RITALIN: MIRACLE DRUG?; DRUG PART OF THERAPY, SAYS DOCTOR

Most arguments about medications are kept in conference rooms and doctors' offices, where physicians debate the value of this pill over that.

Ritalin is dragging everyone into the fray.

Tagged "Kiddie Prozac" by critics, the drug has parents, teachers and doctors taking sides. Some call it is a godsend, allowing children to concentrate and make better grades; others label it a quick fix for lazy teachers and parents seeking a solution to behavior problems.

Regardless of the opinions, use of the drug is increasing quickly. Cape Girardeau schools secretaries, who years ago handed out a few pills a day, now joke about using calculators to figure out Ritalin doses.

Ritalin is a controlled substance, in the same government classification as cocaine and methamphetamine. Physicians prescribe it as part of the treatment of attention deficit disorder or attention deficit-hyperactivity disorder.

The drug increases the level of dopamine in the part of the brain that controls attention and impulses. It allows people with short attention spans to focus on one thing for longer periods of time. In people with normal attention spans who abuse the drug, it works like speed, providing a quick burst of energy.

Experts estimate only 3 to 5 percent of children in the U.S. truly suffer from ADD or ADHD. Five percent of Cape Girardeau elementary-school students already take Ritalin.

The numbers point to a problem: Although children are supposed to go through extensive testing before being diagnosed and given Ritalin, any pediatrician can write a prescription for it.

Dr. James Dinkins has become the local expert on ADD and ADHD. He is associated with the local Children and Adults with Attention Deficit Disorder chapter. Dinkins estimates he has treated 1,000 children with ADD since he opened his Cape Girardeau practice 29 years ago.

Most of Dinkins' patients were diagnosed in their early elementary years, although some were older. Most parents who go to him report children with high IQs, low grades and bad reports from teachers.

If Dinkins decides Ritalin is the right treatment, patients begin taking Ritalin in small doses. They don't take it on weekends or in the summer, when school is out of session. The weaning process typically begins during junior high or high school, although some patients take it well into their adult years.

Dinkins said critics' fears of raising a nation of drug addicts is unfounded.

"Ritalin is not addictive," he said. "It's not a stepping stone to street drugs.

"What if the child doesn't get treated, is emotionally immature and drops out of school? This is the person who is wide open to use drugs. He has no self-esteem and he never got help."

Ritalin should be a small part of an overall treatment system, Dinkins said. That system should include the children, parents, doctors, teachers and counselors. Children on the drug must have structure in their lives -- lists, schedules and tangible rewards for good performance.

These same strategies may be used by teachers in the classroom, Dinkins said. He warned that teachers shouldn't try to make an ADD diagnosis, but should encourage parents to see their doctors.

Mary Ann Hoffman, a registered nurse working in Cape Girardeau schools, said teachers should document behavior they see, but they shouldn't tell a parent to put their child on medication.

"Teachers tell parents the behavior they see in the classroom, and parents can see the grades," Hoffman said. "The behaviors get children in trouble repeatedly with their peers."

But the dramatic effects seen in students on Ritalin have moved some teachers to suggest it by name.

Charlene Peyton, president of the Community Teachers Association, said the CTA doesn't have an official policy on Ritalin, but she and others have personal views. A music teacher, Peyton has worked in education for 29 years.

"I tell parents when a child isn't paying attention, and that's all," she said.

"I'm not sure how I feel about ADD," she said. "Sometimes I think it is a lack of control at home. I don't know if it is a medical condition."