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In this illuminating investigation of the epidemic of attention deficit disorder (ADD) and its most widely prescribed treatment, the powerful psychostimulant Ritalin, psychologist Richard DeGrandpre sounds a warning: we may well be failing our children by treating symptoms and not causes with a quick-fix and ultimately unsatisfactory solution.
Drawing on the latest findings from developmental, psychobiological, and social scientific research, DeGrandpre "criticizes America's obsession with performance and quick satisfaction and the country's reliance on Ritalin [as] a performance-enhancing drug" (Natural Health). He cautions that our society-wide rush to more, and faster, stimulation leaves children especially vulnerable to "sensory addictions." Ritalin Nation exposes the shortsightedness of mere biological explanations of ADD and offers some practical guidelines for cultivating a less-hurried existence and promoting a saner, safer community for our children.
- Sales Rank: #1951899 in Books
- Color: White
- Published on: 2000-05-17
- Released on: 2000-05-17
- Original language: English
- Number of items: 1
- Dimensions: 8.30" h x .70" w x 5.50" l, .56 pounds
- Binding: Paperback
- 288 pages
From Publishers Weekly
As the diagnosis of attention deficit disorder (ADD) has increased among American children, many have begun to challenge the American Psychiatric Association's description and treatment of the problem, namely, that ADD is a disorder of the brain that can be resolved by the psychostimulant Ritalin. Citing prior reports on ADD and the effects of Ritalin, DeGrandpre, visiting professor of psychology at St. Michael's College in Vermont, argues that the effectiveness of Ritalin in treating ADD in no way proves that the disorder has a purely biological foundation. In fact, studies have shown that Ritalin improves the efficiency and attentiveness of children and adults?regardless of whether they have been diagnosed with ADD. Against the "biological" explanation of ADD, however, the author puts forward a cultural-historical critique, which identifies the modern, technological emphasis on speed as the cause of the increased sensory deficits among American children. What Ritalin use reflects, he argues, is "a temporal disturbance in human consciousness," one that "motivates an escape from slowness, thus keeping us forever in the grip of the hurried society. Unfortunately, the author's thesis is unsupported by any original research and is instead based on generalized observations and anecdotes about modern society and the trajectory of Western civilization. Ultimately, while this book may satisfy those who disparage technology, it will be of little help to the clinicians who struggle daily with the problem of hyperactivity in children.
Copyright 1998 Reed Business Information, Inc.
From Library Journal
These three books explore the controversial phenomena of ADHD, which affects two million children in the United States, where about 80 percent of all Ritalin is consumed. Walker, a neurologist/psychiatrist, contends that parents are often intimidated into accepting Ritalin for their children before a complete diagnosis is made and more benign therapies tried. He posits many other causes of hyperactivity, evaluates nondrug therapies, and suggests ways parents can become advocates for their troubled children. Comparing Ritalin to cocaine, Walker classes it with other psychostimulants in terms of addiction and potentially lethal side effects. The broader field of child psychiatry is the domain of Wilens's book. A Harvard psychiatry professor, researcher, and clinician, he presents a valuable "insider's" guide to specific disorders (e.g., ADHD, depression, anxiety, autism). Filled with helpful tables and charts, definitions, commonly asked questions, and sources for further information and support, this book should empower parents to become collaborators in their children's care. Like Walker's compendium of responsible warnings, this user-friendly catalog of current drug information is recommended for public libraries. In contrast, DeGrandpre's (psychology, St. Michael's Coll., VT) scholarly work ventures beyond simple skepticism and quibbling about overdiagnosis to question psychiatry's identification of ADHD as a biologically based brain disease. He argues that societal adjustments and a change in human consciousness are the real antidotes for this development disorder. Viewing hyperactivity in a multidisciplinary context, Ritalin Nation is richly referenced and offers a critical perspective suited to academic and specialized collections. [See also "Paying Attention to Attention Deficit Disorders," LJ 1/99, p. 59-62.]?Antoinette Brinkman, Southwest Indiana Mental Health Ctr. Lib., Evansvill.
-?Antoinette Brinkman, Southwest Indiana Mental Health Ctr. Lib., Evansville
Copyright 1999 Reed Business Information, Inc.
From The New England Journal of Medicine
It has been almost a century since the initial description of what we now call attention-deficit-hyperactivity disorder (ADHD) appeared in the English-language medical literature, and it is remarkable that the disorder continues to provoke strong feelings and controversy. It is particularly striking in view of the substantial advances in our understanding of ADHD, including its underlying neurobiologic features and its treatment. In Ritalin Nation, DeGrandpre argues that ADHD reflects cultural changes rather than any underlying biologic predisposition. The essence of his argument is as follows. We are living in a continually speeded-up society -- in DeGrandpre's words, a "rapid-fire culture," one in which rotary phones have been discarded because they are too slow and in which single-tap faucets are used to speed up the mixing of hot and cold water. This rapid-fire culture has important consequences for children. As compared with children in the past, today's children experience many more stimuli and, as a result, are motivated to engage in more and more stimulus-seeking behavior. In a sense, they become "addicted" to and dependent on continuous sensory stimulation. In DeGrandpre's scheme, the symptoms of ADHD -- hyperactivity and an inability to attend to unstimulating activities such as paying attention in class -- reflect a kind of escape behavior used by the child to maintain sensory stimulation. According to this view, methylphenidate (Ritalin) is effective because it also provides stimulation -- in this case, pharmacologic stimulation.
