ll of a sudden, it seems, millions of American children are said to be afflicted with mental illnesses.  And they’re being put on strong medications—over periods of years—as treatment.  Isn’t it time we stopped and looked at what the mental health establishment is getting us to do to our children?

Overview

As we navigate our way into the 21st century, there is an ominous trend that, strangely, doesn't seem to concern people as much as it should:  Millions of children are now taking psychotropic drugs. And they're not doing it illegally, but by prescription. In fact, the medical and educational establishments are conducting a skyrocketing campaign to get kids, and their parents, to “just say yes” to brain-altering pharmaceuticals, with the drug of choice being Ritalin.  In 1970, when approximately 150,000 students were on Ritalin, America was alarmed enough to get the Drug Enforcement Agency to classify Ritalin and other amphetamine-type drugs as Class II substances, a category that includes cocaine and one that indicates significant risk of abuse.  Despite this apparent safeguard, the number of children taking psychiatric stimulants today has risen over 40-fold; current estimates are that between 6 and 7 million children are taking them.[i]  The American Academy of Pediatrics estimates that as many as 3.8 million school children, mostly boys, are currently diagnosed with attention deficit hyperactivity disorder, and that at least a million children take Ritalin, a figure that many regard as a gross underestimate.  And it is not just schoolchildren who are being dosed with psychotropics:  Even preschoolers—those aged 2 to 4—experienced a tripling of such prescriptions in a recent five-year period.[ii]

Exactly why is all this juvenile pill-popping a problem?  Well, for one thing, Ritalin is a drug that has a more potent effect on the brain than cocaine.[iii]  And we’re supposed to be a country that eschews the use of such mind-altering substances, certainly for children.  For another, Ritalin’s side effects can range from unwelcome personality changes to cardiovascular problems to death.  Plus there’s the very real issue of whether the “diseases” for which this powerful medicine is prescribed are in fact real diseases at all.

The problem becomes further complicated when you consider that, in addition to the Ritalin explosion, increasing numbers of children are also being prescribed antidepressants, and that these are drugs originally designed and tested for adults.  (A fact not generally publicized is that it’s legal to prescribe drugs “off label,” that is, for conditions or populations that they weren’t originally designed for.)  So in 1996, over 700,000 children and adolescents were taking Prozac and similar antidepressants in the SSRI group, an 80-percent increase from just two years earlier.  It’s not that the SSRI’s have been proven effective in battling childhood and adolescent depression.  They haven’t.[iv]  Nevertheless, today, the number of these prescriptions has surpassed one million.  Psychiatrist Peter Breggin estimates that, each year, 10 percent of the school-age population will take one or more psychiatric drugs.[v]  Some children are prescribed several at once.  And the phenomenon continues to grow despite disturbing evidence of severe drug-induced personality changes, manic reactions, and psychotic behavior.

Medication advocates would argue that those children who are prescribed psychotropic drugs do in fact need them.  Children with affective disturbances or attention deficits can focus better, and thus learn better when medicated, they say.  Opponents protest that the efficacy and safety of these drugs have not been proven, and some, further, believe that many psychiatric “conditions” exist only as labels in the minds of psychologists.  Whether or not these conditions are real, one must agree that the exceedingly high numbers of prescriptions written for children in recent years are a cause for grave concern.  And they’re of concern not just to the children and parents directly touched by individual diagnoses, but to society at large.  Consider the Columbine massacre and the rash of other school shootings that have rocked this country recently.  As the Washington Times Insight Magazine reports, “the common link in the high school shootings may be psychotropic drugs like Ritalin and Prozac.”  For example, in 1998, 14-year-old Kip Kinkle killed his parents and then went on a shooting spree at his Springfield, Oregon, high school, killing two and injuring 22.  He was being treated with Ritalin and Prozac.  Then there was the15-year-old taking Ritalin who in 1999 wounded six classmates in Heritage High School in Georgia, and the 18-year-old who raped and murdered a 7-year-old girl in 1997, one week after starting to take Dexedrine.  One can’t help but ask whether psychotropic drugs are dangerous not just to those taking them, but also, in some cases, to “innocent bystanders.”

And there are some other basic questions people are beginning to ask as well:  Do all these children need to be taking all these drugs?  Are they really sick? 
 

 Is Attention Deficit Disorder a Real Disease?

By far, the overwhelming majority of psychotropic prescriptions for children are given for attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD).  In some instances, taking medicine is a prerequisite for attending school, with refusal to comply considered grounds for dismissal, or worse, removal of the child from the home by the state.  This outrages Dr. Fred Baughman, a board-certified child neurologist trained at New York University and Mount Sinai, and a fellow of the American Academy of Neurology.  Baughman feels that it’s one thing for a court to intervene and take over as legal guardian in a case where a child’s life is truly at risk, but quite another thing when psychotropic drugs are forced on children who don’t fit into the mold.  For instance, Baughman says, for religious reasons parents may refuse a needed blood transfusion for a child, or they may refuse to allow treatment of diabetes—a real disease—with insulin, a real treatment.  The courts may have to intervene in such cases.  But courts should have no place in mandating that behavioral problems in children be treated with drugs.  “There are no physical or chemical abnormalities in these children,” Baughman states.   “The idea that there is is a false belief spouted by psychiatry…. For courts to intervene and to mandate such treatment, as though these were legitimate diseases or legitimate medical emergencies, is leading to tyranny over parents of normal children….When we’re talking about…so-called psychiatric disorders, none of them are actual diseases due to physical abnormalities within the child,” states Baughman.[vi]

 A Diagnostic Deficit.  One reason to question the status of ADHD and ADD as real diseases has to do with the method of diagnosis—or lack thereof.  Usually, before labeling a patient with a condition, doctors do extensive testing to discover abnormalities.  They may perform blood tests, x-rays, sonograms, MRI’s, and so on.  But no medical tests exist that can determine the presence of ADHD or ADD; therefore, these “maladies” do not fit the criteria for a disease.

