A concerned physician examines the skyrocketing use of Ritalin to treat attention deficit disorder (ADD) and finds its causes in a mix of disturbing social, cultural, and economic factors as well as in the psychopharmacological model of mental illness. The explosion in ADD diagnosis and Ritalin treatment in the US is a "white, middle-to-upper-middle-class, suburban phenomenon.— Diller, a California pediatrician specializing in child development and behavior, as well as a family therapist, sees ADD not as a manifestation of a chemical imbalance in a child's brain but of a living imbalance in many stressed-out American families. Among the causative factors that Diller identifies are the changing structure of family life, parents equipped with poor parenting techniques but anxious to give their child every advantage, rising academic competitiveness and pressure to succeed, and an overtaxed educational system where large classes provide many distractions and little individual attention. Also contributing are a managed-care health system that looks for low-cost solutions—Ritalin works fast and is a relatively cheap pill—and a school of thought that views ADD as being primarily a neurological disorder. When a behavior problem is classified as a medical disorder, Diller notes, insurance coverage is available and parental guilt is eased. He is not opposed to trying Ritalin but asks that other efforts be made to address a child's behavior and performance problems first, such as parenting/family therapy and monitoring the school situation. Diller draws on numerous cases from his two decades of practice to illustrate both the problem and his own multimodal approach. In his conclusion he proposes steps that parents and professionals can take to halt the surge in ADD diagnosis and Ritalin treatment. Balanced and thoughtful, yet sounds a powerful alarm.
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