DeGrandpre's formulation of the cause of ADHD has a certain seductive appeal. Who among us, inundated and often overwhelmed as we are by e-mail messages, faxes, telephone calls, and seemingly endless meetings, would not like to go back somehow to a slower pace -- "stop the world, I want to get off." The feel-good rhetoric in Ritalin Nation has an eerily familiar ring. It is strikingly reminiscent of arguments for the use of what are best described as idiosyncratic therapies for cancer, brain injury in infancy, and an array of other ailments. These arguments generally share a number of characteristics. Antiprofessionalism is common; there is a strong distrust of modern medical practice. The proponents of most of these idiosyncratic therapies dismiss conflicting points of view, claiming that any controlled studies are biased, perhaps reflecting a conspiracy between institutionalized medicine and government or, as DeGrandpre states, "the immense power, resources, and momentum of the pro-ADD [attention-deficit disorder] medical establishment, the huge commercial push by pharmaceutical companies," and "the authority of American psychiatry." Evidence cited to support these idiosyncratic approaches is often in media other than peer-reviewed scientific journals. DeGrandpre supports his claims that Ritalin is dangerous by quoting "newspaper reports across the country" and accounts on the Internet. Another hallmark of idiosyncratic approaches is their reliance on "natural" treatments -- presumably, treatments that are not only natural but also implicitly or explicitly said to have no possibility of side effects.
The treatment offered for ADHD in Ritalin Nation is consistent with such idiosyncratic therapies. DeGrandpre views the characteristic behavioral traits as developing from family conditions that encourage hyperactive and inattentive behavior. His solution to the problem follows naturally from this formulation: slow the pace of the child's life, specifically by having the parents spend less time at work and more time with the child -- that is, by better parenting.
Here is the great disconnection. We would all agree that life is moving rapidly and that it would be nice if we slowed down a bit. But nowhere is there anything but anecdotes to suggest that rapid-fire culture leads to ADHD and that better parenting would prevent the disorder. Blaming parents for the symptoms, as DeGrandpre suggests, has the ominous overtones of the notion of the "schizophrenogenic mother," long since proved to be a terrible error. In a recent review of Ritalin Nation in the New Yorker, Malcolm Gladwell notes, "Only by a strange inversion of moral responsibility do books like Ritalin Nation seek to make those parents and physicians trying to help children with ADHD feel guilty for doing so."
DeGrandpre fails to acknowledge the tremendous progress that has been made in our understanding of ADHD; instead, he presents homilies about the rapidity of modern life and how the culture of the 21st century may influence children's behavior. Many of the advances in our understanding of ADHD have been reviewed in the Journal within the past few months, and other reviews examine electrophysiologic measures of brain activity and brain imaging, including functional imaging studies, in ADHD. As for treatment, readers of the Journal need to know that rigorous double-blind, placebo-controlled studies have demonstrated the effectiveness of pharmacologic treatments in patients with ADHD and have begun to compare pharmacologic and behavioral approaches. These therapies have been tested in carefully designed scientific studies. Children and adults with ADHD face many difficulties. Denying the problem is not the solution.
Reviewed by Bennett A. Shaywitz, M.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
Most helpful customer reviews
8 of 8 people found the following review helpful.
Powerful expose of Ritalin abuse -a wake up call for America
By Chip Wood
There are no easy solutions to the multiple societal problems Richard Grandpre illuminates so clearly in his new book, but we would do well to pay attention to what he has to say. In a brilliantly constructed examination of our "hurried society" and the "culture of neglect" that surrounds the lives of children today, Grandpre carefully explains the effects of speed, technology and rapid cultural change on our brains and behavior. He argues that drug intervention for what is a social and psychological problem is mis-guided, ineffective and dangerous. He exposes the diagnosis of ADHD as a medical or inherited problem as having no basis in fact and backs up his claim with thorough research analysis. This book will be controversial and disturbing to many readers seeking help for their children, but it is a must read nevertheless.
34 of 38 people found the following review helpful.
Consider the Source
By Peter C. Dwyer
I want to address the Editorial Review from the New Yorker which dismisses this book as a non-scientific, nostalgic plea for a "simpler time." That review claims great scientific progress in understanding ADHD through brain imaging, and cites placebo controlled studies showing the efficacy of Ritalin and other stimulants.
