DEA REPORT
ADD/ADHD Statement of Drug Enforcement Administration
At the conclusion of the
Conference on Stimulant Use in the Treatment of ADHD (ADD/ADHD,
AD(H)D, ADD-ADHD, Attention Deficit Hyperactive Disorder,
Attention Deficit Hyperactivity Disorder, Attention Deficits,
Attention Deficit Disorders, Hyperactivity) San
Antonio, Dec. 10-12, 1996
"Today, we have concluded
a national conference of experts from the fields of research,
medicine, public health and law enforcement brought together
by the U.S. Drug Enforcement Administration (DEA) to examine
issues concerning the prescribing of stimulants to school-age
children for the treatment of Attention Deficit Hyperactive
Disorder (Attention Deficit Hyperactivity Disorder, ADHD
(ADD/ADHD, attention deficit hyperactive disorder, attention
deficit hyperactivity disorder). The principal drug used for
this purpose is methylphenidate, commonly known as
"Ritalin."
The DEA has become alarmed by
the tremendous increase in the prescribing of these drugs in
recent years. Since 1990, prescriptions for methylphenidate
have increased by 500 percent, while prescriptions for
amphetamine for the same purpose have increased 400 percent.
Now we see a situation in which from seven to ten percent of
the nation's boys are on these drugs at some point as well as
a rising percentage of girls. When so many children are
involved in the daily use of such a powerful psychoactive
drugs, it is important for all of us to understand what is
going on and why. The DEA has a responsibility
to the nation to control such abusable legal drugs and to
insure that their use is confined to legitimate medical need.
Certain things have become clear from our deliberations of the
last several days, and the public, parents and decision-makers
need to hear them.
First, let me say that medical
experts agree that these drugs do help the small percentage of
children who need them. But there is also strong evidence that
the drugs have been greatly over-prescribed in some parts of
the country as a panacea for behavior problems. These drugs
have been over-promoted, over-marketed and over-sold,
resulting in profits of some $450 million annually. This
constitutes a potential health threat to many children and has
also created a new source of drug abuse and illicit traffic.
The data shows that there has been a 1,000 percent increase in
drug abuse injury reports
involving methylphenidate for children in the 10 to 14 age
group. This now equals or exceeds reports for the same age
group involving cocaine. The reported numbers are still small
but experts feel that this is only the "tip of the
iceberg."
I do want to emphasize that
medical authorities do believe that ADHD (ADD/ADHD, Attention
Deficit Hyperactive Disorder, Attention Deficit Hyperactivity
Disorder) is a distinct health problem affecting some children
who can be helped by these drugs when prescribed after careful
diagnosis. In those cases,
parents should work closely with their children, the family
physician and school authorities to insure proper
administration and control of the drug. But on the other hand,
when we see that in some localities as many as 15 to 20
percent of the children have been put on Ritalin or a similar
stimulant, there is good reason to conclude that this is
"quick-fix." bogus medical practice which is
nevertheless producing large profits. This far exceeds any
professional estimates of actual need.
Parents need to understand that
we are talking about very potent, addictive and abusable
substances; a potency that can help in the right situation but
can destroy in the wrong situation. Above all, parents need to
educate themselves and protect their children by adopting an
attitude of proper parental caution. Regrettably, much of the
literature and promotion of the drug in recent years has
ignored or understated the potency and abuse potential of
methylphenidate and Ritalin. This appears to have misled many
physicians into prescribing the drug as a quick-fix for
learning and behavior problems.
I want to emphasize that
matters of this kind are vital but cannot be simplified. There
is a legitimate place for these drugs, but we have become the
only country in the world where children are prescribed such a
vast quantity of stimulants that share virtually the same
properties as cocaine. We must
find a better balance. We must turn down the flow which is
rapidly becoming a flood.
In conclusion, I want to call
upon the drug industry, the parent support groups, the
researchers and medical authorities to get a better, more
accurate message out to the public. I want to call upon law
enforcement authorities to root out this new illicit traffic
before it spreads. And I want to urge
parents to educate themselves, protect their children and
teach them a healthy respect for both the good and evil which
drugs can do.