In the absence of objective medical tests to determine who has attention deficit disorder, doctors use task- and memory-oriented psychological assessments, and behavior rating scales, on which teachers and parents rate children on questions such as how much they fidget, how well they follow instructions, or whether they are restless or easily distracted.  An easy-to-see problem here is that the answers are subjective.  What one person views as distractibility, for instance, another may view as natural inquisitiveness.  Another problem is that some of the questions are based on questionable values or assumptions; for example, the Conners’ Parent Rating Scale[vii] asks whether the child “actively defies or refuses to comply with adults’ requests.”  In some life situations, though, disobedience is a virtue.  This questionnaire also asks whether the child “is always ‘on the go’ or acts as if driven by a motor.”  But what about the highly motivated achievers of our society, people who are always on the go because they’re bursting with entrepreneurial or creative energy?  One thinks of Benjamin Franklin as an early example of this.  Interestingly, some doctors, such as Massachusetts psychiatrist Edward Hallowell, are now saying that Benjamin Franklin may have had ADD.  As a Philadelphia newspaper reporter put it, “Why else would a man go out into a rainstorm with a key on a kite hoping for lightning to strike it?”[viii]  So now we come to the obvious questions.  What if Franklin had been drugged for his behavior?  Would his creativity have been dampened, and would our society have been the poorer for it?

Or consider these musings of newspaper columnist Rod Allee:

 “There was a boy who in his early teens was a bad student, failing in many classes.  Thought to be bright and encouraged by his parents and uncles, the boy could not bring himself to pay attention.  He dropped out of school and took long walks.

“Meetings were held.  No psychiatric medicine was available.  The boy’s personality changed not a whit.  Nevertheless the boy became a legend.

“Yes, that boy was Albert Einstein.  It is possible—in my mind, probable—that had psychiatric medicine been prescribed for the young Albert, the world would never have learned about relativity.”[ix]

 Another drawback of ratings questionnaires is that parents and teachers often have a vested interest in the results.  Even with the best of intentions, they may, without realizing it, want a child put on Ritalin, believing that it will help, or that it will make their own lives easier.  Also, it is interesting to note that studies show significant disagreement in how different evaluators assess the same child.  As psychologist Thomas Armstrong explains in his book The Myth of the A.D.D. Child, “In one study, parent, teacher, and physician groups were asked to identify hyperactive children in a sample of five thousand elementary school children.  Approximately 5 percent were considered hyperactive by at least one of the groups, while only 1 percent were considered hyperactive by all three groups.  In another study using a well-known behavior rating scale, mothers and fathers agreed only about 32 percent of the time on whether a child of theirs was hyperactive, and parent-versus-teacher ratings were even worse: they agreed only about 13 percent of the time.”[x]

One way of looking at the phenomenon we call ADD is to say that there is a natural bell curve of children’s behavior patterns, and that those who are particularly active simply fall at one end of it.  In other words, ADD and ADHD are part of the spectrum of healthy human behavior.  Or in the words of Dr. William Carey, University of Pennsylvania professor of pediatrics, “What is now most often described as ADHD in the United States appears to be a set of normal behavioral variations.”  He said this at a 1998 Consensus Development Panel of the National Institutes of Health, a group that did admit, “There is no valid independent test for ADHD.  There are no data to indicate that ADHD is due to brain malfunction.  And finally, after years of clinical research and experience with ADHD, our knowledge about its causes remains speculative.” [xi]  Indeed, although psychiatrists have been studying the multitude of behaviors that have been lumped together as ADHD for decades, no more is known today than was known in the early ‘70s, when ADHD was called hyperactivity or mental brain damage.

What is today called ADD has gone by a variety of names over the course of the past century.  Psychologist Dr. Thomas Armstrong lists some of them; the list includes “organic drivenness,” “restlessness syndrome,” “minimal brain dysfunction,” and “hyperkinetic reaction of childhood,” to name just a few.[xii]  Armstrong is one of the growing number of experts who believe we’ve gone too far in pathologizing part of the spectrum of normal behavior.  The psychiatric establishment, of course, tends to disagree, and many would point to the work of Dr. Judith Rapaport as proof that these conditions are real.  According to Dr. Rapaport’s MRI research, brains of ADHD/ADD children appear to be different from the brains of other children in that parts of the anterior frontal lobe and basal ganglia appear significantly smaller in ADHD/ADD children, particularly on the right side.  These changes would account for some of the behaviors of afflicted children because the frontal lobe controls such functions as response inhibition and the ability to plan complex sequences of actions.

A closer look, however, finds that Dr. Rapaport tested children who were taking medication prior to and during her studies.  Their brain changes, then, could have been caused by long-term use of amphetamines.  Even Dr. Rapaport admitted this in an interview in which she stated, “We are also replicating our anatomical MRI work with boys who have never been treated with stimulants to make sure that the differences in brain structure are not a result of stimulant medication.”[xiii]  The latest research from the University of Buffalo acknowledges this concern, concluding that long-term Ritalin use may cause changes in the brain similar to those seen with long-term use of other stimulants, such as amphetamines and cocaine.

