“Ring out the old, ring in the new” is a popular refrain on New Year’s Eve, but, unfortunately, there seems to be a lot of ‘déjà vu all over again,’ in Yogi’s memorable phrase, particularly when it comes to medicating children.
In mid-December the New York Times reported that poor children are four times more likely to be given powerful antipsychotic drugs than their middle-income counterparts. One study cited in the reporting indicates that poorer children also receive these strong drugs for less serious conditions. Why? Several explanations are offered: Medicaid pays less for psychotherapy and counseling than does private insurance; fewer counselors are available for the poor; and drugs are easier. As one co-author noted, “A lot of these kids are not getting other mental health services.”
That’s today’s news, but for me it literally is déjà vu all over again, because I have reported on this same issue twice, first in the 70’s and again in the mid-90’s.
Back in the late 1970’s when I was with NPR, I spent a couple of months in mental hospitals for poor and middle class children in Maryland and Texas. It was truly horrifying to see how young children whose major problem seemed to be poverty were being drugged. As I recall, their Medicaid coverage was limited to a small number of weeks, after which they were simply released to the streets. By contrast, the children of the well-to-do were less likely to be medicated, more likely to have one-on-one counseling with a psychiatrist, and so forth.
One teenage girl told her story of being walked to the highway and told to hitchhike home. She said a group of young men picked her up, took her to an apartment for sex, and then let her go. Her language was far more graphic, but we ran the story as she told it, with an advance warning to stations. Despite the warning, “Children in Mental Institutions” got me kicked off the air in parts of Texas. (It also led to a lifelong friendship with Fred Rogers of Mister Rogers’ Neighborhood, who happened to hear the program and wrote me a lovely letter about it.)
Fast forward to 1995, when my colleague John Tulenko and I reported on Attention Deficit Disorder. A.D.D.: A Dubious Diagnosis? followed the money trail and showed that, while the disorder was genuine, the A.D.D. epidemic was man-made. We learned that the maker of Ritalin, the popular A.D.D. drug, was quietly funneling money to a supposedly neutral parents’ group called CHADD. CHADD had managed to infiltrate the U.S. Department of Education, which had underwritten a series of so-called ‘public service announcements’ in which CHADD leaders passed themselves off as ordinary parents and praised Ritalin. Simultaneously CHADD was lobbying Congress to change the drug regulations to make methylphenidate—generic Ritalin—easier to come by. At the time the U.S. was consuming about 85 percent of the world’s supply of the drug. When we made the film, several million kids were being medicated, the large majority of them white teenage boys.
We found one heartening piece of good news in that story: African American parents were not inclined to accept a diagnosis that required medicating their children, whether the diagnosis came from a teacher or a counselor, because, as one parent told us, “We have enough drugs in our community. I don’t believe that more drugs are a solution.”
A.D.D. is a peculiar disease. It says, ‘You are deficient because you aren’t paying enough attention to what we (your teachers or your parents) think is important. And so we will medicate you!”
Gene Haislip of the Federal Drug Enforcement Administration Office was responsible for determining annual production quotas for methylphenidate and Ritalin. Haislip told us that, while there was a window of legitimate use for the drug, the data suggested, “this has become a popular fad…especially when you realize that the United States is using five times as much as the entire rest of the planet.”
As journalists are trained to do, we asked, “Who benefits?” We were shocked to discover when we followed the money trail, that Ciba-Geigy, then the primary producer of Ritalin, was covertly funding a parents’ group known as CHADD, Children with Attention Deficit Disorder . While not illegal for a pharmaceutical company to fund non-profit organizations, the transactions (more than $800,000 over three years) were made public, if at all, in very small print. CHADD maintained that there was no quid pro quo, but its widely distributed materials recommended Ritalin by name to parents concerned about their children’s behavior.
Although the American Psychiatric Association recognizes ADD as a mental disorder, the exact cause is unknown, there are no medical tests for it, no clear medical or physical evidence exists of its condition, and the identifying characteristics are blatantly subjective. They include fidgeting with hands and feet, squirming in your seat, getting out of your chair when you’re supposed to sit still, and running about and climbing excessively. That’s a perfect description of millions of impatient children in crowded classrooms.
Clinching the case for us, however, was the first-hand testimony of many boys and their parents, all of whom noted that the condition seemed to disappear during summers, and even on weekends. Whenever school was not a part of their lives!
CHADD, however, was telling concerned parents that ADD was a neurobiological disorder that stemmed from a chemical imbalance in the brain. Ritalin, a psycho-stimulant, presumably corrects that imbalance by activating neurotransmitters– the chemicals that carry messages in the brain.