END QUOTE
Above is a statement by:
Mr. Gene R. Haislip, Deputy Assistant Administrator Office
of Diversion Control Drug
Enforcement Administration United
States Department of Justice Washington,
DC (reproduced verbatim in
its entirety)
Submitted by: Jim
Box San Antonio, Texas
The Journal of College Student
Psychotherapy, Vol. 10(2) 1995, pp. 55-72
The Hazards of Treating
"Attention-Deficit/Hyperactivity Disorder" with
Methylphenidate (Ritalin) by
Peter R. Breggin, M.D. and Ginger Ross Breggin
ABSTRACT. The criteria for
Attention-Deficit/Hyperactivity Disorder focus on behaviors
that adults find frustrating and disruptive. Conflicts between
children and adults are redefined as diseases or disorders
within the children. Treatment with stimulant drugs such as
methylphenidate (Ritalin) will produce greater docility in any
child (or animal) without actually improving conduct or
academic performance. Parents are not informed that they are
trading behavioral control for toxic drug effects. The label
ADHD is attached to children who are in reality deprived of
appropriate adult attention These children require improved
adult attention to their basic needs. [Article copies
available from The Haworth Document Delivery Service:
1-800-342-9678.]
Few mental health professionals
can recite the American Psychiatric Association diagnostic
criteria as delineated in the Diagnostic and Statistical
Manual of Mental Disorders-lV (DSM-IV) (American Psychiatric
Association, 1994), even for the diagnoses they routinely use.
But the diagnostic standards are important in setting clinical
and research trends. Their existence creates a strong, if
potentially misleading, impression of validity for psychiatric
diagnosing in general, as well as for the individual
diagnostic categories. The prescription of medication to
children, for example, is largely justified on the basis of
these diagnoses.
The existence of the diagnoses
also influences how millions of parents and teachers view the
children in their care. Most teachers and many parents of
young people have heard of "hyperactivity" and, more
specifically, Attention-Deficit/Hyperactivity Disorder (ADHD).
Many non-mental health professionals believe they can diagnose
it.
THE DISRUPTIVE BEHAVIOR
DISORDERS (DBDs)
Along with Conduct Disorder and
Oppositional Defiant Disorder, ADHD was originally considered
one of the Disruptive Behavior Disorders in the DSM-III-R
(American Psychiatric Association, 1987). In the DSM-IV, an
attempt is made to separate ADHD from the other two disruptive
disorders at least when ADHD manifests itself primarily as
inattention rather than hyperactivity. The DSM committee found
that while disruptive behavior and attention problems
"often occur together," "some" ADHD
children are not hyperactive and disruptive (Fasnacht, 1993).
Despite any attempt to separate
them, the three diagnoses often overlap with each other and
research projects often refer to them as one group, the DBDs.
The DSM-IV observes that "A substantial portion of
children referred to clinics with
Attention-Deficit/Hyperactivity Disorder also have
Oppositional Defiant Disorder or Conduct Disorder." A
National Institute of Mental Health (NIMH) study similarly
observes, "'Pure' conduct disorder or 'pure' opposition
disorder are relatively rare in clinical samples, with most
cases also qualifying for an attention-deficit disorder
diagnosis" (Kruesiet al., 1992).
The DSM-IV does not discuss the
definition of Disruptive Behavior Disorder, DSM-lll-R states
that DBD children are "characterized by behavior that is
socially disruptive and is often more distressing to others
than to the people with the disorders." The
"illness" consists of being disruptive to the lives
of adults-a definition that seems tailored for social control.
ATTENTION DEFICIT/HYPERACTIVITY
DISORDER
The DSM-IV distinguishes
between two types of ADHD, one marked by inattention and the
other by hyperactivity-impulsivity. The official standard for
ADHD requires any six of nine items under each category. For
hyperactivity-impulsivity the first four items in descending
order include:
1. often fidgets with hands or
feet or squirms in seat
2. often leaves seat in
classroom or in other situations in which remaining seated is
expected
3. often runs about or climbs
excessively in situations in which it is inappropriate (in
adolescents or adults, may be limited to subjective feelings
of restlessness)
4. often has difficulty playing
or engaging in leisure activities quietly (p. 84)
The first four items in the
list for diagnosing the inattention form of the disorder
include:
1. often fails to give close
attention to details or makes mistakes in schoolwork, work, or
other activities
2. often has difficulty
sustaining attention in tasks or play activities
3. often does not seem to
listen when spoken to directly
4. often does not follow
through on instructions and fails to finish schoolwork,
chores, or duties in the workplace (not due to oppositional
behavior or failure to understand instructions) (pp. 83-84)
Those who advocate medicating
children often view ADHD as a specific "mental
illness" with a genetic and biochemical cause. But as the
list of criteria demonstrates, it is one more DBD-another way
a child gets labelled as a source of frustration or
disruption. This is true even in regard to some of
the criteria for the inattention aspect of the disorder. As
Gerald Golden (1991) observes: "The behavior is seen as
being disruptive and unacceptable by parents and teachers, and
the child is socially handicapped as a result."
