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Pediatrician Says Ritalin
Helps, Despite Its Controversy
Doctor Calls Ritalin Form of Drug Abuse
For Some, Refusal of Ritalin is the Problem
Pediatrician Says Ritalin Helps, Despite Its Controversy
By Cheryl K. Chumley
CNS Staff Writer
September 19, 2000
This is the first of a three-part series on the controversies surrounding Ritalin, the frequently prescribed drug for childhood attention disorders
(CNSNews.com) - Prescribing Ritalin is not an exact science, one pediatrician admitted, but patients are normally helped rather than hurt by its use, and tales of abuse are exaggerated.
Not true, say critics of Ritalin and Attention Deficit-Hyperactivity Disorder, which doctors use as a basis for prescribing the stimulant. Referring to federal statistics, those critics charge Ritalin abuse levels have soared in the past few years.
Not only does the U.S. Drug Enforcement Agency classify Ritalin with cocaine and amphetamines as a Schedule II drug, but the use of such medication in children for a disorder that is basically a "fabrication" of the medical community is comparable to "disabling their brains," according to one physician with more than 30 years experience.
"Ritalin is harmful to the brain, and to overall growth," Dr. Peter Breggin said. "Ritalin addiction is becoming increasingly problematic ... and ADHD is a completely fabricated diagnosis with no medical or psychological basis to it."
Still, others in the same field as Breggin view Ritalin in a more positive light.
"There's a good response to [Ritalin]," said Dr. Bruce Meyer, a pediatrician with 30 years' experience who now works with the Columbus Children's Hospital in Ohio. "For the child who is defined by the criteria as having [an attention deficit disorder], there's a tremendous and remarkable success, so the child is able to function in school and function with peers."
Meyer is a general pediatrician, but he also works in the behavior and learning disability area, which means he "sees these kids" with attention disorders "all the time."
Confident in his personal ability to diagnose Attention Deficit-Hyperactivity Disorder, Meyer also admitted that between one and three of every 10 children referred to him for additional analysis and possible treatment are improperly suspected of having ADHD.
"Some come from the parent, some come in from the teacher," he said, adding that he did not know whether those to whom he refused Ritalin were later given the drug by different doctors.
It's a difficult disorder to identify, according to Meyer, so some children are erroneously referred for Ritalin treatment. However, by using proper testing, children can be accurately diagnosed, he said.
Meyer said he performs a complete evaluation of the patient's home and school life, incorporating the opinions of teachers, administrators, parents, clergy, and relatives into any decision to prescribe Ritalin.
"You spend a fair amount of time with the family and child," he said. "The family needs to supply information about [the student's behavior at] school as well as any other information. You put all that together, because there is no specific one test," and then the diagnosis can be made.
Therein lies the problem, according to critics of Ritalin and the diagnosis of ADHD.
Because the diagnosis depends entirely on the perceptions of behavioral abnormalities, opponents say, the margin for error is too wide. Some also accuse the medical field of fabricating the entire syndrome known as ADHD.
"It's not as acute as the numbers would indicate," Meyer said about the apparent explosion of ADHD and Attention Deficit Disorder diagnoses in the past decade. "But the diagnosis of this disorder has been going on over 30 years. It's been called other things, though, [like] minimal brain dysfunction, minimal brain damage."
Still, Meyer acknowledged some critics of Ritalin have a basis for argument; ADHD is "over-diagnosed," he admitted, with an estimated "five to 10 percent of kids in any school" branded with the attention disorder. Guidelines released just months ago, however, should help clarify the diagnosis procedures, he said.
The American Academy of Pediatrics released a report in May, explaining the diagnosis and evaluation procedures to use with patients between the ages of 6 and 12 who are suspected of having ADHD.
Prior to that report, doctors prescribed Ritalin based on information they had gathered from individuals close to the child who could prove he or she was too inattentive in formal and social settings to be considered normal, and was otherwise hyperactive, impulsive, failing in school, and displaying other behavioral problems.