We learned that teachers often recommended Ritalin for certain children. One parent whose son had been recommended for the drug implicated school districts in the growth of ADD. “They’re trying to cut their budgets and trying to keep big populations in the classes, and they can’t have kids who are not under control. Teachers are more than happy to have kids on Ritalin, if it in fact will control their activities in the classrooms.”
Some parents accepted a diagnosis of ADD because it offered a more palatable explanation for their child’s behavior. Helen Blackburn, an educational psychologist for the Greenwich, Connecticut, public schools, put it this way. “Parents want a school-based reason why a child isn’t doing well. And to say that a child is not bright, that he may be a ‘slow learner,’ or that family issues are causing the problems in school, parents don’t want to accept that. They want a diagnosis and a label that then makes the school responsible for solving the problem.”
There are always doctors who will prescribe Ritalin for a child. Simon Epstein, a child psychiatrist in Connecticut, said he prescribed Ritalin for about 150 children a year. He explained his dilemma. “If I tell them that I don’t think it’s clinically indicated, the parents will just go elsewhere. If that’s what they want, they will go on until they find somebody who will prescribe it. ”
We discovered that some CHADD leaders had engaged in dubious behavior of their own, even going so far as to infiltrate parental information videos distributed by the U.S. Department of Education. On these videos, several ranking officials of state ChADD chapters present themselves as ‘typical parents’ agonizing over their children’s condition and then extolling the virtues of Ritalin. An embarrassed Department of Education hastily withdrew the videos after we reported the clear conflict of interest.
At one point, I asked Dr. Parker if he felt compromised by accepting money from Ritalin’s manufacturer and then recommending the drug? Did he feel ‘bought’ by Ciba-Geigy? “I don’t feel bought,” he said. “I feel they owe us that as a matter of fact. I feel they owe it to the parents who are spending their money on medication. They owe it to these families to give them something back.”
Dr. Gene Haislip of the DEA was incredulous. “You mean he really thinks there’s nothing wrong in taking this money and keeping it a secret like they have? Well, I think it’s an outlandish statement to make really, and I must say it surprises me.”
A Ciba-Geigy spokesman expressed satisfaction with the arrangement. “We’re getting big information out there and I think that’s the bottom line here…CHADD is essentially a conduit, providing this information directly to the patient population, and they do a pretty good job of it.”
Subsequently CHADD actively lobbied Congress, something non-profit organizations are not allowed to do, to make it easier to get methylphenidate, the generic form of Ritalin! This despite the gruesome fact that, at the time, the United States was consuming 85 percent of the world’s supply of the drug. ChADD’s lobbying effort was defeated, and for a time the consumption of methylphenidate actually fell. Since then, however, more studies have ‘proven’ that methylphenidate works, and today at least five per cent of our children, most of them young middle class boys, take Ritalin or a similar drug.
Of course it works. It dulls the senses and makes it easier to control a class. For the small number of children who actually are hyperactive and whose condition does not seem to respond to improved diet or more personal attention, the drug may be necessary. For most children, the behaviors that often lead to a diagnosis of ADD are situational and can be changed: smaller classes, more personal attention, less sugar and caffeine, and maybe more hugs at home.
But instead we medicate and, in so doing, deliver a pernicious message: “You have something wrong with your brain, but this little pill will make everything better.”
And apparently we are still sending that pernicious message today. But why not drug kids? It’s cheaper, faster and easier than individual counseling (or attending to underlying problems). And what the heck, they’re other people’s children, not ours, right?
Anyone out there have a New Year’s Resolution to suggest about medicating our children?
The Merrow Report 
I remember well your 1995 documentary on A.D.D. and it’s revelations about drug company influence. And I am happy that your group has continued to do the very best reporting on the education and health of our youngsters. Keep up the great work!
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Thank you for this eye opening report.
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John this makes me furious! I’m used to groups manufacturing science to sell school “reform” but this is the first I’ve read about ChADD. What a disgusting group! That the U.S. consumes 85% of Ritalin does not surprise me. We are, I think, a nation of quick fixes. While some children certainly have dis-ease that can be medicated, a good deal of dis-ease in the classroom, as you note, can and should be taken care of without drugs.
While I do love your rhetorical final question. I will go ahead and bite and say while they are other people’s children, they do live in our shared spaces, interact with our own children, and go on to become the adults who are supposed to hold this society together. They are therefore a matter of general concern.
