Worries About Overactive Kids

By Anastasia Toufexis

They are Dennis the Menace come to life, half-pint hellions who drive parents and teachers to distraction with their disruptive antics. At home they clamber on kitchen counters, unscrew light bulbs and mess up the simplest tasks, from hanging up their clothes to making the bed. In school they throw erasers, kick desks, shove classmates and are so busy making nuisances of themselves that they fail to absorb their lessons. One bedeviled mother speaks for many when she says, "I would have given the kid away."

Such hyperactivity has emerged within the past decade as the most common -- and controversial -- childhood behavioral disorder. According to the National Institutes of Health, as many as 1 out of 10 U.S. youngsters -- mostly boys -- may suffer from the baffling syndrome. Doctors disagree about what causes hyperactivity, or attention deficit hyperactivity disorder (ADHD), as it is now known. Everything from brain damage to stress, food allergies or radiation from TV sets has been suggested. The NIH says the problem is probably a combination of as yet elusive genetic, environmental, neurological or biochemical factors. Diagnosis is difficult, since there is no laboratory test for the disorder, and the symptoms are vague and confusing. "Hyperactivity is in the eyes of the beholder," notes James Kavanagh, an NIH behavioral scientist.

Treatment for hyperactivity includes psychological counseling, special diets that restrict artificial flavorings and preservatives and, most typically, medication with such amphetamines as Ritalin and Dexedrine. For unexplained reasons, these drugs, which usually act as stimulants, dampen impulsive behavior in hyperactive youngsters and enable them to concentrate longer. Up to 750,000 American children now take drugs to control ADHD; that figure is expected to reach 1 million by the early 1990s.

But within the medical field and among parents concern is growing that too many youngsters are being incorrectly labeled and improperly medicated. Hyperactivity has become a convenient diagnostic wastebasket into which doctors and impatient parents, teachers and school administrators toss too many hard-to-handle children. Says pediatrician Martin Baren of Orange, Calif.: "Kids get diagnosed with this when the problem is something else, like a language or learning disability." Or they may be simply rambunctious. A recent study revealed that of 200 children brought to the University of Chicago's ADHD clinic, 40% did not suffer from hyperactivity.

The alarming fact is that many children whose symptoms have been misdiagnosed are being given Ritalin and other powerful drugs. Since 1987, parents around the country have filed more than a dozen Ritalin-related lawsuits against doctors, teachers and school districts. In one such suit, a Washington woman claimed that the drug led her six-year-old son to attempt suicide. Complaints about depression, listlessness and insomnia in medicated % children are common. Valerie Jesson, of Derry, N.H., says her son Casey, 10, became a zombie while on Ritalin: "It knocked him into next week. His eyes would glaze, and he would just sit staring." Jesson is currently locked in a legal battle with New Hampshire's department of education over whether her son's public school can demand that he take Ritalin to attend regular classes.

Many physicians defend the use of Ritalin, citing studies indicating that the drug is generally safe and is effective in about 80% of cases of hyperactive children. Adverse effects are usually limited to temporary appetite loss and insomnia. "Ritalin is not a panacea," says researcher Howard Abikoff of the Long Island Jewish Medical Center, "but without medication we'd be up against the wall."

Yet some medical experts acknowledge that Ritalin is being overprescribed. In Georgia, Michigan, Utah and Maryland use of the drug is two or three times the national average. Says Andrew Watry, executive director of Georgia's medical board: "It's seen by some as a quick fix for behavior problems." The blame belongs not only to doctors, who sometimes give little more than cursory examinations before reaching for the prescription pad, and teachers, who want their classrooms to be peaceful. It also rests on parents, who often expect their children to be stellar performers. ADHD is most commonly diagnosed in prosperous suburbs, where the pressures to achieve are frequently greatest.

Doctors emphasize that drugs should be a last, not a first, resort. Minor interventions, such as moving a child to the front row in class or allowing him more time to complete tasks, can lead to improvement. Rewards -- extra television or a favorite snack -- can help reinforce good behavior. And psychological therapy can bolster a child's flagging self-esteem and address social problems, like a lack of friends, that contribute to his distress. Only when these remedies fail should parents try medication on their overly active youngsters.

With reporting by Joyce Leviton/Atlanta and Marguerite Michaels/New York