September 20, 2000: Column on Ritalin


Hillary Rodham Clinton

September 20, 2000

Last February, the Journal of the American Medical Association reported startling increases in the use of prescription drugs by preschoolers. The use of Ritalin alone, the most commonly prescribed treatment for attention-deficit/hyperactivity disorder, increased 150 percent between 1991 and 1995.

Like many others, I am taken aback by the dramatic increases in the prescription of these drugs for such a young population. On the other hand, though, I know that Ritalin has been a godsend to millions of children, allowing them to conquer their impulsive, hyperactive and inattentive behaviors, and giving them the chance to reach their full developmental potential.

Unfortunately, Ritalin, like many other psychotropic drugs, has never been tested on children younger than 6. And because diagnosis of ADHD is not easy -- there are no diagnostic tests -- concerns linger about both over- and under-diagnosis.

When the JAMA reported the newest figures, I was so concerned that I asked our most senior health policy officials -- including Secretary of Health and Human Services Donna Shalala, Surgeon General David Satcher, Food and Drug Administration Commissioner Jane Henney, Assistant Secretary of Education Judith Heumann and National Institute of Mental Health Director Steve Hyman -- to meet with me at the White House to talk about what could be done to ensure the best course of treatment for children with mental disorders. At the end of our meeting, just weeks after the release of the report, we launched an unprecedented public-private effort to improve the diagnosis and treatment of emotional and behavioral conditions in children.

Since that day, our efforts to ensure that all our children get the care they need have led to progress on several fronts: The American Academy of Pediatrics has issued new guidelines for diagnosing ADHD. The National Institute of Mental Health has begun funding a $5 million multi-site trial on the use of Ritalin to treat ADHD in preschoolers. And because information about the proper diagnosis and treatment of these cases has not reached many of the people who need it most -- including families, teachers and pediatricians -- the NIMH has released a new and easy-to-understand fact sheet designed to help parents make the right decisions when it comes to treating their children.

The FDA has begun to look at some common psychotropic drugs to determine what dosage levels are appropriate for the very young. They are also considering the ethical issues posed when tests are done on such a vulnerable group. And the FDA, together with the NIMH, is planning a meeting next month to discuss pediatric psychopharmacology.

This week, the Surgeon General, in cooperation with 12 other federal agencies, convened a major national conference of experts to discuss the issues that arise when children suffer from mental health problems. Participants are being called on to examine the barriers and challenges to identifying, referring, and treating children with mental health needs, and the obstacles to delivering appropriate care to patients and their families. After listening to their recommendations, the Surgeon General will develop a National Action Agenda to improve the way mental health disorders are diagnosed and treated in young children.

Despite the progress we've made since last March, we know that there are still many unanswered questions that demand our attention. Are the children who are diagnosed with emotional and behavioral conditions provided appropriate care in today's health care system? More specifically, are they receiving the full range of services they require? Are these services being managed appropriately? And finally, does insurance cover the options necessary to provide the best care?

We must also look at the extraordinary increase in marketing expenditures for a whole range of medications, including Ritalin. We need to determine whether such marketing has encouraged excessive and inappropriate use of pharmaceutical products, or if it has been constructive in making the public more aware of available treatment options.

This much is clear: Coordination between the various providers in a child's life must improve. Health providers and educators must be better trained to assess behavioral and mental problems. Families must be involved in all aspects of treatment. And there must be more research on the 0-5 year old population, so that parents can be well-informed about the treatment choices they are called upon to make for their own children.

This week's conference, together with the actions we have already taken, marks a very important step forward. But in no way can this be the last step. We must continue to demand answers to our questions. Nothing less than the health and hope of our nation's children -- as well as the peace of mind of their parents -- is at stake.

To find out more about Hillary Rodham Clinton and read her past columns, visit the Creators Syndicate web page at


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