We might also take a look at some of the classrooms and teachers who have a significant number of children on drugs in order to endure the teachers and their teaching. Perhaps many children can’t concentrate because they are bored out of their skulls by an education system rooted in the the late 1800s.
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John, I agree with your huge concern about this. But what the article does not address is the long term effects of this drug, or what happens when the kids are taken off it. Is there research done on this? I suspect there is a compelling disturbing story here as well. Marjorie
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I’m a former children’s social worker who investigated allegations of child abuse. I was amazed at the number of reports I received of abuse or neglect from teachers, principals, and school counselors that were false or exaggerated in order to coerce uncooperative parents into medicating their children. In almost all of these cases, I saw little evidence that the child suffered from ADD or ADHD.
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John, I’m glad you qualify your report by noting that sometimes the use of medication is warranted. Scientologists and those (such as Dr. Peter Breggin) who have connections with Scientology will probably use your report to argue that there should be no use at all of psychotropic medications. Breggin and the Scientologists have argued for years that there is no such thing as mental illness (although Breggin does say there is something he calls “psychic overwhelm”), and they also claim that psychotropic medications actually cause the mental problems they are supposed to cure. Breggin and Co. don’t explain why mental illness has been described and reported for centuries, even though psychotropic medications have been around for little more than fifty years. Nevertheless, the problem you’re describing is real and needs to be addressed. One big step toward solving the problem would be to fix our broken mental-healthcare system. In Dr. E. Fuller Torrey’s book “Out of the Shadows,” he explains why the system is broken and says what must be done to fix it. If we would follow Torrey’s suggestions, mental health care would be available for everyone in this country, regardless of socio-economic status, so all parents would have access to psychotherapy for their children if they needed it. Real health care reform would help to move us in that direction.
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I have long suspected that the prevalence of Ritalin prescriptions was and is unwarranted. My New Year’s resolution with reference to medicating our children is to change the way we deliver mental health care services. No one should be denied counseling services or psychotherapy. Nor should these services be limited to ’20 visits per year’ as my insurance plan stipulates. The human body should be treated as a whole. To divide and separate the various parts of the body for treatment — eyes, teeth, brain, feet, and the rest of the body — is to deny the very plain and logical fact that these various parts work together to make up a fully functioning human being. Neglect one part and you compromise the whole. Periodontal disease has been linked to heart disease and yet many people cannot afford dental insurance or going to the dentist at all. And everyone out there knows someone whose mental health problems are affecting that individual’s general health. You don’t have to be Einstein to see that good preventative health care — including counseling — is a solution to many health problems and would, I believe, greatly curb this dangerous drug habit we have foisted off on the children of this nation.
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When the documentary aired in 1995, it became a favorite of what might be called ‘the Bregginites’and the Scientologists. Dr. Breggin is in the film, by the way.
It continues to be shown, incidentally. For many years I stayed in touch with some of the kids who were put on Ritalin, including one who took himself off the drug.
Marjorie’s question about long-term impact is a valid one. I suspect that message, ‘here’s a pill for your problems,’ has created a mind-set about how to cope with subsequent problems, but I don’t know if anyone researched that.
If you haven’t see the documentary, please take a look now.
John
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It’s so wonderful to meet a kindered soul! I’m a pediatric occupational therapist and have first hand experience as a participant in the diagnostic and medication mania in school settings. The outcome of the inflitration of health care workers into the education system has not been a positive one for many children, and I’m sad to think I was a part of this for many years. I’m now actively doing workshops/webinars for teachers and occupational therapists on this topic of overmedication of children, but it seems as if this trend has escaped all reason and sense.
I developed the following 10 step programs for schools as a behavior management strategy, that your readers might be interested in. They can find it here: http://www.zonein.ca. Good luck John, and Thank You for all that you do to support children!
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As a 47 year old adult currently winding down a course of stimulants for a very thoroughly diagnosed case of ADHD I can quite confidently say that stimulants do not dull the senses. In fact they markedly increased my ability to focus on whatever I was doing at the time. When one is in the ADHD state it really is like being lost in a fog- and the vividness of the world when stimulants bring you to your senses is a joy to behold. I have chosen to focus on learning about attention and meditation- and the medication is now often redundant, except when I am overtired and should by rights be going to bed ( in a more civilised world). Interestingly the course I have chosen makes the vividness of the initial stimulant experience accessible all the time.
I am certainly not of the opinion that stimulants need to be used long term or should be the sole treatment- but when one is down in a hole of complete confusion they are very helpful.
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I might add that current understandings of ADHD are proposing that it is an intermediate phase in the development of a range of mood and anxiety disorders.
