Fall 1998
Articles
Reviews
1998 Award Recipients
1997 Award Recipients
Special Presentation
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Book Review: Running on Ritalin
by William Lord Coleman, M.D.
FAAP, Chapel Hill, NC
Running on Ritalin: A Physician Reflects on Children, Society, and Performance
in a Pill. Lawrence Diller, MD. Bantam Press, 1998, 25.95 (hardback).
"Something is awry, all right, but something not entirely medical in
nature." This quotation from The Mind’s Fate by Robert Coles, MD (incidentally
the recipient of our Section’s 1998 Dale Richmond Award) is the opener in Dr.
Diller’s book and sets a thoughtful tone.
Dr. Diller, a full time behavioral-developmental pediatrician and family therapist,
writes about ADD-Ritalin as a clinical phenomenon and dilemma and as a metaphor of our
perception and treatment of children, which are driven by societal pressures for high
performance, quick fixes, sound bite explanations, and the business of managed-care. The
pressures are on children, parents, and all health care providers. This book is well
researched (about 30-40 references per chapter), loaded with practical and interesting
information (clinical and historical), and easy to read.
Dr. Diller presents a balanced and solid argument as he asks us all to reconsider the
present obsession with ADD and medication and the narrow biomedical perspective. It covers
several domains:
ADD and its evolution (and recent explosive growth) as the leading behavioral
diagnosis in children, and his model of a comprehensive evaluation and appropriate
treatment of children and families, often using illustrative case studies from his 20
years of practice. The office-based doctor practices in Walnut Creek, CA, a high-powered,
upper-middle bedroom-commuting suburb of the San Francisco Bay Area. He incorporates
constructive and scientifically based criticisms of the present dominant biomedical model
and offers alternative-additional approaches. He includes often under-utilized strategies
of working with schools and using federal laws like Section 504 of the Vocational
Rehabilitation Act and the Individuals with Disabilities Education Act (IDEA). Some
chapter titles are The Myths and Realities of Ritalin; The Power of the Biological
Paradigm; Evaluating for ADD; Non-Drug Treatments for ADD; Making the Most of a Drug
Intervention for ADD; Teenagers, Adults, and ADD.
The confusion and stress that children, parents, teachers, psychologists, and
physicians experience. Parents looking for a pill for a "chemical imbalance" in
the midst of a complex psychosocial situation. A pediatrician colleague recently told me,
"I feel guilty when I prescribe Ritalin," but doing so during a 15-20 minute
first visit. One of my most difficult clinical situations is telling a family that the
child does not have ADD and I can’t prescribe stimulant medication, sort of like a
primary care provider stating he/she can‘t prescribe antibiotics for viral URI.
Relevant chapter titles are Doctor’s Dilemma; In the Eye of the Beholder; and ADD in
an Age of Victims’ Rights and Managed Care.
His own personal musings, wisdom, intuitions, insights, hopes and concerns about
broader social, ethical, and child-rearing issues, which I find close to mine. Some
chapter titles are: Welcome to Ritalin Nation: An ADD Culture Arises; The Politically
Correct Parenting Trap: How Coping with Difficult Kids Gets Harder; and Performance in a
Pill: What Ritalin Says About Us.
Running on Ritalin is an important and informative book for all primary care
providers, specialists, and parents. It is very timely as the pendulum begins to swing the
other way, towards a more ecological-contextual and biopsychosocial approach to the
diagnosis and treatment of ADD; and towards a broader conceptualization and better
understanding and treatment of children who don’t meet expectations or who march to a
different drummer.
Running on Ritalin should be on the shelf of everyone who cares for children,
adolescents, and adults with ADD and/or provides guidance for those who think they have
ADD. Suggest it to parents, but be sure to get it back if they borrow your copy. This book
is a winner and a keeper.
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