The AAP has yet to release the follow-up to that report, which will detail the treatment methods for those with ADHD.
"First we had to develop diagnostic guidelines, and those were released earlier this year," said Sheryl Cash, with the public affairs department of the AAP in Illinois. "Then, we felt we had to develop treatment guidelines. We're working on that now. They should be completed within a year."
Diagnostic criteria for ADHD in children, according to the AAP's May report, includes an assessment of six or more symptoms of inattention, hyperactivity, and/or impulsivity that have continued for six months or longer in at least two social or formal settings, such as home and school.
The report said if a child often "makes careless mistakes in schoolwork," "does not seem to listen when spoken to directly," "has difficulty organizing tasks," "avoids, dislikes, or is reluctant to engage in tasks" such as schoolwork or homework, becomes "easily distracted by extraneous stimuli," and is "often forgetful in daily activities," he or she could possess an attention and hyperactivity disorder, if those symptoms are present in a way that is determined "inconsistent with developmental level."
Other signs indicating a potential disorder are if the child - to a degree considered abnormal - fidgets with his/her hands or feet, leaves his/her classroom seat unexpectedly, runs and climbs "excessively" in "inappropriate situations," has difficulty playing quietly, talks "excessively," "blurts out answers before questions have been complete," shows difficulty waiting for his or her turn, "often interrupts or intrudes on others," or behaves in an over-active manner.
While the AAP works to complete its treatment report, opinions and research findings on the safety of Ritalin - methylphenidate - continue to vary.
"It's not addictive," Meyer said, "but it can be abused. But for the routine day-to-day practice of treating kids ... it is a safe medication."
Doctor Calls Ritalin Form of Drug Abuse
By Cheryl K. Chumley
CNS Staff Writer
September 20, 2000
This is the second of a three-part series series on the controversies surrounding Ritalin, the frequently prescribed drug for childhood attention disorders.
(CNSNews.com) - Congressional testimony from the U.S. Drug Enforcement Administration in May verified and clarified earlier findings regarding the addictive properties of Ritalin when abused.
Classified as a Schedule II controlled substance along with cocaine and amphetamines, the stimulant known clinically as methylphenidate has the potential to cause psychological and physical dependence.
Possible effects, according to the DEA Internet site, include "increased alertness, excitation, euphoria, increased pulse rate and blood pressure, insomnia, and loss of appetite."
Withdrawal symptoms, according to the Internet description, consist of "apathy, long periods of sleep, irritability, depression, and disorientation." Hallucinations, convulsions, and death can result from an overdose.
Ritalin, however, is still considered safe when prescribed for medical reasons, said Rogene Waite, a public information officer with the DEA in Washington, D.C.
"If they take it correctly, under a doctor's care, they should be fine, if the doctors are conscientious, if the teachers are conscientious, if the parents are conscientious," Waite said. "However, the potential for abuse is there."
Terrance Woodworth, deputy director of the DEA's office of diversion control, testified in May before a Congressional committee on education and the workforce that "the medical use of stimulants in the treatment of ADHD in children continues to escalate," and the abuse of Ritalin "has increased significantly since 1990."
Ritalin abusers are classified as such if they acquire, purchase, and sell the stimulant illegally. However, those children who have been erroneously diagnosed with Attention Deficit-Hyperactivity Disorder and treated with Ritalin may also be categorized as abusers, according to Woodworth.
"A number of questionable practices have contributed to the diversion and abuse of stimulant medication, including improper diagnosis, lack of adequate information to youth, parents, and school regarding the abuse potential of these drugs, and lax handling of medication," Woodworth indicated during his congressional testimony.
United Nations statistics indicate the U.S. "produces and consumes about 85 percent of the world's production of methylphenidate," he continued.
The reasons for that high percentage of consumption can be attributed, in part, to the various reasons used by American doctors to diagnose ADHD.
