The use of ritalin
Parents throughout the country are being pressured and compelled by schools to give psychiatric drugs to their children. Teachers, school psychologists, and administrators commonly make dire threats about their inability to teach children without medicating them. They sometimes suggest that only medication can stave off a bleak future of delinquency and occupational failure. They even call child protective services to investigate parents for child neglect and they sometimes testify against parents in court. Often the schools recommend particular physicians who favor the use of stimulant drugs o control behavior.
These stimulant drugs include methylphenidate (Ritalin, Concerta, and Metadate) or forms of amphetamine (Dexedrine and Adderall). My purpose today is to provide to this class the scientific basis for rejecting the use of stimulants for the treatment of attention deficit hyperactivity disorder or for the control of behavior in the classroom or home. I. Escalating Rates of Stimulant Prescription Stimulant drugs, including methylphenidate and amphetamine, were first approved for the control of behavior in children during the mid-1950s.
Since then, there have been eriodic attempts to promote their usage, and periodic public reactions against the practice. In fact, the first Congressional hearings critical of stimulant medication were held in the early 1970s when an estimated 100,000-200,000 children were receiving these drugs. Since the early 1990s, North America has turned to psychoactive drugs in unprecedented numbers for the control of children. In November 1999, the U. S. Drug Enforcement Administration (DEA) warned about a record six-fold increase in Ritalin production between 1990 and 1995.
In 1995, the International Narcotics Control Board INCB), a agency of the World Health Organization, deplored that 10 to 12 percent of all boys between the ages 6 and 14 in the United States have been diagnosed as having ADD and are being treated with methylphenidate [Ritalin]. In March 1997, the board declared, “The therapeutic use of methylphenidate is now under scrutiny by the American medical community; the INCB welcomes this. ” The United States uses approximately 90% of the world’s Ritalin.
The number of children on these drugs has continued to escalate. A recent study in Virginia indicated that up to 20% of white boys in the fifth grade were receiving timulant drugs during the day from school officials. Another study from North Carolina showed that 10% of children were receiving stimulant drugs at home or in school. The rates for boys were not disclosed but probably exceeded 15%. With 53 million children enrolled in school, probably more than 5 million are taking stimulant drugs.
A recent report in the Journal of the American Medical Association by Zito and her colleagues has demonstrated a three-fold increase in the prescription of stimulants to 2-4 year old toddlers. II. The Dangers of Stimulant Medication Until recently, no studies have systematically examined the rate of psychotic symptoms caused by routine treatment with stimulant drugs such as methylphenidate (Ritalin) and amphetamine (Dexedrine, Adderall). Doctors who prescribe stimulant drugs often seem forgetful to the fact that they can cause psychoses, including manic-like and schizophrenic-like disorders.
Without providing a scientific basis, the literature often cities rates of 1% or less for stimulant-induced psychoses. The rate of psychotic symptoms that appear during stimulant treatment has recently een investigated in a 5-year retrospectives study of children diagnosed with Attention Deficit Hyperactivity Disorder (ADH). Among 192 children diagnosed with ADHD at the Canadian clinic, 98 had been placed on stimulant drugs, mostly methylphenidate. Psychotic symptoms developed in more than 9% of the children treated with methylphenidate.
The psychotic symptoms caused by methylphenidate included hallucinations and paranoia. When children developed depression, delusions, hallucinations, paranoid fears and other drug-induced reactions while taking stimulants, their physicians mistakenly oncluded that the children suffered from clinical depression, schizophrenia or bipolar disorder that has been unmasked by the medications. Instead of removing the child from the stimulants, these doctors mistakenly prescribed additional drugs, such as antidepressants, mood stabilizers, and neroleptics.
Children who were put on stimulants for inattention or hyperactivity ended up taking multiple adult psychiatric drugs that caused severe adverse effects, including psychoses and tardive dyskinesia. It is time to recognize that the supposedly increasing rates of schizophrenia, epression, and bipolar disorder in children in North America are often the direct result of treatment with psychiatric drugs. They should be classified as adverse reactions, not as primary psychiatric disorders.
Doctors need to become more expert as identifying these adverse reactions in children and more aware of how and why to taper children from psychiatric medications. When parents are willing to take a fresh approach to disciplining and caring for their children, or when the childrens school situation can be improved, it is usually possible to taper them off of all psychiatric medications. The parents are then relieved and gratified to see their children increasingly improve with the removal of each drug. Whats the answer to this widespread, unwarranted use of medication in the treatment of children?
As long as we responds to the signals of conflict and distress in our children by subduing them with drugs, we will not address their genuine needs. As parents, teachers, therapists, and physicians we need to retake responsibility for our children. We must reclaim them from the drug companies and their advocates in the medical profession. At the same time, we must address the needs of our children on an individual and societal level. On the individual level, children need more of our time and energy. Nothing can replace the personal relationships that children have with us as parents, teachers, counselors, or doctors.
On a societal level, our children need improved family life, better schools, and more caring communities. III. The Educational Effect of Diagnosing Children with ADHD It is important for the Education Committee to understand that the ADD/ADHD diagnosis was developed specifically for the purpose of justifying the use of drugs to ubdue the behaviors of children in the classroom. The content of the diagnosis in the 1994 Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association shows that it is specifically aimed at suppressing unwanted behaviors in the classroom.
