Law Limits Ritalin Recommendations

News article

By: Cable News Network

Date: July 17, 2001

Source: CNN.com. "Law Limits Ritalin Recommendations." July 17, 2001.

About the Author: CNN.com is the web portal for the Cable News Network, a twenty-four hour news channel launched by Ted Turner in 1980.

INTRODUCTION

In 1937, medical staffers at Bradley Hospital in Providence, Rhode Island fed hyperactive children stimulants in an effort to control their behavior; the drug, dextroamphetamine, helped to calm the children. In 1954, the drug company Ciba Pharmaceutical Company patented the drug methylphenidate, known as Ritalin, for use with patients experiencing depression, narcolepsy, and chronic fatigue. Ritalin quickly became the drug of choice to treat hyperactivity in children by the 1960s.

Hyperactivity as a medical condition was first reported in medical journals such asLancet in the early 1900s. Restlessness, fidgeting, poor impulse control, inappropriate physical energy in certain contexts are markers for hyperactivity in children that came to be called minimal brain dysfunction in the 1940s, hyper-active child syndrome in the 1950s, attention deficit disorder in the 1970s, and most recently, attention deficit/hyperactivity disorder, or ADHD. Until recently, the cause of clinical ADHD was unknown, though researchers speculate that a dopamine imbalance in the brain triggers the behaviors associated with hyperactivity.

In the United States, boys experience clinical diagnoses of ADHD at a rate four times higher than girls. By the 1990s, in the United States, ADHD diagnoses had increased so dramatically that a backlash against the disorder in the form of publications, television shows, and websites led to a standoff between doctors and parents who treat children with ADHD with medications and parents, doctors, and educators who argue that the actual incidence of ADHD in the population is very small, and that the over diagnosis is a result of cultural norms and school practices that do not tolerate normal childhood behaviors.

Peter Breggin, a psychiatrist and director of the International Center for the Study of Psychiatry and Psychology, notes that research shows that the calming effects of Ritalin and other stimulant drugs such as Adderall and Strattera are, in fact, toxic reactions to the drugs themselves. In testimony before Congress, Breggin noted that the United States uses more than ninety percent of Ritalin produced worldwide, and that out of a population of approximately 54 million school children, in the year 2000, more than five million were taking prescription stimulants; nearly ten percent of all schoolchildren, but mostly white boys. By comparison, the stimulant rate for school children in Great Britain and France is dramatically lower; in France, prescriptions for stimulants must be written in hospitals, not by primary care physicians or pediatricians.

As ADHD diagnoses soared in the United States, changes in day care and education settings required children to spend longer amounts of time indoors or in institutional environments, reduced indoor and outdoor recess time for schoolchildren, reduced physical education, increased time devoted to standardized testing; some ADHD critics point also to changing expectations from parents and educators concerning childhood behavior. Hyperactivity, in other words, is subjective, and critics of ADHD rates claim that changing social conditions in the United States are creating the ADHD epidemic itself while ADHD proponents state that better detection, awareness, and treatment drive the increase in diagnoses.

By the late 1990s, some parents of children labeled hyperactive by teachers and administrators found themselves in conferences with school teachers, principals, and psychologists discussing an ADHD diagnosis; in many instances, such meetings ended with the school's requirement that the child receive medication as a condition for attending school. At times, parents, concerned about negative side effects of Ritalin and other stimulants that include loss of height, cardiovascular damage, and sleep disturbances, refused to medicate. The conflict that ensued led to laws such as the Connecticut law discussed below.

PRIMARY SOURCE

HARTFORD, Connecticut (AP)—When Sheila Matthews' son was in first grade, a school psychologist diagnosed him with attention deficit/hyperactivity disorder and gave his parents information on Ritalin.

Matthews refused to put him on the drug. She believed the boy was energetic and outgoing but not disruptive, and she suspected the school system was trying to medicate him just to make it easier for the teachers.

Now the state of Connecticut has weighed in on the side of parents like Matthews with a first-in-the-nation law that reflects a growing backlash against what some see as overuse of Ritalin and other behavioral drugs.

The law—approved unanimously by the Legislature and signed by Gov. John G. Rowland—prohibits teachers, counselors and other school officials from recommending psychiatric drugs for any child.

The measure does not prevent school officials from recommending that a child be evaluated by a medical doctor. But the law is intended to make sure the first mention of drugs for a behavior or learning problem comes from a doctor.

