Can Ritalin kill a child?

By Dr. Samuel L. Blumenfeld

On March 21, 2000, 14-year-old Matthew Smith dropped dead of a heart attack while skateboarding. The ninth-grader had been on Ritalin since the first grade. Lawrence Smith, father of the youngster, has testified that Monica, school social worker, made them feel threatened, when she told them that if they didn't take Matthew to the doctor with their evaluation and recommendation for Ritalin that Michigan Social Services could charge them for neglecting their son's educational and emotional needs.

"His last report card was his best," says Lawrence Smith. "But it wasn't worth it for us. Putting him on Ritalin was the worst decision I've ever made." And that's because no long-range study had been made of the effects of Ritalin on children who take it over a number of years.

It has also been known since 1986 that methylphenidate, the generic term for Ritalin, causes shrinkage of the brain. A study that appeared in Psychiatry Research (Vol. 17, 1986) states: "The data in this study are suggestive of mild cerebral atrophy in young male adults who had a diagnosis of HK/MBD during childhood and had received stimulant drug treatment for a period of time."

Another study published in Archives of General Psychiatry (July 1996) found that "Subjects with ADHD had a 4.7 percent smaller total cerebral volume." Fifty-three of the 57 subjects with ADHD had been previously treated with psycho-stimulants. Apparently, these drugs constrict the flow of blood.

Despite these alarming findings, nearly 6 million children take Ritalin or one of a number of other stimulants in order to attend school. According to the Boston Globe (May 14, 2002): "New Englanders buy more of the stimulant Ritalin and its generic equivalents per capita than residents of any other part of the country." Believe it or not, New Hampshire is the nation's leading consumer of methylphenidate, the generic name for Ritalin. Next in consumption is Vermont, Massachusetts, Rhode Island and Maine.

Why such high consumption in New England? The region has more doctors per capita, and therefore more children are likely to be prescribed medication for so-called attention disorders. Also, New England has a high concentration of liberals who love the public schools and are more inclined to be cooperative when educators recommend drugging their children. In addition, more and more adults are taking Ritalin and its competitor, Adderall.

Parents Magazine and Good Housekeeping of September 2002 had two-page ads for Adderall XR, suggesting that life for a child could be so much better if he were on the drug. The ad reads:

Finding the right medication may help you see a big difference in how your child feels about himself or herself and what he or she is able to accomplish all day, every day! … Ask your doctor if a change to patient-friendly Adderall XR could be right for your child.

In other words, "Parents, please switch from Ritalin to Adderall." The ad then has these cautionary words about side effects:

Adderall XR is for patients with a confirmed diagnosis of Attention-Deficit Hyperactivity Disorder (ADHD) … The most common side effects are decreased appetite, loss of sleep (insomnia), abdominal pain, and emotional lability [instability] … Amphetamines have a high potential for abuse. Caution is advised in patients with a history of high blood pressure or mental illness …There is a potential for worsening of motor and phonic tics and Tourette's syndrome.

When parents are advised to put their child on Ritalin, no examination is made to see if that child might be allergic to its side effects. Of course, some children seem to benefit from the drug. Otherwise, there wouldn't be 6 million children on it and other similar drugs. But the power of methylphenidate is closer to cocaine than aspirin.

Recently, I received a call from a father being pressured by a school to put his son on Ritalin. What did I think of the idea, he asked. I told him of the sudden death of some children, the violent and murderous behavior of others, and the fact that Ritalin shrinks the brain. He wanted me to tell all of this to his wife who was inclined to go along with the school. So he put her on the phone. She listened politely. But when I told her of the shrinkage of the brain, she wanted to know if it produced any behavioral change. I said I didn't know, but I thought that more brain was better than less brain.

As far as I knew, no investigations had been made by medical researchers on what happens to intelligence when the brain atrophies. But I got the distinct impression that this boy's mother was not alarmed by brain shrinkage per se. If I could not demonstrate a definite loss of intelligence or nervous-system capability, then brain shrinkage was really nothing to worry about.

In fact, the Detroit News of Dec. 12, 2002, reported that there was indeed nothing to worry about. The article's headline said it all: "Ritalin is safe – and it works." An excited reporter wrote:

For more than a generation, we've been "drugging" our unruly children to calm them down. And in doing so, we have risked damaging their young brains and setting them up for long-term drug addiction – or so we have been warned.

But now, that mantra is being turned inside-out. The first long-term results of what some have called a huge drug experiment on our children shows what almost no one expected.

Not only do the stimulant drugs used to treat "Attention-Deficit Hyperactive Disorder" – or ADHD as it is known – not damage the brain, they appear to enhance brain growth, helping afflicted children catch up in brain size to their more "normal" peers.

That blockbuster finding, printed recently in the Journal of the American Medical Association, is finally easing the fears of parents afraid of these drugs and is sending experts on a mission to get the word out.

Apparently the article in the Journal of the AMA is based on a 10-year study by the National Institute of Mental Health. The study revealed that children with ADHD indeed have smaller brains to begin with, but those treated with psycho-stimulants such as Ritalin experience brain growth.

What is one to believe? The National Institute of Mental Health is a federal bureaucracy used by Congress to justify expenditures of billions of dollars to solve such problems as the genetic causes of dyslexia.

What about those studies cited earlier in this article showing that these drugs reduce brain size? Apparently they were performed by experts not on the payrolls of the drug companies and not geared to gaining federal funding. Which means that parents must still be wary of drugs that can kill young children.