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- I appear today as Director of the International Center
for the Study of Psychiatry and Psychology (ICSPP), and also on my own
behalf as a practicing psychiatrist and a parent.
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- Parents throughout the country are being pressured and
coerced 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.
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- 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 to control behavior.
These stimulant drugs include methylphenidate (Ritalin, Concerta, and Metadate)
or forms of amphetamine (Dexedrine and Adderall).
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- My purpose today is to provide to this committee, parents,
teachers, counselors and other concerned adults a 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.
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- 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 periodic 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.
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- 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.
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- 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 stimulant 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.
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- 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.
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- II. Legal Actions
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- Most recently, four major civil suits have been brought
against Novartis, the manufacturer of Ritalin, for fraud in the over-promotion
of ADHD and Ritalin. The suits also charge Novartis with conspiring with
the American Psychiatric Association and with CHADD, a parents' group that
receives money from the pharmaceutical industry and lobbies on their behalf.
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- Two of the suits are national class action suits, one
is a California class action and one is a California business fraud action.
The attorneys involved, including Richard Scruggs, Donald Hildre, and C.
Andrew Waters have experience and resources generated in suits involving
tobacco and asbestos. That they have joined forces to take on Novartis,
the American Psychiatric Association, and CHADD indicates a growing wave
of dissatisfaction with drugging millions of children.
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- The suits and the contents of the complaints are based
on information first published in my book, Talking Back to Ritalin (1998),
and I am a medical expert in these cases.
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- III. The Dangers of Stimulant Medication
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- Stimulant medications are far more dangerous than most
practitioners and published experts seem to realize. I summarized many
of these effects in my scientific presentation on the mechanism of action
and adverse effects of stimulant drugs to the November 1998 NIH Consensus
Development Conference on the Diagnosis and Treatment of Attention Deficit
Hyperactivity Disorder, and then published more detailed analyses in several
scientific sources (see bibliography).
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- Table I summarizes many of the most salient adverse effects
of all the commonly used stimulant drugs. It is important to note that
the Drug Enforcement Administration, and all other drug enforcement agencies
worldwide, classify methylphenidate (Ritalin) and amphetamine (Dexedrine
and Adderall) in the same Schedule II category as methamphetamine, cocaine,
and the most potent opiates and barbiturates. Schedule II includes only
those drugs with the very highest potential for addiction and abuse.
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- Animals and humans cross-addict to methylphenidate, amphetamine
and cocaine. These drugs affect the same three neurotransmitter systems
and the same parts of the brain. It should have been no surprise when Nadine
Lambert presented data at the Consensus Development Conference (attached)
indicating that prescribed stimulant use in childhood predisposes the individual
to cocaine abuse in young adulthood.
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- Furthermore, their addiction and abuse potential is based
on the capacity of these drugs to drastically and permanently change brain
chemistry. Studies of amphetamine show that short-term clinical doses produce
brain cell death. Similar studies of methylphenidate show long-lasting
and sometimes permanent changes in the biochemistry of the brain.
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- All stimulants impair growth not only by suppressing
appetite but also by disrupting growth hormone production. This poses a
threat to every organ of the body, including the brain, during the child's
growth. The disruption of neurotransmitter systems adds to this threat.
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- These drugs also endanger the cardiovascular system and
commonly produce many adverse mental effects, including depression.
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- Too often stimulants become gateway drugs to illicit
drugs. As noted, the use of prescription stimulants predisposes children
to cocaine and nicotine abuse in young adulthood.
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- Stimulants even more often become gateway drugs to additional
psychiatric medications. Stimulant-induced over-stimulation, for example,
is often treated with addictive or dangerous sedatives, while stimulant-induced
depression is often treated with dangerous, unapproved antidepressants.
As the child's emotional control breaks down due to medication effects,
mood stabilizers may be added. Eventually, these children end up on four
or five psychiatric drugs at once and a diagnosis of bipolar disorder by
the age of eight or ten.
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- In my private practice, children can usually be taken
off all psychiatric drugs with great improvement in their psychological
life and behavior, provided that the parents or other interested adults
are willing to learn new approaches to disciplining and caring for the
children. Consultations with the school, a change of teachers or schools,
and home schooling can also help to meet the needs of children without
resort to medication.
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- IV. The Educational Effect of Diagnosing Children with
ADHD
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- 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 subdue 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.
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- 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.
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- 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."
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- Once again, the diagnosis itself, formulated over several
decades, leaves no question concerning its purpose: to redefine disruptive
classroom behavior into a disease. The ultimate 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.
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- V. How the medications work
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- Hundreds of animal studies and human clinical trials
leave no doubt about how the medication 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.
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- Table II provides a list of adverse stimulant effects
which are commonly mistaken as improvement by clinicians, teachers, and
parents.
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- VI. What is Really Happening
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- Children become diagnosed with ADHD when they are in
conflict with the expectations 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.
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- By diagnosing the child with ADHD, blame for the conflict
is placed on the child. Instead of examining the context of the child's
life why the child is restless or disobedient in the classroom or home
- the problem is attributed to the child's faulty brain.
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- Both the classroom and the family are exempt from criticism
or from the need to improve, and instead the child is made the source of
the problem. The medicating of the child then becomes a coercive 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.
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- VII. Conclusions and Observations
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- 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.
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- By diagnosing and drugging our children, we shift blame
for the problem from our social 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.
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- 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.
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- 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.
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- 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.
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- Appendices: Tables I & II, and description of ICSPP
Scientific Sources
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- This report draws on hundreds of published scientific
studies. I have provided the committee with two sources for the specific
citations: My scientific presentation to the NIH Consensus Development
Conference and my peer-reviewed scientific paper that expands on it. My
book, Talking Backing to Ritalin (1998), also elaborates on many of these
issues and provides many scientific citations. A more recent book, Reclaiming
Our Children: A Healing Solution to a Nation in Crisis (2000), further
describes the harm done by drugs and proposes solutions for teachers, parents,
and other adults
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