Russell Barkley (1991, p. 13)
states, "Although inattention, overactivity, and poor
impulse control are the most common symptoms cited by others
as primary in hyperactive children, my own work with these
children suggests that noncompliance is also a primary
problem." It is not surprising that some children are
noncompliant with Barkley. He not only wants to medicate them,
he blames the child for conflicts that the child is having
with family and school. As he puts it, ". . . there is,
in fact, something 'wrong' with these children" (p. 4).
He does not make a similar indictment of the authorities in
the child's life, such as parents or teachers, although they
have much more control over the conditions that determine the
child's life and mental condition.
A DISEASE THAT GOES AWAY WITH
ATTENTION
The symptoms or manifestations
of ADHD often disappear when the children have something
interesting to do or when they are given a minimal amount of
adult attention. This is agreed upon by most or all observers
and indirectly finds its way into the DSM-III-R and DSM-IV The
DSM-IV specifies that the symptoms may become apparent when
the child is in settings "that lack intrinsic appeal or
novelty" and may be minimal or absent when "the
person is under very strict control, is in a novel setting, is
engaged in especially interesting activities, is in a one-to
one situation," including being examined
by the doctor. Most advocates of ADHD as a diagnosis also note
that it tends to go away during summer vacation.
WHO'S GOT THE PROBLEM?
If the list of criteria for
ADHD has any use, it identifies children who are bored,
anxious, or angry around some of the adults in their lives or
in some adult-run institutions, such as the school and family.
These "symptoms" should not red flag the children as
mentally ill. They should red flag the
adults as requiring new efforts to attend to the needs of the
children.
When a small child, perhaps
five or six years old, is persistently disrespectful or angry,
there is always a stressor that child's life-something over
which the child has little or no control. Sometimes, the child
is not being respected, because children learn more by example
than by anything else. When treated with respect, they tend to
respond respectfully. When loved, they tend to be loving.
While the source of the child's upset may turn out to be more
complicated than that-perhaps the parent is too afraid or
distracted to apply rational discipline and lets the child run
wild, or perhaps the child is being abused outside the
home-the source always lies in the larger world. Children do
not, on their own, create severe emotional conflicts within
themselves and with the adults around them.
Children aren't bored,
inattentive, undisciplined, resentful or violent by their
individual natures; but the stigmatizing label ADHD implies
that they are. These children are usually more energetic and
more spirited, or more in need of an interesting environment,
than their parents and teachers can handle. One of the early
advocates of hyperactivity as a diagnosis describes them as
unusually dynamic bundles of energy (Weeder, 1973). Yet they
are being diagnosed with a mental illness-a label that can
follow them into adulthood to ruin their future lives.
DAD ATTENTION DEFICIT DISORDER
(DADD)
In my clinical experience, most
so-called ADHD children are not receiving sufficient attention
from their fathers who are separated from the family, too
preoccupied with work and other things, or otherwise impaired
in their ability to parent. In many cases the appropriate
diagnosis is Dad Attention Deficit Disorder (DADD) (Breggin,
1991).
The "cure" for these
children is more rational and loving attention from their
dads. Young people are nowadays so hungry for the attention of
a father that it can come from any male adult. Seemingly
impulsive, hostile groups of children will calm down when a
caring, relaxed, and firm adult male is around. Arlington High
School in Indianapolis was cancelling many of its after-school
events because of unruliness, when a father happened to attend
one of them (Smith, 1993):
" That evening there was
an odd quietness on [the father's] side of the auditorium. It
turned out that when he would tell his group to settle down,
some students would second him. One said: "That's Lena's
father. You heard him. Be quiet; act right." (p. 5)
Since then the school has begun
to enlist volunteer dads for its after-school events.