Ref Dr Thomas E Brown:
“Regardless of how comorbidity between ADHD and other disorders
might be defined and measured, the incidence of overlap
tends to be much higher than for other combinations of disorders.
One obvious question arises from these high rates of comorbidity:
Why are individuals with ADD so much more likely
to have additional psychiatric disorders? The sequence of appearance
of these disorders offers a clue: usually ADHD is the first
psychiatric disorder to appear, whereas other disorders emerge
later in childhood, adolescence, or adult life.
One possible explanation is that ADD is not just one more
among other psychiatric disorders; it may be foundational in the
sense that a person with ADHD-related impairments of executive
function is more vulnerable to other psychiatric disorders.”
The pdf of “ADHD and Cooccurring conditions”- (of which the above is an extract) can be found at
http://www.drthomasebrown.com/research/index.html
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For what it’s worth, I’d like to add that the various uses for Ritalin are not lost on it’s users. I graduated high school in 1995 and saw a lot of Ritalin abuse during my high school, and later, college years. It was traded, sold and shared, and then either swallowed or snorted in combination with alcohol. Kids would say, “Oh, I only take it when I really need to focus. The rest I share with my friends.” I tried it once in a recording studio, at 19, on the recommendation of a 28-year-old who told me that a line of Ritalin and some whiskey gave him the relaxation and focus to work at his best. I’m sure there are legit Ritalin users out there, but personally, I’ve only seen it as a super easy-to-get recreational drug.
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As the grandmother of a child with ADHD and as an educator I can’t let this article go without a comment. We knew Sam had special needs when he hit the public school system at age 5. He was lucky in kindergarten where he had a male teacher who understood his need to move around and to touch things. School came to a crashing halt when he got to first grade with a series of female teachers. Thus began our quest to find someone who understood that children, especially boys, need to move, touch, explore their learning environments not as my friend Nancy Rambush (American montessori) used to say “sit down, shut up, and count to 100.” My daughter was called almost daily to get her report on Sam’s behavior (now she gets a daily email). When we discovered Sam was not learning to read my daughter asked that he be evaluated. He got a dx of ADHD and learning disabled…enough disability to qualify him for support services. We thought this was a breakthrough….boy were we wrong. Sam ended up in a resource room with children performing far below him. Pretty soon he didn’t want to go to school anymore. His behavior at home wasn’t that great either and no reward or punishment made a difference. We knew our only hope was to get Sam back into a regular classroom. After resisting for 8 years my daughter finally took him to a psychiarist who prescribed meds for Sam. After a few adjustments in doseage Sam is a different child. He’s still cute, funny, charming, inquisitive, sensitive and smart. He’ll probably be Ivy League material. He’s back in the regular classroom and still can’t read. Somehow he managed to be “proficient” in reading and language arts and “above proficient” in math and science on the state standardized tests despite his inability to read. When he encounters a new teacher my daughter can count on a 3pm call from the school. The school failed Sam. Sam’s only hope was the meds. He still struggles on a daily basis but we remind ourselves that it could be worse. And he doesn’t hate school anymore.
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John, as usual you have struck a sensitive chord not only in the educational world, but in our society as well. It seems, particularly in the US, we opt for the “quick fix” whenever given the choice of short term benefits over long term solutions. After decades in the high school classroom, I answer your rhetorical question with a resounding, “NO!” These kids ARE OUR kids in the sense that our mission as teachers is defined by the relationships we either build or destroy in our daily classroom interactions.
My best friend, a physics teacher of many years, had a nice analogy that, whenever we point a finger at someone else, remember we have three fingers pointing back at ourselves.
A Jan 2 article in the “American Statesman” reported on the effects on parents and teachers of Central Texas parents being able to access their children’s grades on line. An Austin teacher points out some obvious advantages to the policy, but also observes the added pressures on teachers for rapid reporting of grades, adding another layer of duty to already over-crowded schedules, and especially failing to “help students who need it the most.” Here, low income parents without Internet access cannot benefit from this policy the way higher income aggressive parents can and do. Like the excessive use and promotion of ADD drugs, the idea is that the problem lies with the child, not the parent and family. And, once again, our public schools are singled out as the locations for fixing problems which do not originate with them. The problem with overly-medicated persons is that this hides the real causes for bizarre behaviors (stresses from over-crowding, provocative media blasts, nearly continual stimulation by junk foods, trendy music and lyrics, non-stop schedules in and out of school) and convinces many of us that the problem has gone away. It has, rather, gone underground, and we do not seem to yet have any long-term longitudinal studies of the resulting effects upon adult behavioral problems like depression and addictions.