Those supporting a biological explanation for ADHD sometimes refer to PET scan studies.  In the early ‘90s the National Institutes of Mental Health conducted studies using PET scans to measure glucose activity in the brains of normal children and those considered to have ADHD.  It was reported that the scans showed lower glucose activity in the brains of ADHD individuals.  But it was later admitted that the initial study results could not be duplicated.  Also, the individuals in the ADHD group had taken stimulants as part of their treatment.  This is germane because stimulants lower glucose activity in the brain, a fact that has been known since the 50s.  Thus the PET scan results do nothing in terms of defining a genuine brain disorder.  They do, however, bring up the important question of whether or not stimulant drugs are adversely affecting the brains of children.  This is not the first time that study data have raised questions as to Ritalin’s role in brain structure changes.  In 1986, a research team found brain shrinkage in 50 percent of 24 young adults with hyperactivity since childhood, and concluded that cortical atrophy may be a long-term adverse effect of stimulant treatment.  Actually, while doctors have long known that stimulants can cause brain damage when used chronically at high doses, no one has looked at the possibility that chronic low-dose usage, such as with drugs that are commonly used for ADHD, can cause brain damage as well.

 An American Phenomenon.   An important argument against the thesis that ADHD and ADD are actual conditions is that the epidemic appears to be confined to North America.  The use of Ritalin and similar prescriptions is overwhelmingly concentrated in the United States and Canada.  In fact, these two countries account for 96 percent of their use throughout the world, and children in the U.S. have been estimated to be from 10 to 50 times more likely to be labeled as having ADD than their counterparts in Britain or France.[xiv]  In American public schools, about 10 percent of all children in grades K-12 carry an ADHD diagnosis.  Europe, by contrast, has a fraction of one percent so labeled.  Could the United States and Canada really be so unique in the recent drastic upsurge of this malady?

Many in the health field are calling for more research in this area.  For instance, Thomas Moore, senior fellow in health policy at George Washington University Medical Center, who feels that brain damage from Ritalin is more common than has been admitted, often questions the rationale of giving Ritalin to children, stating that the chemical imbalance theory has not been established by any scientific evidence.  And while the public is given information by the National Institutes of Mental Health that ADHD is neurobiological in nature, NIMH psychiatrist Peter Jensen stated in 1996, “The National Institutes of Mental Health does not have an official position on whether ADHD is a neurobiological disorder.”   In other words, this agency is talking out of both sides of its mouth—not that this is an uncommon phenomenon in Washington.

Psychologist Diane McGuiness summed up the situation in 1991 by saying, “We have invented a disease, given it medical sanction, and now must disown it.  The major question is, how do we go about destroying the monster we’ve created?  It is not easy to do this and still save face.”

  Psychiatry’s Campaign of Labeling—and Lobbying

 Despite the lack of evidence supporting the existence of ADHD and ADD, many parents never think to question the teachers, psychologists, and pediatricians who have labeled their children with these conditions, or to ask about the possible consequences of routine medication with a Class II substance.  Those who do express concern are reassured that the experts know best, and then often sent to CHADD, or Children and Adults with Attention Deficit Disorders, a nationwide advocacy group for ADHD/ADD adults and parents of children diagnosed with the disorders.  The group is ostensibly an objective agency guided by the latest scientific findings.  Its messages: that ADHD and ADD are legitimate diseases necessitating medical treatment, that prescribed treatments are safe, and that parents refusing to medicate their children are negligent.  But there’s something that CHADD doesn’t tell its audience, and that is that the group was created and funded by the manufacturer of Ritalin—originally Ciba-Geigy, now Novartis—for the purpose of increasing sales. 

In effect, CHADD is a lobbying group.  And it’s a powerful one, with more than 500 chapters and 32,000 members.  “Most parents are unaware that the group is funded by Novartis,” notes Dr. David Stein, author of Ritalin is Not the Answer:  A Drug-Free Practical Program for Children Diagnosed with ADD or ADHD.[xv]  “I’ve had many of them come to my talks, only to walk out shaking their heads that they didn’t know all this stuff,” Stein says.  “They’re given very biased information all along, and they become believers that they have children with diseases and that drugs are absolutely necessary, which is sad.”[xvi]

Dr. Jeffrey Schaler is a psychologist, a consultant on legal matters associated with the issue of personal responsibility, and author of Addiction is a Choice.[xvii]  It is his view that ADHD and ADD are not pathological diseases, but socially constructed labels that members of the mental health profession use to control children, to homogenize people, and, basically, to create a nation of zombies.  These conditions are not listed in standard textbooks on pathology, Schaler points out, and, in truth, he believes, these are moral judgments masquerading as medical judgments.  Thus, what we need to do, he says, “is teach parents to just say no to psychiatrists who advocate drugging children in the name of treating a mythical disease.”[xviii]

Schaler feels, in short, that psychiatry is pathologizing behavior.  But behavior is not the same thing as a disease, because behavior is made up of activities that people choose to engage in for reasons that are important to them.  “That’s not true for real diseases like diabetes, Alzheimer’s disease, syphilis, and tuberculosis,” Schaler points out.  “You can’t decide to stop having those particular diseases, and they also don’t vary by culture.  What we call mental illnesses, abnormal behaviors, or mental disorders, are all culture-specific.”

