Attention Deficit Disorder and Ritalin: A Look at the Research
Bryan K. Bajakian, D.C.
November- December 2003

There is extensive research available that demonstrates the need to avoid the use of such drugs as Ritalin, Adderal, or Cylert when "treating" hyperactivity disorders in children. Unfortunately, the drug manufacturers market the drugs very well and to many parents and health care providers, the downsides of such medications are vague or even unknown.

I have referenced two specific studies that assessed the role of Chiropractic treatments in the management of children who have been diagnosed with hyperactivity disorders. These studies, both separate from one another, revealed that hyperactivity, and other behavioral conditions responded well to chiropractic care and even exceed results seen from medication. 1,2

One medical study demonstrated the existence of a positive relationship between cranial motion restrictions and learning disabled children, as well as children with a history of an obstetrically complicated delivery. 3

Nerve and spinal system compromise can result from the traumatic pulling, twisting, and compression that a newborn's spine is exposed to during a forceful birth. Traumatic Birth Syndrome is not a new concept; it has been commonly accepted by experts in both the medical and chiropractic fields. Birth trauma often adversely affects the bones at the base of the skull, the brain stem and the soft tissue surrounding it. The cervical (neck) nerve roots are often stretched as the baby's head is pulled from the birth canal.

Two prominent German MD's published papers in the late 80's and did clinical work with newborns and infants to address what atlas chiropractors allude to ANVS. Gottfried Gutman, MD addressed what he called "Atlas Blockage" (ANVS) and stressed the importance of having the atlas area of infants examined after birth, especially if the birth was difficult. He treated over 1,000 infants and documented the positive clinical results derived from correction for "Atlas Blockage" by performing specific light force adjustments to the atlas vertebrae.4

Another medical study revealed that due to the physical forces incurred during delivery, 80 % of ALL children born exhibited mis-alignments of their upper cervical spine. Dr. H. Biederman, a German MD, wrote a paper stressing the importance of the neurological structures in the atlas and occipital (base of the skull) areas. Biederman described atlas misalignments is newborns with the term "Kinematic Imbalances due to Suboccipital Strain" (KISS Syndrome). According to Biederman this "blockage" can be corrected by "manual therapy of the suboccipital area of the upper cervical spine".5

Both Gottfried and Biederman specifically attributed these syndromes to the compromised positions that the head and neck of an infant are susceptible to during the birth process.

Such Subluxations, as they are known in the Chiropractic profession, have been shown to result in a multitude of dysfunctional disorders within children which include ADD/ADHD, Difficulty Sleeping, Headaches, Asthma and Allergies, Lethargy, Sinus conditions, and acute/chronic ear infections.

In 1971 a study entitled "Hyperactive Children as Teenagers: A Follow - up Study" was performed. 83 Children were followed up on, from 2 to 5 years after being diagnosed as hyperactive or as having attention deficit. 92 % of the children were treated with Ritalin. Results were as follows:

1. 83 % had trouble with frequent lying
2. 78 % found it hard to sit still and study
3. 60 % of the children were still overactive and had poor schoolwork (the original reasons for being put on Ritalin), but in addition were now viewed as rebellious
4. 59 % had some contact with police
5. 59 % were viewed as a discipline problem at school
6. 58 % had failed one or more grades 7- 57 % had reading difficulties
7. 52 % were destructive
8. 44 % had arithmetic difficulties
9. 34 % threatened to kill their parents
10. 23 % had been taken to the police station one or more times
11. 15 % had talked of or attempted suicide. 6

1987 - Satterfield study states: "We found juvenile delinquency rates to be 20-25 times greater in our hyperactive drug-treated only group than in the normal control group." In the "Delinquency Outcome for the drug-treated group" the results were: of 61 Boys,

1. 46% were arrested for one or more felony offenses before age 18
2. 30% were arrested for 2 or more felony offenses
3. 25% were institutionalized

The authors go on to state "Studies of the long term effectiveness of drugs have been consistently discouraging." 7

1976 - Study by Riddle & Rapoport - it was concluded that among the continuously treated hyperactive children it was found that peer status and academic achievement did not seem to improve. 7

1976 - Study by Hechtman &Weiss stated: Thirty-five individuals aged 17 to 24 in whom severe chronic hyperactivity had been diagnosed 10 years before were studied together with 25 matched controls. Cognitive style tests indicated continued difficulty in reflection (resulting in more errors) but less impulsivity (longer reaction time) in the hyperactive individuals. Compared with controls, hyperactive subjects were continuing to have more scholastic difficulty, although this difference seemed to be less pronounced than 5 years before.

