I can't agree. It is true that the courts have ordered medical intervention when a child's life is threatened. Judges have overruled the wishes of Christian Scientist parents not to give antibiotics to children who face life-threatening infection. Similarly, blood products have been given to children in surgery over the objections of Jehovah's Witnesses. But those situations are quite different from ones in which ADHD is diagnosed and Ritalin is prescribed, according to Dolores Sargent, a former special education teacher now practicing family law in Danville, Calif.

"ADHD children and families do not face immediate life-threatening situations," she says, "and ADHD continues to be a 'disease' with multiple causes and no definitive markers. It's unlikely any decision that insists on the use of Ritalin for ADHD could withstand a court challenge."

The existence of effective alternative treatments makes any forced decision to medicate children against parents' wishes both legally and ethically shaky. Yet, the willingness of some CPS workers to pursue families unwilling to dose their children shows how strongly entrenched medication for behavior problems in children has become in our country.

A local CPS office cannot demand that a child be medicated -- yet -- but it can ascertain whether a child is safe in his or her parents' home. Legally, CPS can alert parents that their child's uncontrollable behavior, which puts the child at significant risk of abuse at home, must change. If they feel this advice is not being taken, the agency can remove children from their homes.

What seems to be overlooked in this simplistic, and seemingly convenient, way of dealing with hard-to-handle kids is that alternative strategies to medication exist, from family counseling to short-term respite care. The perceived superiority, rapid onset and inexpensive nature of Ritalin make it a very attractive choice for school administrators, who may pressure parents of students who threaten to drain their beleaguered schools of time or money As more and more families opt for the Ritalin fix, it becomes easier to insist that other families in similar situations try the drug, even though these families may not want their kids to take stimulants.

I still prescribe Ritalin, but only after assessing a child's school learning environment and family dynamics, especially the parents' style of discipline. But I continue to ask questions about Ritalin in a country where we use 80 percent of the world's stimulants. I have no doubt that Ritalin "works" to improve short-term behavior and school performance in children with ADHD; however, it is not an equivalent to or substitute for better parenting and schools for our children.

I was surprised to see Surgeon General David Satcher quoted recently as saying that he believes Ritalin is underprescribed in our country. I participated in last week's Conference on Children's Mental Health sponsored by his office and found that Ritalin is thought to be both underprescribed and overprescribed, depending upon the community being assessed and its specific threshold for ADHD diagnonsis and Ritalin treatment.

Data shows, for example, that African-American families use Ritalin at rates one-half to one-quarter of their white, socioeconomic peers. Asian-American youth are virtually absent in statistics for Ritalin use. I happen to believe that Satcher's comments were intended for these communities and, ironically, will not have any impact on them. Instead, I think, his statement will have perverse impact on white middle- and upper-middle-class families. In some communities, Ritalin use among boys in this group is as high as one in five.

After much agonizing, Sammy's parents decided to put him in a special education class rather than give him Ritalin and, for the moment, things are going well for him. But they plan to move from the Bay Area, largely because of Sammy's school experience.

With 4 million children taking Ritalin in America today, there are undoubtedly millions of other parents struggling with the decision of whether to medicate their children. The McCormacks' story demonstrates the dilemmas and pressures many of these families face. Proponents of drug treatment for children's behavior problems applaud those parents who choose Ritalin to improve their children's learning experience. But civil libertarians -- and doctors like me -- worry about the specter of more families being forced against their will to put their children on psychiatric medication. These families, and their right to make choices for their children, deserve our support and protection.

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