine months of the year—he was fine, undrugged, during the summer. The problem with this explanation is that, fifty years ago, schools had classrooms in which kids had to sit and be quiet.
4. Fifty years ago, undiagnosed ADHD kids were a serious problem, but while we have largely solved that problem with drugs, other school problems have gotten worse, which is why, on net, things are no better now than then. That seems inconsistent with at least the stronger claims about just how much of a problem ADHD is in the classroom and how common it is.
As these brief comments suggest, I don't have a clear answer to the puzzle. Suggestions? Pointers to webbed discussions that might help?