At other times, the so-called
disorder should be called TADD: Teacher Attention Deficit
Disorder. Due more to problems in our educational system than
to the teachers themselves, few students get the
individualized educational programs that they need.
PROFESSIONALLY DISCREDITED
In 1993 neurologist Fred
Baughman, Jr. noted that studies have failed to confirm any
definite improvement from the drug treatment of these
children. Baughman cites estimates of the frequency of ADD
that vary from 1 in 3 to 1 in 1000. He therefore asks,
"Is attention-deficit hyperactivity disorder, after all,
in the eye of the beholder?"
The eye of the beholder theme
echoes Diane McGuinness who has systematically debunked ADHD
as the "emperor's new clothes." According to
McGuinness in a chapter in The Limits of Biological Treatments
for Psychological Distress (1989):
"The past 25 years has led to a phenomenon almost unique
in history. Methodologically rigorous research . . . indicates
that ADD [Attention Deficit Disorder] and hyperactivity as
"syndromes" simply do not exist. We have invented a
disease, given it medical sanction, and now must disown it.
The major question is how we go about destroying the monster
we have created. It is not easy to do this and still save face
. " (p. 155)
According to Richard E. Vatz
(1993), "Attention-deficit disorder (ADD) is no more a
disease than is 'excitability.' It is a psychiatric,
pseudomedical term."
Frank Putnam (1990), a director
of one of NIMH's research units, recently applauded "the
growing number of clinicians and researchers condemning the
tyranny of our psychiatric and educational classification
systems." Putnam finds that it is "exceedingly
difficult to assign valid classifications" to
children, and yet "children are by far the most
classified and labeled group in our society." He warns
against "the institutional prescriptions of a system that
seeks to pigeonhole them." (p. I)
A PHYSICAL BASIS TO ADHD?
A study led by NIMH's Alan
Zametkin (Zametkin et al., 1990) received a great deal of
publicity for finding increased brain metabolism in positron
emission tomography (PET scans) of adults with a history of
ADHD in childhood. However, when the sexes were compared
separately, there was no statistically significant difference
between the controls and ADHD adults. To achieve significance,
the data was lumped together to include- a disproportionate
number of women in the controls. In addition, when individual
areas of the brain were compared between controls and ADHD
adults, no differences were found. It is usually possible to
massage data to produce some sort of statistical result and
Zametkin's study is a classic illustration.
Since ADHD is not a disorder
but a manifestation of conflict, we doubt that a biological
cause will ever be found. Golden (1991) put it simply:
"Attempts to define a biological basis for ADHD have been
consistently unsuccessful. The neuroanatomy of the brain, as
demonstrated by neuroimaging studies, is normal. No
neuropathologic substrate has been demonstrated . . ."
(p. 36)
Meanwhile, the emphasis on
possible genetic and biological causes of upset behaviors in
children obscures the growing body of research confirming
their psychosocial origins (reviewed in Green, 1989; Breggin,
1992).
NO SPECIFIC DRUG TREATMENT
Contemporary experts agree that
methylphenidate affects all children in the same way and is in
no way specific for children diagnosed ADHD. Golden (1991)
observes, ". . . the response to the drug cannot be used
to validate the diagnosis. Normal boys as well as those with
ADHD show similar changes when
given a single dose of a psychostimulant" (p. 37).
Within an hour after taking a
single dose of a stimulant drug, any child tends to become
more obedient, more narrow in focus, more willing to
concentrate on humdrum tasks and instructions. Parents in
conflict with a little boy can hand him a pill, knowing he'll
soon be more docile.
It is commonly held that
stimulants have a paradoxical effect on children compared to
adults, but these drugs probably affect children and adults in
the same way. At the doses usually prescribed by physicians,
children and adults alike are "spaced out," rendered
less in touch with their real feelings, and hence more willing
to concentrate on boring, repetitive schoolroom tasks.
At higher doses, both children
and adults become more obviously stimulated into excitability
or hyperactivity. There is, however, great variability among
individuals and a number of children and adults will become
more hyperactive and inattentive at the lower doses as well.