And note that the ADHD/ADD boom is just one facet of a growing campaign to increase psychiatric labeling.  In adults, the expanding list of socially based “abnormal” behaviors includes caffeinism and compulsive gambling.  In children, we see oppositional disorder and avoidant disorder.  Even shyness is considered a pathological state.  As neurologist Fred Baughman points out, the “bible” of psychiatric labeling, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, which listed 112 mental disorders in its 1952 edition, now lists 374.[xix]  Have we really discovered 262 new illnesses in recent years?  It seems, rather, that what we have done is created the therapeutic state predicted by Dr. Thomas Szasz in his 1963 classic Law, Liberty, and Psychiatry.   Szasz wrote about medicine and the state becoming united in much the same way that the church and the state once were.  Today, psychiatry has become an extension of the law, and the extent to which it is being used to deprive people of liberty and justice is staggering.  Consider the hundreds of thousands of people forcibly committed and drugged in American psychiatric institutions that we don’t usually hear from, or about.

The trend to classify children, in particular, as psychologically abnormal is especially alarming, as labels tend to remain with youngsters throughout their school careers and beyond, resulting in lowered self-esteem and limited options.  For example, an “emotionally disturbed” child placed in a special education class early on is likely to be tracked in that class throughout his or her school career.  As a result, fewer opportunities for enrichment are granted, and less academic and social progress is expected and thus attained.  Another detriment is that the appropriate response for these conditions is usually medication, the long-term iatrogenic effects of which may cause more harm than the original behavior.

 Class-Action Suits Filed.  A ray of hope in this picture is that parents are beginning to understand the harm that is being done to children, and class action lawsuits are now being filed against Ritalin manufacturer Novartis.  For instance, in New Jersey, families are suing Novartis, along with the American Psychiatric Association and CHADD, accusing them of conspiring to overdiagnose ADD in order to increase Ritalin sales.[xx]  They claim that Novartis persuaded the psychiatric association to define ADHD as an illness, so that the company could then profit by selling a treatment for it.  Further, they say, the company gave hundreds of thousands of dollars to CHADD, which they consider a front group, to help convince parents that medicating children is a good idea.  Similar class-action suits are being filed in other states, including California and Texas.[xxi]  Psychiatrist Peter Breggin supports these legal efforts, pointing out that, “This diagnosis [ADHD] was created for the specific purpose of suppressing children….Every single item in the list of symptoms has to do with controlling large groups of children in classroom settings.  Could it be a defect in the brain that makes you do everything a teacher can’t stand?…We’ve got a disease that goes away if you act in an interesting, warm, caring, engaged way with these kids.”[xxii]

Why We Medicate Children

A newspaper cartoon shows a school plastered with posters reading, “Just say no to drugs” while the school nurse asks a group of children if they’ve taken their Ritalin today.  It is indeed ironic that we, as a society, try to keep kids from taking drugs they want to take while on the other hand we force them to take drugs they may not want to take.  To understand this phenomenon, we need to explore whose interests the drugging of children serves.  We need to take a look at the perspective of our overcrowded school systems, at parents too busy to spend time with their children, and, naturally, at the manufacturers of these highly profitable items.

A Quick Fix for Schools. Psychologist Daniel Elkind, in his 1981 classic The Hurried Child, discussed the increasing “industrialization” of our schools, with their regimented schedules, even at the elementary level, and their focus on turning out quality-controlled products, i.e., students.[xxiii]  Today, with administrators under the gun to have their students perform well on standardized tests, and with more troubled children in the schools, the atmosphere has not gotten any more relaxed.  The inescapable fact is that schools have an interest in keeping order, in keeping children quiet and calm so they can get on with the business of teaching and learning.  And psychiatric medicines do help keep schoolchildren under control.  So, in the words of developmental pediatrician Dr. Joseph Keeley, “We sometimes use medications to make kids fit into schools rather than schools to fit the kids.”[xxiv]

Of course there are better ways to make schools work, such as appropriate therapy for troubled youngsters, custom-tailored education plans, and small classes.  But these approaches are more difficult—and more expensive.  Thus, the school district may have a vested interest in medication as a quick, less costly, fix, although this may not be what’s best for a particular child.  Says Dr. David Stein, “The drugs blunt their behavior.  They don’t act out in class, and they sit there quietly….The difficulty is that children learn nothing from a drug.”[xxv] 

Schools justify the need for medications by saying that children on Ritalin learn better because the drug allows them to focus, but that claim has never been proven.  According to Stein, so-called ADD children can learn when they want to; it’s just that schools expect too much of students and do not engage them.  “This country has started teaching second- and third-grade material in kindergarten, and children begin to get burnt out by the time they’re in the second grade.  They wind up hating schoolwork.  And that’s the key.  These children can play very complex video games, and they can read the instructions, because they enjoy doing it.”[xxvi]

            The situation in American schools today was chillingly illustrated for me by a teacher I talked with recently.  She works for a state-funded organization that sends teachers, social workers, psychologists, and speech therapists to disadvantaged schools for support.  Once a week, she explained, there are meetings with the principal, other staff, and sometimes parents to discuss specific problem children.  “Although we are given no specific training in how to advise or function as a team,” she said, “we are looked at as experts, and our advice is highly regarded.  In my experience, the meetings are merely attempts to find quick-fix solutions, and since the psychologist dominates, the answer to a great many childhood problems is an ADHD or ADD diagnosis for which medication is considered the logical solution.” 