Restlessness, both reported and observed, continued to be a problem for the hyperactive individuals, and socialization skills and sense of well being continued to be poorer than in the controls.

The authors concluded that methylphenidate (Ritalin) did not significantly alter poor long-term academic performance, delinquent behavior or poor emotional adjustment. 9

1978 - Study by Blouin stated the following: "Clinical treatment with Ritalin was found to have no beneficial effect, and there was some evidence to suggest a poor behavior outcome for the drug-treated group."

1980 - Ackerman report entitled "Report on Drug Withdrawal Symptoms"; "The abstinence (withdrawal) syndrome associated with amphetamines, methylphenidate (Ritalin) is marked by lethargy, sleep disturbances and prolonged depression." "Depression is perhaps the most significant symptom."

In review of the reported "shootings" perpetrated by minors in schools or relating to other social situations of such age groups, in each case that the shooter's medical files were available for review, Psychotropic drugs were found in the child's system. Such a finding is further bolstered by the follow references.

In the book, "Predicting Dependence Liability of Stimulant and Depressant Drugs" researchers Travis Thompson, Ph.D. and Klaus R. Unna, M.D. describe the "chronic effects of stimulants in man": "Perhaps the best-known effect of chronic stimulant administration is psychosis. Psychosis has been associated with chronic use of several stimulants; e.g., d- and 1- amphetamine methylphenidate (Ritalin-P), phenmetrazine and cocaine." 10

1987 - The Diagnostic and Statistical Manual of Mental Disorders III-R, states: That methylphenidate (Ritalin), along with other amphetamine-type drugs and cocaine, can create "persecutory delusions" and may "cause a highly organized, paranoid delusional state ndistinguishable from the active phase of schizophrenia." It states "The person may harm himself or herself or others while reacting to delusions." 11

This American Psychiatric Association's Manual goes on to state: "Initially, suspiciousness and curiosity may be experienced with pleasure but may later induce aggressive or violent action against 'enemies'. Delusions can linger for a week or more, but occasionally last for over a year." This DSM III-R also states "Suicide is the major complication of withdrawal from methylphenidate and other amphetamine or amphetamine-like drugs."12

1991 - Journal of Behavioral Optometry, "The Efficacy of the Use of Ritalin For Hyperactive Children". This study evaluates 22 previous studies/articles since 1976 concerning Ritalin use for hyperactive children. It states: "The fact that the above studies do not show the efficacy of Ritalin for helping hyperactive children should be apparent to the skeptic and make a skeptic out of the believer. But the argument should not stop at this point. The weak evidence of the value of Ritalin must now be viewed in the light of its reported side effects." And it concludes: "...at this time there is scant evidence for the use of Ritalin in hyperactive children to produce improved learning. This lack of evidence is consequential because of the many side effects produced by Ritalin administration."

1988 - Journal of the American Academy of child and Adolescent Psychiatry, January 1988 Case Study entitled: "Methylphenidate-induced Delusional Disorder in a Child With Attention Deficit Disorder With Hyperactivity" discusses a case study involving a 6 year old child, J. R. who was placed on 20mgs of Ritalin in the morning and 10mgs in the afternoon, but due to measurable weight loss after 1 ½ months the dosage was decreased to 20mgs. After 4 months the child was placed on 20mgs of the sustained released Ritalin, the results were as follows: "Approximately 6 months into therapy, J.R.'s mother reported that the child was becoming physically and verbally aggressive and difficult to manage. He was agitated and verbalized repeatedly that "someone" was " going to kill "him." .. .the child was suspicious and delusional, accusing others of thinking homicidal thoughts towards him " "J.R.'s the stimulation (Ritalin) therapy was terminated and his behavioral disorganization and psychosis resolved completely over the next several days but only with a full return of his attention problems and hyperactivity."