I am not a nostalgic person longing for the simplicity of the early '50's. I am a licensed certified clinical social worker, authorized to perform DSM-IV diagnosis and to do psychotherapy. I have an advanced law degree in Law, Psychiatry and Criminology. I have over five years' experience working with disturbed children in various capacities. And over the past two years I have read twenty-five books, pro and con, on ADHD, stimulants, biopsychiatry and psychiatric medication. What I want to say is this:
The New Yorker exaggerates the state of scientific knowledge about the alleged biological and genetic basis of ADHD. Virtually all ADHD brain imaging studies are seriously flawed - the studied ADHD children have been on stimulant medication. IF any abnormalities were found, they would most likely be caused by the medication, not by the disorder.
So far, the few "differences" found between ADHD and "normal" brains are only averages between the ADHD and "normal" groups studied. There is a very large overlap between the two groups; brain imaging cannot, therefore, distinguish a "normal" individual's scan from one with "ADHD."
Moreover, even if a consistent difference were found in ADHD brains, biopsychiatry couldn't tell if it's caused by exposure to psychiatric drugs, by environment, or by heredity. Stimulants are known to produce brain changes in laboratory animals; experience, too, is known to alter brain structure ("brain plasticity'); despite the human genome hype, no replicable causal relationship has been established between genes and mental illness.
The New Yorker reviewer must know of the 1998 National Institute of Health's Consensus Conference on ADHD. Conference participants were largely those who accept biopsychiatry and its view of ADHD. Nonetheless, the conference summary concluded that there was no known biological cause of ADHD, adding that the same was also true of most serious psychiatric disorders.
Think about that. Biopsychiatry justifies medicating millions of ADHD children on the grounds that ADHD is a physically-based conditon. Yet they have to admit they don't really know of any brain defect causing ADHD. Then they seek to minimize what should be an immensely embarrassing admission by saying, "But don't worry - we don't know the physical basis of schizophrenia and the other serious mental illnesses either."
That is why this review is entitled "Consider the Source." Biopsychiatry's claims are misleading. For decades they have represented scientific "progress" in studying the brain as having reached the stage of actual knowledge clearly supporting their biological treatments. This is demonstrably not so.
My second point: the "science" behind placebo controlled studies showing Ritalin's efficacy, simply ain't necessarily so. The NIH Consensus Conference summary acknowledges: "There are no data establishing the long term safety and efficacy" of Ritalin and other stimulants for ADHD. This is a huge admission, considering how long Ritalin has been around. The Summary also acknowledges that Ritalin produces little or no improvement in social adjustment or in educational achievement (it makes some kids more passive in class, but actually impairs higher level cognitive functions. Long term achievement tests fail to show improvement on Ritalin).
Finally, regarding the quality of placebo controlled studies in this area, check out Breggin.com, in which Peter Breggin, M.D. presents A Critical Analysis of the NIMH Multimodal Treatment Study for Attention Deficit/Hyperactivity Disorder (The MTA Study). Despite biopsychiatry's attempts to marginalize Dr. Breggin, he remains a prodigious and courageous intellect in this field, who has been qualified as an expert witness in numerous malpractice and product liability cases involving psychiatric drugs accross the country. In fact, he was the sole invited presenter on stimulant medications' adverse effects at the NIH Consensus Conference on ADHD.
Dr. Breggin convincingly establishes that the MTA study, one of the largest and most widely cited on Ritalin's efficacy, has numerous fatal flaws, and in fact could as well be interpreted as proving Ritalin's LACK of efficacy.
For these reasons, I apply an acid test to writings about mental health: if, like the New Yorker reviewer, an author uncriticaly cites the scientific "advances" behind current biopsychiatric treatments, or if such an author claims placebo controlled studies establish the effectiveness of psychiatric drugs, I know there's something wrong. The brain science and genetics to support their claims just aren't there; the placebo controlled studies are notoriously manipulable and are routinely used to show things that just can't be supported.
Richard DeGrandpre may not have everything right. Biopsychiatry may be right about some things. But you can't show it by the kind of argumentation presented by the New Yorker reviewer. Unfortunately, that and worse (TV ads are horribly misleading in the same way)are what the public usually gets. The N. Y. Times, the Washington Post, Time, Newsweek, etc., routinely just parrot writers like the New Yorker reviewer.
7 of 7 people found the following review helpful.
a courageous expose of "hyperculture" and its victims
By JDanco@worldnet.att.net
Dr. DeGrandpre makes a most compelling case for the cultural determinants behind attention deficit disorder, bravely taking on the entrenched orthodoxy of biological psychiatry, the pharmaceutical industry, the parents-as-victims movement, and the media which would defend them all. He defends the victims of our speed-up culture, the children, and brilliantly shows the moral and psychological weaknesses of the drug "cure" Ritalin offers. As a psychologist with considerable experience in this field, I found the book an easy read, but readers without such a background or at least a strong interest in the topic might get a little bogged down in his footnoted recap of the research. Parents should invest the effort, however, especially before succumbing to the temptation to drug their children.
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