The diagnosis is divided into three types: hyperactivity, impulsivity, and inattention. Under hyperactivity, the first two (and most powerful) criteria are “often fidgets with hands or feet or squirms in seat” and “often leaves seat in classroom or in other situations in which remaining seated is expected. Clearly, these two “symptoms” are nothing more nor less than the behaviors most likely to cause disruptions in a large, structured classroom.
Under impulsivity, the first criteria is “often blurts out answers before questions have been completed” and under inattention, the first criteria is “often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities. ” Once again, the diagnosis itself, formulated over several decades, leaves no question concerning its purpose: to redefine disruptive classroom behavior into a disease. The ltimate aim is to justify the use of medication to suppress or control the behaviors. Advocates of ADHD and stimulant drugs have claimed that ADHD is associated with changes in the brain.
In fact, both the NIH Consensus Development Conference (1998) and the American Academy of Pediatrics (2000) report on ADHD have confirmed that there is no known biological basis for ADHD. Any brain abnormalities in these children are almost certainly caused by prior exposure to psychiatric medication. IV. How the medications work Hundreds of animal studies and human clinical trials leave no doubt about how the edication works. First, the drugs suppress all spontaneous behavior. In healthy chimpanzees and other animals, this can be measured with precision as a reduction in all spontaneous or self- generated activities.
In animals and in humans, this is manifested in a reduction in the following behaviors: (1) exploration and curiosity; (2) socializing, and (3) playing. Second, the drugs increase obsessive-compulsive behaviors, including very limited, overly focused activities. V. What is Really Happening? Children become diagnosed with ADHD when they are in conflict with the xpectations or demands of parents and/or teachers. The ADHD diagnosis is simply a list of the behaviors that most commonly cause conflict or disturbance in classrooms, especially those that require a high degree of conformity.
By diagnosing the child with ADHD, blame for the conflict is placed on the child. Instead of examining the context of the child’s lifewhy the child is restless or disobedient in the classroom or homethe problem is attributed to the child’s faulty brain. Both the classroom and the family are exempt from criticism or from the need to mprove, and instead the child is made the source of the problem. The medicating of the child then becomes a compelling response to conflict in which the weakest member of the conflict, the child, is drugged into a more compliant or submissive state.
The production of drug-induced obsessive-compulsive disorder in the child especially fits the needs for compliance in regard to otherwise boring or distressing schoolwork. VI. Legal Action Class action suits for fraud and conspiracy in over-promoting the stimulant medication Ritalin (methylphendiate) have been filed in three states. Three national organizations re named as defendants: (1) Novartis (formerly Ciba Geigy), the manufacturer of Ritalin, (2) CHADD (Children and Adults with Attention Deficit/Hyperactivity Disorder), a parents organization that is partially funded by drug companies, and (3) the American Psychiatric Association.
The suit charges that Novartis, CHADD, and the American Psychiatric Association committed fraud in conspiring to over-promote the diagnosis Attention Deficit Hyperactivity Disorder (ADHD) and its treatment with the stimulant drug, Ritalin. The law suits charge that the drug company deliberately, intentionally, and egligently promoted the diagnosis of ADD/ADHD and sales of Ritalin through its promotional literature and through its training of sales representatives.
In so doing, despite knowledge of such problems and/or adverse reactions, defendants willfully failed to address or provide adequate information to consumers, doctors, and/or schools concerning many significant hazards of methylphenidate The suit also charges the Ritalin manufacturer with Activity supporting groups such as Defendant CHADD, both financially and with other means, so that such organizations ould promote and support (as a supposed neutral party) the ever-increasing implementation of the ADD/ADHD diagnosis as well as directly increasing Ritalin sales.
Although the suit was motivated by concern about the over-medicating of Americas children, the class action is nit restricted to children. Adults who have purchased Ritalin for children or for themselves in the last four years are potentially eligible to participate in the suit. The suit seeks compensation for those who paid for Ritalin, regardless of whether or not the medication caused any harm or damage. VII. Conclusions and Observations Many observers have concluded that our schools and our families are failing to meet the needs of our children in a variety of ways.
Focusing on schools, many teachers feel stressed by classroom conditions and ill-prepared to deal with emotional problems in the children. The classroom themselves are often too large, there are too few teaching assistants and volunteers to help out, and the instructional materials are often outdated and boring in comparison to the modern technologies that appeal to children. By diagnosing and drugging our children, we shift blame for the problem from our ocial institutions and ourselves as adults to the relatively powerless children in our care.
We harm our children by failing to identify and to meet their real educational needs for better prepared teachers, more teacher- and child-friendly classrooms, more inspiring curriculum, and more engaging classroom technologies. At the same time, when we diagnosis and drug our children, we avoid facing critical issues about educational reform. In effect, we drug the children who are signaling the need for reform, and force all children into conformity with our bureaucratic systems. Finally, when we diagnose and drug our children, we disempower ourselves as adults.
While we may gain momentary relief from guilt by imagining that the fault lies in the brains of our children, ultimately we undermine our ability to make the necessary adult interventions that our children need. We literally become bystanders in the lives of our children. It is time to reclaim our children from this false and suppressive medical approach. I applaud those parents who have the courage to refuse to give stimulants to their children and who, instead, attempt to identify and to meet their genuine needs in the school, home, and community.