            This teacher told me she will never forget an experience she had when she was fairly new to team meetings.  “After another teacher had expressed concern about an active second grader, the psychologist and psychology intern reported their findings to the parents at a team meeting.  They said that the boy fit the ADHD profile because he had gotten out of his seat so many times in class and couldn’t sit still without fidgeting.  They suggested that he should be taken to a doctor for follow-up. 

            “The mother initially asked an intelligent question:  ‘Will the doctor perform a special kind of test to determine that my son has a medical disorder?’  The team could not answer that question in the affirmative since no such test is performed.  The doctor merely observes the child’s behavior, looks at the behavior checklist filled out by the parent and teacher, and then fills out a prescription.  What the psychologist and intern did instead was talk about CHADD and what a great support it would be to these parents.

            “While the mother appeared immediately receptive to persuasion, the quiet father wore an expression of concern in his eyes.  The principal asked what was wrong, and the father responded in one word: ‘Ritalin.’  The team then turned their attention to soothing the father, saying that medication would be in the boy’s best interest because once he was calm he would be able to pay attention to his schoolwork and succeed in his studies.” 

            When the meeting ended, the teacher said, she pulled the father aside and told him that she understood his concerns.  “I told him that many parents were opposed to medicating their children and that alternative approaches did exist.  Then I handed him a brochure on alternative approaches.”  She felt she had to take a discreet approach because she’d learned, from past meetings, that it was useless to speak up.  The psychologists are so married to their ideology that they’re quick to shoot down the opposition.  “Even though I attempted to be confidential,” she reported, “the room was small, and I could feel the psychologist’s eyes glaring at me, as if she was going to use the information to report me to the thought-control police.” 

            Once the parents left, the teacher went on to relate, the red-faced principal exclaimed, “That burns me up!  Here we are trying so hard to help their son, and the father gives us a hard time.”  Obviously, the principal did not understand why the idea of medicating a young child, possibly every single day for the rest of his life, should concern parents.

Soon after that, the parents complied.  The next time this teacher saw the second-grader in her math group, he was already on Ritalin, so she was able to see a before-and-after contrast in personality.  The child had been a bit antsy before, calling out or even getting out of his seat from time to time, but his behavior seemed normal.  Now the child seemed severely depressed.  He would cry for the smallest slight, losing a turn in a board game, for example, and even crawl under the table to cry.  He had never acted that way before.  On one occasion he told the teacher that he wanted to kill himself.  She reported that to the psychologist, who seemed annoyed at the trouble.  Soon the psychologist reported back to the teacher that the parents didn’t notice any difference in behavior.  He would continue as before. 

            This teacher went on to make the point that biological “treatments” for childhood social disorders are not discriminatory; i.e., she has seen the same arrogance and insensitivity in an affluent school district on the other side of town.  In the high school where she worked as a reading specialist, teachers confronted with children they deem problematic routinely say to peers and parents, “He [or she] should be on meds.”  The students’ perceived problems can range from inability to focus to acting out to just not being able to read.  At one meeting, highly educated parents of a very bright young lady with reading difficulties were looking for a specific diagnosis to work with and were told by the psychologist to consider seeing a doctor about her daughter’s possible ADD—attention deficit disorder without the hyperactivity component.  To the teacher’s relief, the parents glanced at each other, snickering to themselves, as if to say, “I can’t believe you would say such a thing.”

If only more parents would laugh in the face of this absurdity.  Some parents do seem aware of the ADD controversy, but overall there is blind acceptance of ADD as a true medical condition and of medication as a requirement. 

It should be noted that it’s not just elementary and high schools that seem to need a drug to help them run smoothly, but preschools and day care centers also.  As writer Robyn Suriano recently pointed out in the Orlando Sentinel,[xxvii]  “The drug [Ritalin] reached its heyday in the 1990s, after more children started attending day care.  In a preschool, kids must follow instructions and behave just like older children in classrooms.  Rambunctious ones are not easily tolerated in these surroundings, where workers must watch many children.”  This is not to say that day care centers are necessarily bad, but there are a lot of inadequately staffed and equipped ones.  These trap preschoolers in confining, boring situations for 10 hours a day and then complain when they act like the active, inquisitive, and needy young creatures that children just barely out of babyhood normally are.  That drugs are used to remedy this situation is unconscionable, especially considering that Ritalin’s label warns that the drug is only for those aged 6 and over.  But “off-label” prescription is legal, and it’s happening.  As a Wall Street Journal article reported,[xxviii] the use of prescription drugs to control toddlers’ behavior has increased dramatically in the past decade.

The Journal article did give voice to a couple of dissenting professionals concerning this trend.   Psychiatrist Joseph Coyle, chairman of the Department of Psychiatry at Harvard Medical School, was one.  The brains of young children are developing rapidly, he pointed out, and drugs can alter the process.  Coyle also cited the financial interests of managed care in creating a system in which doctors are too busy to do much more than prescribe.  And Dr. Julie Zito, an associate professor at the University of Maryland’s School of Pharmacy, was especially skeptical of the use of Ritalin to combat attention-deficit disorder in two-year-olds.  “What is abnormally inattentive in a two-year-old?” she asked.

