Originally created 05/14/00

Gender affects prescription of Ritalin



When 10-year-old Owen Zylla wakes up, he has the energy of 10 people.

The energy lasts all day, and at night he sleeps like a rock, says his mother, Ruth Garrison.

Though he has mild cerebral palsy, a brain disease that manifests into muscular incoordination and speech disturbances, Owen's energy was characterized as strong hyperactivity - a symptom of attention-deficit hyperactivity disorder, or ADHD.

After consulting with a pediatrician and a psychiatrist, Mrs. Garrison and her husband put Owen on Ritalin.

The drug is said to increase a child's alertness or calm them down by stimulating certain aspects of brain activity.

"The Ritalin seemed to make him more tense," Mrs. Garrison said. "His compulsive behavior (if he touched one elbow, he would have to touch the other) and kinetic movements were magnified."

The Ritalin didn't work for the Columbia County fourth-grader, but throughout the school systems in Richmond, Columbia and Aiken counties boys are overwhelmingly placed on the drugs more than girls at a ratio of 3-to-1, a statistic that mirrors national levels. Throughout the country, boys are placed on psychiatric medicines at about the same rate, doctors say.

Experts say boys' rough-and-tumble behavior is sometimes misjudged as hyperactivity. Girls, when diagnosed, are more often labeled attention deficit, they say.

"That doesn't mean the disorder is more common in boys," said Dr. Morris Cohen, professor of neurology, pediatrics and psychiatry at Medical College of Georgia. "It may simply be indicating that because boys tend to be more active than girls, they get identified more easily as having behaviors that are problematic."

Dr. Heidi Feldman - an associate professor of pediatrics at University of Pittsburgh who helped write the new guidelines recommended May 1 for doctors prescribing behavior drugs to children - said her group, the American Academy of Pediatrics, also has noticed the trend of boys being prescribed the drugs more often than girls.

"I don't think anyone is quite sure whether there is some sort of genetic explanation or hormonal explanation or exactly what it is," Dr. Feldman said. "All of the neuro-behavior disorders seem to have a male predominance."

In Richmond County, with 51 out of 58 schools responding to a survey by The Augusta Chronicle, 1,148 pupils are on behavioral drugs. Boys, who make up about 50 percent of the district's 35,542 pupils, constitute 76 percent of those taking the drugs.

In Columbia County, 756 pupils take the drugs, according to figures from 23 of the district's 24 schools. Boys make up 75 percent of those on the drugs. There are 18,617 pupils in the district, with boys being half of the enrollment.

In Aiken County, with all schools responding, 851 pupils take the medications. In that county, boys make up 77 percent of those taking the drugs and about 50 percent of the district's 24,298 pupils.

Additionally, a recent report published in the Journal of the American Medical Association found a 50 percent increase, between 1991 and 1995, in children age 2 to 4 who were prescribed behavior-changing drugs such as Ritalin and Prozac.

In area counties, first- through fifth-graders are placed on the drugs more than others.

THE MEDICAL ASSOCIATION'S study questions whether children are being prescribed drugs for behavior when, in the past, they would have been characterized as "kids being kids."

Kay Blanchard, director of testing and psychological services in Columbia County, said she's not surprised to learn that boys in the area are prescribed the drugs more than girls.

"It goes back to what I believe are unconscious role expectations that we all have, based on gender," she said. "Not only in school but from the time they are born. I think girls are sometimes raised to be people-pleasers, and that may give them a little advantage in the classroom in some ways."

Dr. Asma Q. Fischer, a pediatric neurologist for University Hospital, said adults have to take precautions with all aspects of a child's behavior, making sure nothing else exists before placing them on medications.

DR. FISCHER SAID a teacher who is sensitive to a child's needs can pick out one who has problems. But not every child who is diagnosed with ADHD has the disorder, she pointed out.

"They may have something like absence seizures, which for a few seconds the brain fires off and the child is not responsive to anything - it may be less than a second," Dr. Fischer said. "Then if the child can't piece together what's happening in the classroom, he looks hyperactive and fidgety because he doesn't know what happened during the seizure.

"So it's really important when a child seems to be hyperactive or attention deficit, that the basic medical reasons be ruled out. It could be something as simple as being hyperactive from a caffeine overload, if the child has been drinking Coke all day long. There may be other reasons: parents may be getting divorces, someone may have died, someone may be getting abused, and the way that children express anxiety is by becoming hyperactive."

Dr. Fischer has prescribed Ritalin to children who she says had the disorder. More often, she said the problems lie somewhere else.

"I cannot stress enough that if the teachers do observe hyperactivity, that a physician should see them and screen them for basic medical problems before they are placed on any drug," she said. "A psychological test is not enough."

She's right, according to the American Academy of Pediatricians. The group's new recommended guidelines say children age 6 to 12 must exhibit symptoms in at least two settings, such as home and school, and the symptoms must hurt the child's academic or social functioning for at least six months before being placed on the drugs.

WHEN MISDIAGNOSED, Dr. Fischer said, the drugs aren't toxic but would not be effective.

"The main drawback of being misdiagnosed is whatever is underneath as the real reason for the hyperactivity remains hidden, and precious time is wasted," she said.

In Owen's case, Mrs. Garrison said, the only thing she regrets about placing her 10-year-old son on Ritalin is time wasted getting to the real problem - seizures. He was placed on Tegretol, a seizure medication.

"Ritalin wasn't the right medication in his case," Mrs. Garrison said. "But it has worked for other parents. I think parents put their children on the medications out of frustration, because after trying everything else, they don't know what else to do."

Mrs. Garrison recommends parents do what she did: Get several opinions from different types of doctors - pediatrician, neurologist and psychologist.

"Then be open to what they say," she said, "not only about the medication but behavior or cognitive therapy as well."

Reach Faith Johnson at (706) 823-3765 or faithj@augustachronicle.com.