A National Institute of Health expert panel reported in 1998 that the methodology used by physicians to diagnose the disorder varied to such a great degree that an untold number of prescriptions for Ritalin had been inaccurately written. Conversely, the NIH also said there's evidence that "under-diagnosis" of ADHD was a problem in some areas of the country, Woodworth said.
The decision by a doctor to prescribe Ritalin also appears to be based, in part, on where that doctor lives and works. Those doctors living in New Hampshire and Vermont, for instance, recommended Ritalin for their patients between three and four times more often than did physicians in California and Hawaii, according to the DEA.
While the number of children actually diagnosed in the U.S. with ADHD remains an "unknown," Woodworth reported, evidence gathered from "poison control data, emergency room data, and high school surveys all indicate that the abuse of methylphenidate has increased significantly since 1990."
Woodworth added that data has proven "neither animals nor humans can tell the difference between cocaine, amphetamines, or methylphenidate when they are administered the same way at comparable doses. In short, they produce effects that are nearly identical."
Woodworth's report and others like it have critics of Ritalin alarmed.
One of the perceived problems is with the nonspecific statistics detailing both the numbers of children treated with Ritalin and the numbers of ADHD diagnoses nationwide.
In fact, statistics vary depending on the source. Grandparents and Parents Against Ritalin, Inc. estimates two million children nationwide are on Ritalin and 3.5 million adolescents have been diagnosed with "some form of ADHD."
The DEA maintains the number of adolescents labeled with ADHD is unknown. And the American Academy of Pediatrics reports "hyperactivity or inattention is diagnosed in nine percent of children" aged six to 12. It says the US has seen a "several-fold increase in prescriptions for stimulant medication among children" in the past 10 years.
"I have never had a child in my practice that I couldn't calm down in an hour. That means [ADHD] is not a neurological disorder," said Dr. Peter Breggin, in response to statistics indicating the disorder is on the upswing.
Breggin, an outspoken opponent of Ritalin use and a cynic of the ADHD syndrome itself, has maintained a medical practice since 1968, is the author of several books and publications outlining the risks associated with adolescents' use of stimulant drugs, and is the director of the International Center for the Study of Psychiatry and Psychology in Bethesda, MD.
Better parenting skills, he said, should replace drugs as the solution to perceived adolescent behavioral problems that are not diagnosed based on physical reasons.
"ADHD is a completely fabricated diagnosis with no medical or psychological basis to it," Breggin said, outlining what he called the ludicrous assessments applied to those suspected of the disorder, like fidgetiness, the tendency to blurt out answers, and the inability to apply adequate attention to homework.
Prescribing Ritalin to a child is tantamount to abuse, Breggin said, describing the known effects of stimulant drugs on animals tested in laboratory settings. "It's worse than beating a child on the behind," he said. "It's more like beating the child on the brain.
"If you give stimulant drugs in relatively small doses to any animal, they crush all spontaneous behavior, like escape attempts, exploratory activities, socializing, grooming," he continued. "When you do this to a child, it's the same.
"Basically, the medication only works by disabling the brain of the child. The only reason you want to prescribe [stimulant drugs] to the child is if you want him in the disabled state."
Ritalin also stunts a child's growth, Breggin said, by suppressing the appetite and "disrupting" the ability of the growth hormone to function.
Breggin - who believes five or six million American children have been improperly diagnosed with ADHD - said physicians prescribing Ritalin should instead focus their efforts as he does, on deciding first if the child has difficulty "adjusting to the world" in general, or "just has a problem at school" versus "at home," and then on applying proper counseling techniques.
No matter what, he continued, parents should refuse to listen to medical providers or others who advocate drugs as the only answer.
"I'd do home-schooling before I'd drug my child," Breggin said. "It's wrong to prescribe [Ritalin]. I don't think we should do this to our kids, period. We're knocking off our best and our brightest, and we need to reclaim our children."
Breggin also pointed to United Nations and National Institute of Health statistics and findings as evidence that those outside the US do not view common childhood behavioral problems as worthy of drug treatments.
"The Europeans think we're crazy," he said.