It was Dr. Zito who, along with colleagues from the University of Maryland, Johns Hopkins, and Kaiser Permanente’s Center for Health Research, authored a study on “Trends in the Prescribing of Psychotropic Medications to Preschoolers.”[xxix]  Published in the Journal of the American Medical Association, the study contained some unsettling findings concerning very young children and psychotropic drugs.  The researchers found that poor—and particularly black—children are being prescribed Ritalin at younger and younger ages.  A 300-percent increase in prescriptions to the very young between 1991 and 1995 was cited.  The study also mentioned Prozac being given to children younger than one year of age, to the tune of some 3000 prescriptions in 1994.

Parental Abdication.  To an extent, ADHD and ADD are products of a baby boomer generation that has abdicated a tremendous amount of responsibility for parenting.  A typical scenario might involve a very “successful” couple, with both partners working long hours and neither one able to spend much time with the child.  They do plan to get more involved one day, but in the meantime, they will pay for day care, baby sitters, tutors, and counselors.  And when the child’s behavior becomes a little too erratic from lack of parental attention, they will pay for psychological services.  They are told their child has ADHD, for which medication is needed.  A side effect of the medication may be agitation, for which more drugs are then recommended.  So now the child is on Ritalin and Prozac, and has been placed in special classes.

What a difference it could make if these parents realized that slowing down to spend time with the family, and, in effect, taking responsibility for what goes on in their lives, could resolve many behavior issues.  Child development research tells us that the biggest influence on children is the example set by parents.  Teaching self-discipline and resisting temptation are tremendously important factors in good parenting.  When parents take responsibility for parenting they teach their children responsibility as well. 

The inverse, which is happening today, is that children are learning that it is okay not to take responsibility for what they’re doing.  Living only for now, they lack future orientation.  Many of these children don’t think five minutes ahead of time, and they certainly don’t think about what they are going to do with their lives.  But the parents just assume that their children’s behavior is not anyone’s fault, and that a drug will fix things.  Says Dr. Schaler, “By virtually ignoring [their children] and calling their acting out behaviors a neurological disorder, they are, in effect, scapegoating the neurology of the child.” [xxx] 

Financial Incentives.   Before ADD and ADHD came into vogue, amphetamines were seldom prescribed.  Ritalin was given for narcolepsy, a rare neurological disorder that causes people to fall asleep unexpectedly despite adequate sleep, but sales were minuscule.  Now, thanks to the popularity of ADD and ADHD, Ritalin sales are significantly healthier.  Moreover, the psychiatric establishment has seemingly discovered several other childhood disorders, including pediatric depression, for which medications are routinely prescribed.  By the way, most of the people prescribing psychiatric drugs are not psychiatrists, but primary-care physicians, who have not received the kind of sophisticated mental-health training needed to understand what’s involved in prescribing these life-altering substances.  Our managed-care system of health care bears at least some of the blame for this trend.  As a recent article in Parents magazine point out,  “Here, as with almost everything else in the tangled world of health care, economics plays a decisive role.  Drugs have become the treatment of first resort when kids exhibit behavioral problems, partly because most managed-care plans readily cover the cost of medication but often won’t pay for long-term alternative treatments, such as talk or behavioral therapy.”[xxxi]

The people who manage managed care are not particularly interested in getting to the source of patients’ problems, focused as they are on the bottom line and the quick fix.  Psychiatrist Dr. David Kaiser elaborates:  “When I talk to a managed care representative about the care of one of my patients, they invariably want to know about medications I am using and little else, and there is often an implication that I am not medicating aggressively enough.  There is now a growing cottage industry within psychiatry in advocating ways to work with managed care, despite the obvious fact that managed care has little interest in quality care and realistic approaches to real patients.  This financial pressure by managed care contributes added pressure for psychiatry to go down a biological road and to avoid more realistic treatment approaches.”[xxxii]  

The boom in psychiatric drug sales has been helped along by a vigorous marketing campaign.  Psychiatrist Loren Mosher reports that at meetings of the American Psychiatric Association, drug companies “basically lease 90 percent of the exhibition space and spend huge sums in giveaway items.  They have nearly completely squeezed out the little guys, and the symposiums that once were dedicated to scientific reports now have been replaced by the pharmaceutical-industry-sponsored speakers.”[xxxiii]  And pitches for drugs are made not just to medical practitioners, but also to teachers and parents. In the early 1990s, pharmaceutical companies distributed pamphlets to schools nationwide on how to diagnose ADHD and ADD, conditions for which medication was presented as the solution.  During this time America saw a dramatic rise in Ritalin consumption, close to a 700-percent increase.  Ritalin’s manufacturer also funded CHADD to encourage parents to support the drug solution and to keep public confidence levels high.  Today, drug companies continue to spend hundreds of thousands of advertising dollars in psychiatric journals.

They’ve also started advertising in popular magazines.  Recently, some stimulant manufacturers have gone against standard international practice and begun marketing directly to parents.  Here’s how The New York Times describes this appalling trend:[xxxiv]

“In the back-to-school section of this month’s [Aug. 2001] Ladies’ Home Journal, tucked among the ads for Life cereal, bologna and Jell-O pudding, are three full-page advertisements for the A.D.H.D. treatments.

“The ads evoke a sense of Rockwellian calm.  Children chat happily next to a school bus.  A child’s hand gently touches the hand of an adult.  In one, for the new drug Metadate CD, an approving mother embraces her beaming son as the drug itself is named and promoted.

“This is a first.  Metadate CD, like Ritalin, Adderall and similar drugs, are what are known as Schedule II controlled substances, the most addictive substances that are still legal. (Schedule I drugs like heroin and LSD are illegal.)

