Abstract
Remembering Ritalin is an interesting and thoughtful discourse on the many controversies that continue to swirl around the medical diagnosis and treatment of ADHD. Dr. Diller has written extensively on this topic in the past, and the current book is a follow-up to his book, Running on Ritalin, in which he illustrates some of the clinical and sociocultural challenges through select case presentations from his private practice as a developmental pediatrician. In Remembering Ritalin, the author provides the reader with a 15-year follow-up of many of these patients—again using clinical material to highlight some of the persistent clinical challenges and sociocultural issues and controversies. Dr. Diller is candid not only in sharing his clinical perspectives on his patients but also in confessing his own ambivalence about diagnosing and treating these conditions as often as he does. On one hand, he shares his grave concerns about the state of our society that leads to so many youth and young adults being diagnosed with ADHD and then treated with medication to “fit in.” On the other hand, he confesses his willingness—on an individual patient level—to prescribe psychotropic medications for some of these because these medications can effectively function as a “lubricant” to enable these youth to better fit in.
Remembering Ritalin is written for a lay audience, and Dr. Diller indeed has a relatively engaging writing style that is enjoyable to read. I suspect this book will appeal not only to readers of Running on Ritalin but also to the many families and other individuals who care about ADHD from either a personal or societal perspective. Those who dismiss ADHD as a legitimate condition will no doubt be disappointed that Dr. Diller does not go further in his critique of the ADHD epidemic as a pop phenomenon.
Although clinicians and academicians who work in this field (i.e., readers of this journal) are not the target audience for this book, many would likewise find the book worthwhile and benefit from Dr. Diller’s clinical observations, his academic insights, and his sociocultural perspectives—even if they are not inclined to agree with all of his premises and biases.
Although I enjoyed reading Remembering Ritalin, I was disappointed to encounter several areas where the narrative is misleading or inaccurate. In most cases, the errors are relatively minor and do not compromise the broader message. However, there are other sections where the lack of precision substantially undermines the accuracy of the text, and it is these passages where lay readers will come away with distorted perceptions of ADHD. For example, the author states early in his book that, unless indicated otherwise, “ADHD” is shorthand for all subtypes identified in the Diagnostic and Statistical Manual of Mental Disorders and that he will distinguish between ADHD and attention deficit disorder when important; unfortunately, he often fails to make critical distinctions between subtypes when discussing outcome or comorbidity. Although many specialists in this field will know that the Multi-modal Treatment of ADHD (MTA) study and the Milwaukee study focused on hyperactive children, lay readers—the primary audience for the book—will not; thus, many readers will believe that the poor outcome for ADHD–Combined type extends to those with the Inattentive subtype as well. This lack of precision is regrettable, although easily remedied in a second edition.
With respect to the Milwaukee cohort, Dr. Diller contrasts the outcomes of his patients from those in Dr. Barkley’s follow-up study—repeatedly attributing the differences to socioeconomic status (SES). Although SES was indeed one major factor, I was disappointed that the author failed to acknowledge some of the other changes that have occurred in the 20+ year interim—such as improvements in medication delivery and legislative mandates for special education services and educational accommodations.
Most of the other misstatements of fact are more limited in scope. For example, the author mischaracterizes the American Academy of Pediatrics’ (AAP) treatment guidelines for ADHD as “promote Ritalin as a first and only treatment for ADHD.” The AAP also recommends behavior therapy as a “first and only” treatment. The last paragraph of the last chapter disappoints when the author summarizes the effects of stimulant medications on height. Diller writes, “Finally, in 2010, definitive comparative studies . . . concluded there is an ultimate loss of height . . . about an inch or two on average.” Inexplicably, the reference cited by the author is from 2005. More substantively, results from the definitive study—the growth data from the MTA study—have not yet been published.
It is unfortunate that more attention was not paid to the final edits of the book, and I wish I could look past the passages that are lacking with respect to precision and/or accuracy. Nonetheless, the book’s shortcomings notwithstanding, I believe that Dr. Diller has an important perspective to share and that parents and professionals concerned with the mental health of children would ultimately benefit from reading Remembering Ritalin. I would love to see this book get a broad readership once the relatively focused shortcomings in the manuscript are addressed. Dr. Diller’s perspective is too important not to be more widely appreciated. 1