The chief sponsor, state Rep. Lenny Winkler, is an emergency room nurse. "I cannot believe how many young kids are on Prozac, Thorazine, Haldol—you name it," Winkler said. "It blows my mind." While she has no problem with the use of Ritalin under a doctor's care, Winkler said a teacher's recommendation is often enough to persuade parents to seek drug treatment for their child's behavior problems.

"It's easier to give somebody a pill than to get to the bottom of the problem," she said.

Nationally, nearly 20 million prescriptions for Ritalin, Adderall and other stimulants used to treat ADHD were written last year—a thirty-five percent increase over 1996, according to IMS Health, a health care information company. Most of those prescriptions were for boys under twelve, IMS Health said.

In some elementary and middle schools, as many as 6 percent of all students take Ritalin or other psychiatric drugs, according to the federal Drug Enforcement Administration.

Dr. Andres Martin, a child psychiatrist at the Yale University Child Study Center, said schools have no business practicing psychiatry.

"We've all heard these horror stories of parents who are told, 'If you don't medicate your child, he can't be in the classroom,'" he said. "You never hear the school say, 'If you don't take the damn appendix out, this kid has a bad outcome.' You say, 'Your kid has a stomach ache. Take him to the doctor.'."

The Connecticut Association of Boards of Education has taken no position on the bill. Nor has the Connecticut Education Association, the state's largest teachers union. But union President Rosemary Coyle said the she believes the problem is overstated.

"I really believe teachers do not practice medicine," Coyle said. "We don't recommend kids get on drugs."

Concern about Ritalin and other drugs is widespread. The Texas Board of Education adopted a resolution last year recommending that schools consider non-medical solutions to behavior problems. The Colorado school board approved a similar resolution in 1999, and legislation regarding psychiatric drugs in school has been proposed in nearly a dozen states.

In the New Canaan school district, Matthews and her husband took their son, now eight, to a private psychologist, who said the boy has trouble with reasoning. He now receives special education from the school system.

"I was able to get, for $2,000, a different label that has an educational connotation, rather than medical," said Matthews, who did not want her son's name used.

New Canaan district officials did not return repeated calls for comment. But Matthews said she has resolved many of her differences with the school system, which did not threaten to remove her son from class.

"I'm really thrilled" about the new law, she said, "because it gives parents an awareness that there should be a clear difference between education and medication. Our schools are now getting into the field of mental health. That's not what we send our children to school for."

SIGNIFICANCE

In addition to Connecticut, states such as Minnesota and Texas passed similar laws. The Minnesota law gives parents the choice not to submit their child for special education testing, while requiring that non-prescription drug strategies, such as diet change, schedule change, and other accommodations, be explored before considering Ritalin or other stimulants for hyperactive behavior.

While proponents of such "anti-Ritalin" laws state that such laws prevent teachers and administrators from assuming the role of physician and diagnosticians, many professional educators claim that the laws go too far. In Connecticut, for instance, the law prohibits school officials from specifically recommending a particular drug; officials may recommend that a child be evaluated, but the evaluation and diagnosis must come from a doctor. Teachers and administrators cannot mention any drugs by name. At the same time, parents have reported threats from school administrators to report parents to Child Protective Services for failure to medicate a child, even when the child has no formal diagnosis. Such state laws are designed to provide clear guidelines concerning ADHD and other developmental and behavioral diagnoses.

In 2005, the revision of the Individuals with Disabilities Education Act included a provision protecting parents from coercion concerning such controlled substances as Ritalin, Adderall, and Dexedrine. In addition, the 108th Congress was, as of May 2006, considering a bill that would remove federal funds from schools where officials required medication as a condition for attendance. As ADHD diagnoses increase in the United States, and with a 500 percent increase in stimulant drug prescriptions in the United States from 1991–2000, such laws shape the approaches schools take in dealing with the crossroads of school structure, family choices, biology, and medicine.

FURTHER RESOURCES

Books

Richardson, J. Common, Delinquent, and Special: The institutional Shape of Special Education (Studies in the History of Education). London: Routledge Falmer, 1999.

Periodicals

Breggin, Peter M.D. "Psychostimulants in the Treatment of Children Diagnosed with ADHD: Risks and Mechanism of Action." International Journal of Risk & Safety in Medicine. 12 (1999): 3–35.

Diller, Lawrence H. "The Run on Ritalin: Attention Deficit Disorder and Stimulant Treatment in the 1990s." The Hastings Center Report. 26 (1996).

Web sites

U.S. Department of Education. "Special Education & Rehabilitative Services." <http://www.ed.gov/policy/speced/guid/idea/idea2004.html> (accessed May 28, 2006).