“In keeping with a 1971 international treaty, such controlled substances have never been marketed directly to consumers, only to doctors.  There is, however, no federal law to prevent drug companies from doing it….The new magazine advertisement by Celltech Pharmaceuticals, the British maker of Metadate CD, states, ‘Introducing Metadate capsules.  One dose covers his A.D.H.D. for the whole school day.’”

According to The Times, in the year 2000 close to 20 million prescriptions were written for ADD medicines, with sales bringing in about $758 million.  It is true that a lot of this profit goes into research that tests drugs’ safety and efficacy.  The obvious down side to this, though, is that with companies funding their own testing, results can be biased, as it is not in a company’s best interest to get negative results that discourage business. 

This conflict-of-interest situation raises ethical issues that are especially troublesome when you consider that it is children who are being targeted by these drug companies.  Furthermore, today it’s not just the classic “problem child” who is being targeted for stimulant consumption.  As Peter Breggin points out in Talking Back to Ritalin,[xxxv] there is a wide range of children being given stimulants, from the truly hyperactive child who can’t sit still for a second to the child without severe behavior problems who is simply dreamy or inattentive.  As is the case with other psychotropics, the net of this drug’s reach seems to have widened.   

 Ritalin’s Side Effects

Psychiatrists often say that Ritalin is safe, having few side effects, and none that are severe.  This is just not true.  Here’s a rating scale listing possible side effects that parents and teachers are supposed to fill out—answering “no problem,” “mild,” “moderate,” or “severe”—as a child begins to take stimulant medication.  It’s included in a book written by medical professionals for parents of so-called ADD children:[xxxvi]

·        Decreased appetite

·        Problem getting to sleep

·        Problem staying asleep

·        Anxious or fearful

·        Irritable

·        Looks like a zombie (staring)

·        Decreased spontaneity

·        Depressed (even crying)

·        Headache

·        Stomachache

·        Tics (e.g., twitches, jerks, blinks, squints)

·        Vocal tics (e.g., throat clearing, sniffing, grunting)

·        Skin rash

·        Embarrassment because taking medication

·        Psychosis (irrational thinking, hallucinations, extreme anxiety or inappropriateness

·        Rebound effect as drug wears off: increased symptoms, hyperactivity and/or depression

If these were rare side effects, there would be no need for such a questionnaire.

The Potential for Psychosis.  There is no getting away from the fact that Ritalin is a stimulant, classified as an amphetamine-like drug because of its properties.  As Prozac Nation author Elizabeth Wurtzel put it, writing in The New York Times,[xxxvii]  “Whatever good Ritalin can do to help center those with attention problems, it does so for a simple reason:  It is an amphetamine.  In fact, Ritalin is more or less the same as what is sold as speed on the streets.”

The reality is that 10 mg of Ritalin is equivalent to 5 mg of amphetamine.  And like amphetamines, Ritalin can cause psychotic behavior.  This information is in fact included in the warnings of the drug-packaging information.  And psychiatrists, although they may not be forthcoming with facts when they are pulling out their prescription pads, do know that stimulants can make children psychotic.  In a 1999 Canadian Journal of Psychiatry report study,[xxxviii] 98 children received stimulant drugs for ADHD and were on them for almost two years.  Six of the children developed psychotic symptoms during treatment.  The journal concluded that physicians should have “...an awareness of the potential of psychotic side effects from stimulant medication when prescribing for children.”

What’s frightening is that this study documented a better than 6- percent rate of psychotic behavior in children taking stimulants at a time when 5 to 7 million children are now taking the stimulant Ritalin.  Psychiatrists have known for decades that Ritalin can cause psychotic behavior.  In 1975, psychiatrist Daniel Friedman wrote that Ritalin was one of five drugs that “produced psychotic reactions.”  Even at low doses amphetamine-like drugs “may occasionally produce psychotic states, and such psychosis may be prolonged, resembling paranoid psychosis.”  In fact, in 1973, psychiatrists were giving amphetamines to volunteers in order to observe their reactions.  The reactions frightened researchers, who noted that several of the subjects expressed “a desire to kill” or to do something “bad or destructive.”[xxxix]  Researchers concluded that there was a potential danger of impulsive murderous violence caused by amphetamine-induced psychosis.

Dyskinesia and Other Problems.  Many children taking Ritalin will develop involuntary muscle contractions and limb movements known as tics, or dyskinesia.  A study published in the Archives of Pediatric and Adolescent Medicine[xl] showed that this can happen to up to 9 percent of children taking stimulants.  Other studies in the peer-reviewed medical literature bear out this association,[xli] [xlii] [xliii] as well as the Ritalin-psychosis connection.  Also, Ritalin has also been shown to have an adverse effect on heart tissue and has been linked to cancer.  In the mid-90s, the FDA forced Ritalin’s maker to send letters to 100,000 doctors, warning them of a possible link between the drug and liver cancer.  Researchers reported to the FDA that their studies show “clear evidence” that link the drug to cancer.  The FDA changed the warning to “some evidence,” a change that was protested by one of the main researchers.  A formal proposal to keep the wording “clear evidence” was presented to an FDA panel, but this was defeated by a vote of 4 to 3.  “Clear evidence” became “some evidence,” and ultimately the FDA publicly announced that there was “a weak link” between Ritalin and cancer and that doctors should not be concerned about continuing to prescribe the drug.