For Some, Refusal of Ritalin is the Problem
By Cheryl K. Chumley
CNS Staff Writer
September 21, 2000
(This is the third of a three-part series series on the controversies surrounding Ritalin, the frequently prescribed drug for childhood attention disorder.)
(CNSNews.com) - As the American Academy of Pediatrics works to complete its treatment guidelines for adolescent attention disorders, some in the nation are finding their battle against Ritalin a lengthy and expensive one.
One couple living outside Albany, NY also found the fight futile.
When Jill and Michael Carroll decided to halt Ritalin treatments for their seven-year-old son because of a concern over side effects, the county's child protective services took them to family court.
"The Ritalin affected his appetite, and his parents took him off," said Chris Weddle, an attorney with the firm that helped defend the Carrolls. "The Department of Social Services filed charges against them for educational neglect."
Under pressure from the school, the child services, and the judge - and concerned that their son could be taken from their custody - the Carrolls agreed to comply with the order of the psychologist who had previously prescribed Ritalin.
Though the Carrolls were allowed to pursue a second opinion from another medical practitioner who could have recommended the disuse of Ritalin, the case gave critics of Attention Deficit-Hyperactivity Disorder more ammunition to continue the fight.
It also reinforced the fears of parents who feel their custodial rights are being replaced by the advisements of school administrators and the opinions of doctors.
"The school districts like Ritalin because it keeps children calm," said Richard Wexler, executive director of the National Coalition for Child Protection Reform in Alexandria, VA. "They definitely have a vested interest. Special education [for problematic students] is one of the biggest costs schools face."
Wexler wondered whether some teachers and administrators purposely tout the benefits of Ritalin because they know better behaved children will need less segregation and individual tutoring and the costs of specialized education programs will be lower.
If that isn't true, Wexler asked, "Why are 20 percent of the white children in some school districts on" the stimulant?
"Whether or not the districts do this to keep children quiet, the fact is, that's where the vested interest lies," Wexler said.
"I'm not saying Ritalin is bad for all children," he continued. "It's genuinely beneficial to some. But I am saying the best people to make that decision is the parents."
The manufacturer of Ritalin also has a vested interest, according to a class action lawsuit involving hundreds of people, filed in May by the Dallas, TX firm, Waters and Kraus.
Dr. Peter Breggin, director of the International Center for the Study of Psychiatry and Psychology in Bethesda, MD and a practicing physician for more than 30 years, is acting as a medical consultant on the lawsuit, which alleges the manufacturing company Novartis, the American Psychiatric Association, and a parents organization "committed fraud in conspiring to over-promote the diagnosis [ADHD] and its treatment with the stimulant drug, Ritalin" in order to gain financially from the endeavors.
The parents organization Children and Adults with Attention Deficit-Hyperactivity Disorder is accused of participating in the conspiracy because "it is partially funded by drug companies," according to the press release documented on Breggin's Internet site.
To some, common sense dictates that parents should decide whether their children are prescribed Ritalin, since the American Academy of Pediatrics has only just released its diagnostic guidelines for ADHD, and is still working to complete its treatment advisements, due for release within a year.
Even when that document is finished, however, and the methodology for prescribing Ritalin and other attention disorder drugs is based more on hard fact than perception, comparison, and opinion, another concern will remain unanswered: what are the long-term negative effects of methylphenidate on children?
"The long-term effects of stimulants remain in doubt," the National Institutes of Mental Health reportedly concluded in 1992. The organization recently stated that "a great deal of research is still needed to determine the effects and benefits of medications in children of all ages."
As the research progresses, Breggin and nearly a dozen others continue more formal attempts to spread a drug-free message. A three-day conference in New York on Sept. 22nd was aimed at "Reclaiming Our Children." from the perceived adverse affects of medically prescribed Ritalin and other stimulants.
Speakers there will try to teach, among other things, how to work with "ADHD diagnosed children without drugs" and ways to critique the "psychiatric drug research" process.
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