Often kids I run accross smoking around school will give the stock response that what they are doing does not affect me, so a)why should I care, and b)it is none of my business. We should and must care and it IS our business because the costs, economically (health care and lowered productivity), medically, and socially are costing every one of us in both subtle and obvious ways.
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Wow……so many differing opinions, perspectives and stances are reflected in these comments. There is, in America, an epidemic of children being diagnosed with mental illnesses. Children, some as young as 2 years old, are being diagnosed with mood, conduct and bipolar disorders, autism spectrum disorder, pervasive developmental disorder, speech and language disorders, poor social skills, sensory integration disorders, anxiety and depression. And in the world of child psychiatry these subjective diagnoses are tossed around like bargain basement merchandise. But it’s ADHD that within 30 years has gone from a rare disorder to an unprecedented epidemic. This controversial topic has sparked a fiery debate which has created a contentious atmosphere. Many healthcare professionals, parents and teachers are convinced that ADHD is a heritable genetic neurobiological disorder caused by a chemical imbalance in the brain. On the other end of the spectrum there are opponents who denounce ADHD as a valid or legitimate medical disease. They contend that the diagnosis of children and the incautious use of drugs obscures and leaves unaddressed the social and environmental factors in children’s lives that may be the real source of the problem. ADHD turns out to be a misnomer and people who have symptoms have remarkably good attention spans as they are doing activities that they enjoy or find stimulating. In essence, ADHD is context driven and isn’t a disorder at all during hands-on activities or ones that reward spontaneity.
Is the ADHD epidemic sweeping our nation about learning disabilities or it it about learning to be disabled? It is about scrambled neurotransmitters and chemical imbalances or is it about increased market share for drug companies, increased funding for research, increased business for practitioners, increased funding for special ed, and increased sales of books, tapes, seminars and other products and services? Are children the raw materials for the ADHD industry? Have they simply become funding mechanisms to be screened, labeled and medicated? Someday Americans will wake up and realize the ADHD emperor has no clothes. When dealing with a vague and subjective diagnosis such as ADHD, that may stigmatize an individual for life, we need to make absolutely certain that fact and fiction aren’t confused in the name of science and that public policy and guidelines are based on scientific research and no by judgments based on speculation of certain individuals and institutions.
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There are indeed many Boring teachers and teachers who cannot control their children. However, there are also many children with mental and emotional disorders. The problem is you can’t see them in the same way you can see a broken arm.
There are also many children with learning disabilities and, because they go undiagnosed, these kids get frustrated when they can’t keep up, and yes, they can be disruptive. CHADD should be put out of business. But schools need to do a much better job of getting kids with disabilities tested, and getting qualified psychologists to help with mental and emotional problems.
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In response to Jim MacGuire, Peter Breggin has nothing to do with Scientology. And it is not true that he believes mental illnesses don’t exist. He is very aware of the existence of mental illnesses.
But he knows and can cite mountains of scientific evidence that all psychotropic drugs impair the brain, that they all are associated with tolerance and withdrawal effects and that people who take the neuroleptics like Zyprexa, Risperdal, Geodon and Abilify – which includes millions of children in this country – will die 25 years younger than other people.
He also knows and can cite mountains of scientific evidence that good psychotherapy is more effective than medication and is associated with a much lower relapse rate. The biggest problem with the use of medication is that it prevents people from dealing with the cause of their symptoms and deprives them of an opportunity to learn how to manage their emotions and thoughts so that they can learn how to live the way they want to live.
Get your facts straight Mr. Macguire.
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Mr. Galves, I have read some of the books by Breggin and by his mentor, Thomas Szasz. If you had read their books, you would know that they argue that mental illnesses were dreamed up by psychiatrists to give themselves jobs. I know a number of people who have mental illnesses and my facts are straight. Good psychotherapy is an essential part of the treatment for those with mental illnesses, but psychotherapy alone is not enough. I don’t deny that when poor diagnoses are made, both psychotherapy and medications may not help and may make the illness worse. But Peter Breggin and those who argue as he does that all psychotropics impair the brain are denying facts that are well established and known to millions. And your denials can cause harm to people whose loved ones have just been diagnosed as having a mental illness, because those people may refuse to have their loved one treated with medication. I was someone who accepted what Breggin wrote as fact, and my son almost died as a result.
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What a terrific article. I posted a link to it on the homepage of http://www.MothersofBadBoys.com. The topic of drugs and kids comes up frequently among the mothers and others on the site. Thank you, Mr. Merrow.
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