“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?