The conclusion: "J.R.'s psychological disturbance certainly seemed to have been associate with his methylphenidate therapy." The final paragraph of this study states: "Young (1981) suggested that psychotic reaction to stimulants in children may be common, as prescribing physicians are generally less alert to possible signs of toxicity when these medications are prescribed within normally accepted dose ranges. J.R.'s reaction was certainly more intense than what has usually been described and it is unlikely that his behavioral changes would have gone unnoticed indefinitely. On the other hand, as most reported instances of psychotic reactions in children have involved less dramatic behavioral changes, such as tactile hallucinosis, there may be considerably potential for such changes to remain unrecognized for prolonged periods of time." 13

Ritalin is speed. A representative from the DEA (Drug Enforcement Agency) stated that neither humans nor animals can differential between Cocaine and Ritalin. Ritalin has the same drug classification as morphine, opium and cocaine. In fact the Diagnostic and Statistical Manual of Mental Disorders states that Ritalin is an extremely addictive substance and that classical symptoms of Ritalin usage and cocaine dependence are the same. Also stated in the Manual is the main complication of withdrawal from Ritalin substance is suicide. According to Medical Economics, chronic use of Ritalin has produced psychosis. Ritalin is definitely not a safe drug.

The late Robert Mendelson, M.D. made a most interesting comment about ADHD and the use of Ritalin, Dr. Mendelson stated that "So many children are being called hyperactive by the experts that I wonder whether many of them actually are perfectly normal in contrast to the hypoactive children who serve as the reference base. If we're not careful,

we'll soon find the non-hyperactive being drugged with prescriptions for hyperactivity to arouse them from there lethargy.

In the publication, Physiological Medicine, Roselise Wilkinson MD. states "We deplore the careless manner in which Ritalin use is regarded by many educators, psychologists, and medical personnel. It is often prescribed hastily, without adequate evaluation and by authority figures who are placing unreasonable pressure on parents who wish to do the best for their child."

Ritalin itself is used mainly in school age children and is the subject of much debate. Ritalin is a central nervous system stimulant that activates the arousal system in the brain stem and cortex, in effect producing increased alertness. How it does this is unknown. The only other indication for use of Ritalin is for the condition of narcolepsy, a disorder of abnormal sleep. (An oxymoron perhaps).

The manufacturer of Ritalin (Ciba-Geigy) warns that the drug should not be used under the age of six, yet the fastest growing age group has been documented to be the 2-5 year olds. The long-term effects of Ritalin have not been established and of course the mechanism of how Ritalin works in the body is admitted in writing by the company who manufactures the drug as, "not understood". Some side effects of Ritalin are: stunting of growth, depression, chronic headaches, nervousness, skin rash, blood pressure and pulse changes and development of Tourette's Syndrome.

I currently maintain serious concerns about training children to take drugs to deal with their problems, rather than seeking safe and natural means as an initial resort. Since the answers involve actual active parental involvement, dietary supervision, and periodic spinal check-ups to assess the degree of function of a child's nervous system, it is only too easy to offer a chemical solution in the form of a pill.

I won't argue it is easier to prescribe a pill than it is to actively work with a child in how they deal with the problems that live has to offer them. It has been estimated that our current generation experiences more stress in one year of our lives than our grandparents experienced in their entire lifetime. With the advance of technology and the increased demands being placed on our children to adhere to a set of societies guidelines of what "normal" behavior entails, the tendency to offer a quick yet potentially deadly solution is definitely becoming more attractive.

Too many tragedy's have resulted from the practice of prescribing very powerful drugs for our children, and then reading in the papers as to how a seemingly "normal" child failed to wake in the morning or went to school and violently took the lives of other children.

I always refer to children as our future. We must ask ourselves if we taint our children today and we instill in them flawed social, physical, and emotional traits, what kind of future have we created for our children and our grandchildren?

This article written by Bryan K. Bajakian, D.C., was originally a letter written to a school teacher that Dr. Baajakian met at the store. The letter writing was prompted by their conversation about children, ADD and the current modes of treatment.

Dr. Bryan is a Life University graduate, an excellent chiropractic educator, a current I.C.P.A member and a successful family practitioner in NJ.

He can be visited at: www.chiropractic4all.com

References available on-line at: www.icpa4kids.com