A problem that some children and teenagers experience with Ritalin is called rebound.  When the drug is metabolized and the level in the bloodstream goes down, these children seem to go back to a hyperactive state “and then some.”  They may get excitable or impulsive, or develop insomnia.[xliv]  In fact, as many as half the so-called ADHD children on medications report some presleep agitation, called P-A.[xlv]  Physicians try to handle this problem by decreasing the last dose of the day, or, alternatively, adding another dose, so that the child sleeps with a new supply of Ritalin in his blood.  Sometimes this works, but one has to wonder about the advisability of children taking a sleep-pattern-altering drug over the long term.

Yet another Ritalin side effect is the stunting of growth that occurs in some children taking moderate to high stimulant dosages over a period of years.  This happens not just because stimulants can diminish appetite, but also because they may alter the body’s natural balance of growth hormones.[xlvi]  The growth-stunting phenomenon doesn’t seem to have alarmed the medical establishment as much as it should.  Consider the advice given by clinical psychologist Dr. John Taylor in his book Helping Your Hyperactive/Attention Deficit Child.[xlvii]  The author notes, first, that some physicians recommend taking the child off medication during vacation periods, so that he can catch up in height and weight.  Then Taylor counsels: “The crucial question is whether your child’s behavior can be tolerated if he or she is unmedicated (or undermedicated) during the summer months.  Several adjustments are available.  Your child can play outdoors more, attend camps, participate in athletic programs or other vigorous play activities, or even be sent to live with a relative.  There is little or no requirement for intense academic pursuits, there is no need to sit still for hours as is required in school, and summer entertainments can take advantage of your child’s interests to prevent boredom….Among those who are not given any medication-free periods and who experience the stunting effect, the average amount is less than two inches.  If stunting occurs and becomes an important psychological issue, choice of hair style and footwear can compensate.”

At least three questions arise.  First, if it’s possible to give a child a stimulating and active life in the summer, at camp or with relatives, why can’t this be done in the winter, in school and with the nuclear family?  Surely arranging for more outdoor playtime, and more interesting activities, is preferable to putting a child on drugs.  Second, do parents and doctors have the right to stunt a child’s growth for any reason other than, perhaps, to save his life?  And third, even if “choice of hair style and footwear can compensate,” for decreased height, how is the child going to feel about this later, when he understands what’s been done to him?

In addition to all the potentially damaging effects of Ritalin one has to factor in the reality that it doesn’t work.  Yes, it does make some children better behaved at certain times.  But there are no studies showing improved academic performance or social behavior over the long term.[xlviii]  What has been shown over the long term is that the side effects can become quite serious.  

The Deadly Consequences of Long-Term Stimulant Use

Most people assume that drugs are proven safe before they are marketed.  But this is not always the case, especially when you consider the long-term picture.  Science knows very little about the long-term effects of medicating children.  In effect, children have been guinea pigs.  The results of this grand experiment are only now becoming evident, and sometimes the consequences are deadly.

Consider the case of Stephanie Hall, a first grader placed on Ritalin because her teacher felt she was “just a little bit too antsy,” according to her mother.  “[The teacher] suggested that Stephanie go for testing, so we went the route of a neurologist who said she could throw a ball and read a book and a psychologist who said she had average intelligence but, yes, she was a little easily distracted.  So now she qualifies to be medicated.”  When she turned 12, the prescription was increased; that very day, Stephanie died from cardiac arrest in her sleep.  Says her mom, “Her death was caused by cardiac arrhythmia with no family history of any type of heart problem whatsoever, and she died a day after her medicine had been increased.  It kind of adds up.” [xlix] 

A double tragedy struck the Hall family when Stephanie’s sister Jenny, also a long-term Ritalin user, started to have seizures.  Subsequent medical tests revealed a brain tumor.  Mrs. Hall believes that Jenny was misdiagnosed; as a result proper medical attention was delayed.  She states, “There’s Jenny’s ADHD, it’s a brain tumor.  I’m not saying everyone that is labeled ADHD has a brain tumor….But there’s the possibility that a child could have an underlying neurological disease that really needs treatment.”  Mrs. Hall also wonders whether the medication could have precipitated or exacerbated Jenny’s condition:  “It probably made her condition worse because prior to being on medication she never had seizures.  I later read that if you have a low threshold to seizures you should never take Ritalin to begin with.”[l]  She and her husband are suing Novartis, the maker of Ritalin, for producing a defective product and concealing adverse reactions and deaths related to its use.[li] 

The once trusting mother advises parents to learn from her mistakes:  “Don’t trust your doctor.  Question him over and over.  If you are not happy with what he says, if you have an intuitive feeling that something doesn’t seem right, it’s not.  Get second and third opinions. It may not seem reasonable to have to go to that extent, but if it’s at the price of your child, it is.  I hope others can learn from my tragedy and realize that a doctor’s word is not God’s law.”[lii]

In a more publicized story, Matthew Smith, a 14-year-old from Michigan, had also, like Stephanie Hall, been taking Ritalin from the time he was in first grade.  After eight years of ingesting the drug daily, Matthew suddenly became pulseless and died while riding his scooter.  An autopsy performed by the county medical examiner, a Dr. Dragovic, found that Matthew’s heart muscle was diffusely replaced with scar tissue, as were the muscular walls of the coronary vessels.  Much to the displeasure of the psychiatric and pharmaceutical industry, the doctor publicly stated that Matthew’s death was undoubtedly due to heart damage akin to that regularly seen in deaths among amphetamine addicts, and that his death was clearly due to the Ritalin.