The Over-prescription of Ritalin for Suspected Cases of ADHD

Authors

  • Jason Y. C. Chan
  • Talisa A. Dennis
  • Melissa A. Macleod

DOI:

https://doi.org/10.18192/riss-ijhs.v2i2.1519

Keywords:

Methylphenidate, Ritalin, over-prescription, ADHD

Abstract

Methylphenidate (Ritalin), the current leading form of treatment for Attention Deficit Hyperactivity Disorder (ADHD), has seen a dramatic increase in prescription rate over the past ten years. No contemporary biological basis for ADHD diagnosis results in physicians making their diagnoses based on behavioural symptoms such as hyperactivity and inability to focus. Considering that these symptoms are behaviours that anyone may express at one point in their life, the risk of over-diagnosis of the disease increases. This may subsequently lead to over-prescription of Ritalin. This paper aims to evaluate and identify the causes and effects of Ritalin over-prescription. Key literature on ADHD reveals that the diagnostic criteria for ADHD has undergone various modifications since the disease was first identified; therefore, different experts may have different opinions on what are regarded as symptoms of the disorder. Furthermore, recent research has demonstrated that Ritalin can increase cognitive performance in both healthy individuals and in ADHD patients. Such data indicates that Ritalin has the potential to be abused by healthy individuals looking to increase their cognitive performance. Correspondingly, Ritalin has been reported to be used by college students to boost their academic performance. In addition, the over-prescription of Ritalin raises several ethical issues: as children are the most common age group to be diagnosed with the disease, critics question whether prescribing a drug for a behaviourally based diagnosed disease is appropriate; also it is thought that the drug may affect the originality and creativity of the children which may hinder their personal development. While alternative behavioural therapy is available for the disorder, it tends to be more expensive and time-consuming than a drug prescription; this may explain why Ritalin remains the dominant form of treatment. This paper concludes that the prescription of drugs for ADHD should be cautioned and that more time and resources should be invested on developing consistent diagnostic criteria as well as potential alternative treatments to drugs for the disorder. 

References

Agay, N., Yechiam, E., Carmel, Z., & Levkovitz, Y. (2010). Non-specific effects of methylphenidate (Ritalin) on cognitive ability and decision-making of ADHD and healthy adults. Psychopharmacology, 210(4), 511-519. doi: 10.1007/s00213-010-1853-4

Brimble, M. J. (2009). Diagnosis and management of ADHD: A new way forward? Community Practitioner, 82 (10), 34-37.

Clarke, J. N. (2008). Health, illness, and medicine in Canada (5th ed.). Don Mills, Ontario: Oxford University Press.

Dopheide, J. A. (2009). The role of pharmacotherapy and managed care pharmacy interventions in the treatment of ADHD. The American Journal of Managed Care, 15 (Suppl. 5), S141-S150. doi: 10.3109/01612840903075395

Flaskerud, J. H. (2010). American culture and neurocognitive enhancing drugs. Issues in Mental Health Nursing, 31(1), 62-63. doi: 10.3109/01612840903075395

Jahromi, L. B., Kasari, C. L., McCracken, J. T., Lee, L. S., Aman, M. G., McDougle, C. J., ... & Posey, D. J. (2009). Positive effects of methylphenidate on social communication and self-regulation in children with pervasive developmental disorders and hyperactivity. Journal of Autism and Developmental Disorders, 39(3), 395-404. doi: 10.1007/ s10803-008-0636-9

Krautkramer, C. J. (2005). Beyond creativity: ADHD drug therapy as a moral damper on a child’s future success. The American Journal of Bioethics, 5(3), 52-53. doi: 10.1080/15265160591002845

Mick, E., Faraone, S. V., & Biederman, J. (2004). Age-dependent expression of attention-deficit/hyperactivity disorder symptoms. The Psychiatric Clinics of North America, 27(2), 215-224. Retrieved from http://dx.doi.org/10.1016/j.psc.2004.01.003

Outram, S. M. (2010). The use of methylphenidate among students: The future of enhancement? Journal of Medical Ethics, 36(4), 198-202. doi: 10.1136/jme.2009.034421

Poulin, C. (2007). From attention-deficit/hyperactivity disorder to medical stimulant use to the diversion of prescribed stimulants to non-medical stimulant use: Connect- ing the dots. Addiction, 102(5), 740-751.

Sadler, J. Z., Jotterand, F., Lee, S. C., & Inrig, S. (2009). Can medicalization be good? Situating medicalization within bioethics.Theoretical Medicine and Bioethics, 30 (6), 411-425. doi: 10.1007/s11017-009-9122-4

Singh, I. (2005). Will the “real boys” please behave: Dosing dilemmas for parents of boys with ADHD. The American Journal of Bioethics, 5(3), 34-47. doi: 10.1080/15265160590945129

Singh, I. (2007). Clinical implications of ethical concepts: Moral self-understandings in children taking methylphenidate for ADHD. Clinical Child Psychology and Psychiatry, 12(2), 167- 182. doi: 10.1177/1359104507075920

Sparks, J. A., & Duncan, B. L. (2008). Do no harm: A critical risk/benefit analysis of child psychotropic medication. Journal of Family Psychotherapy, 19(1), 1-19. doi: 10.1080/08975350801904072

Tomasi, D., Volkow, N. D., Wang, G. J., Wang, R., Telang, F., Caparelli, E. C., ... & Fowler, J. S. (2011). Methylphenidate enhances brain activation and deactivation responses to visual attention and working memory tasks in healthy controls. NeuroImage, 54(4), 3101-3110. doi: 10.1016/ j.neuroimage.2010.10.060

Volkmar, F. R. (2003). Changing perspectives on ADHD. The American Journal of Psychiatry, 160(6), 1025 -1027. Retrieved from http://dx.doi.org/10.1176/ appi.ajp.160.6.1025

Downloads

Published

2016-03-10

Issue

Vol. 2 No. 2 (2012)

Section

Articles

License

  • All authors published in the IJHS will retain copyright of their article. 
  • Authors grant the IJHS the right of first publication of their submitted articles. 
  • All articles published in the IJHS are licensed under a Creative Commons Attribution License that allows others to share articles if original authors and journal of initial publication are acknowledged. 
  • The IJHS is published online and in print, therefore the journal is not responsible for any unauthorized misuse of published content in either electronic or print form
  • The IJHS retains the serial distribution rights to all contents
  • It is the responsibility of the authors and not the IJHS to ensure proper permissions for all cited work have been obtained