Tuesday, April 14, 2009

Book Review: Running on Ritalin, by Lawrence H. Diller, M. D.

Running on Ritalin is not just a book about ADHD or medications for children. Instead, it takes  a broader look at the issues involved in diagnosing, treating, and prescribing for our children. Although the book focuses on Ritalin and ADHD, much of the material is also applicable to other situations, such as those children with other diagnoses, such as autism, and those taking different medications.  Since Running on Ritalin (Bantam Books, New York) was published in 1998, it may be a bit dated as far as medicines and statistics, but the advice for parents and the general themes more than make up for this.
Dr. Diller is unusual in that he was not only trained as a Pediatrician, but also as a Family Therapist at the Mental Research Institute in Palo Alto, CA. Because of this unusual background, Dr. Diller is able to discuss treating his clients with both family therapy and medication. In his book, he takes a moderate, middle of the road stance, defining ADHD as stemming from both brain chemistry and environmental factors, such as school and parenting demands. The author looks into many of the factors involved, such as the impact of modern society and educational expectations, the strain on school resources from having so many children needing special services, the demands on parents, and the ethics of medicating children.
That moderate, balanced view, backed up by published research, is really the strength of this book. As far as treatment, Diller recommends a multimodal treatment, which may include medication, individual and family counseling, and special educations services, as appropriate. He backs this recommendation up with both published studies, (Unfortunately there are not a lot of those out there.) and anecdotes from his own patient experiences. As a therapist myself, I know that my clients may need a variety of different approaches in order to function at their best level. As a scientist, I always appreciate when authors back up their statements with data and published studies.
Dr. Diller is also balanced in his viewpoint of the diagnosis. “... I feel a bond with those who want society to appreciate and adapt to the range of diversity in children’s personalities. On the other hand, I recognize that the ADD child must learn to cope with socially approved expectations and responses, and that this may sometimes require the use of medication. It seems to me critical to raise questions about a society where several million children are taking Ritalin. In everyday terms, however, children and families must adapt to social norms, while we work on broader levels to make room for all kinds of people with all kinds of strengths and weaknesses.” (p. 217)
There’s also an interesting chapter on special accommodations for those with disabilities, both in school and the workplace. This has always been a tough issue, and it only grows more so as our school budgets get stretched tighter in this economy.
In general, this book probably raises as many questions as it gives answers, but they’re important questions, questions we all need to be asking.