The British are much more
cautious about using stimulants for children. Grahame-Smith
and Aronson (1992), authors of the Oxford Textbook of Clinical
Psychopharmacology and Drug Therapy, suggest that stimulants
may work in children the same way they impact on rats, by
"inducing stereotyped behavior in animals, i.e., in
reducing the number of behavioural responses . . ." (p.
141). Stereotyped behavior is simple, repetitive, seemingly
meaningless activity, often seen in brain damaged individuals.
The textbook states somewhat suggestively, "It is beyond
our scope to discuss whether or not such behavioural control
is desirable" (p. 141).
TOXIC PSYCHIATRY
One way to understand the
routine effect of any psychiatric drug is to look at its more
extreme or toxic effects (Breggin, 1991). The clinical or
"therapeutic" effect is likely to be a less intense
expression of the toxic effect. In discussing
methylphenidate's "cognitive toxicity," James M.
Swanson (1992) and his coauthors summarized the literature:
"In some disruptive children, drug-induced compliant
behavior may be accompanied by isolated, withdrawn, and
overfocused behavior. Some medicated children may seem
"zombie-like" and high doses which make ADHD
children more "somber," "quiet," and
"still" may produce social isolation by increasing
"time spent alone" and
decreasing "time spent in positive interaction" on
the playground.!"
Meanwhile, as Swanson et al.
(1992) confirm, there's no evidence that methylphenidate
improves learning or academic performance. This is confirmed
in various reviews (Breggin (1991); Coles (1987); McGuinness
(1989); and Swanson et al. (1992)).
THE LONG-TERM EFFECTS
"REMAIN IN DOUBT"
As the National Institute of
Mental Health succinctly stated, "The long-term effects
of stimulants remain in doubt" (Regier and Leshner,
1992). The FDA-approved information put out by the drug
company, Ciba-Geigy, admits "Long-term effects of Ritalin
in children have not been well established" (Physicians'
Desk Reference, 1994, p. 836). Yet methylphenidate is
typically advocated as a long-term treatment.
NIMH further states that
studies have demonstrated short-term effects such as reducing
"class room disturbance" and improving
"compliance and sustained attention." But it
recognizes that the drugs seem "less reliable in bringing
about associated improvements, at least of an enduring nature,
in social-emotional and academic problems, such as antisocial
behavior, poor peer and teacher relationships, and school
failure."
While estimating that ". .
. between 2 and 3 percent of all elementary school children in
North America receive some form of pharmacological
intervention for hyperactivity," (p. 3) NIMH continues to
encourage giving methylphenidate to increasing numbers of
children.
METHYLPHENIDATE AND COCAINE
Parents are seldom told that
methylphenidate is "speed"-that it is
pharmacologically classified with amphetamines and causes the
very same effects, side effects, and risks. Yet this is
well-known in the profession. For example, Treatments of
Psychiatric Disorders observes that cocaine, amphetamines, and
methylphenidate are "neuropharmacologically alike"
(American Psychiatric Association 1989, p. 1221). As evidence,
the textbook points out that abuse patterns are the same for
the three drugs; that people cannot tell their clinical
effects apart in laboratory tests; and that they can
substitute for each other and cause similar behavior in
addicted animals (American Psychiatric Association, 1989,
p.1221. Also see Breggin, 1991, and Breggin and Breggin,
1994a&b). The DSM-IV confirms these observations by
lumping cocaine, amphetamine and methylphenidate abuse
Before it was replaced by other
stimulants in the 1980s, methylphenidate was one of the most
commonly used street drugs (Spotts and Spotts, 1980). In our
home town of Bethesda, youngsters nowadays sell their
prescribed methylphenidate to classmates who abuse it along
with other stimulants.2 In working with community groups, we
often hear anecdotal reports of individuals who have graduated
from using medically prescribed methylphenidate to alcohol or
street drugs. One of the authors (P.B.) has seen some cases in
his own practice.
Like any addictive stimulant,
methylphenidate can cause withdrawal symptoms, such as
"crashing" with depression, exhaustion, withdrawal,
irritability, and suicidal feelings. Parents will not
recognize a withdrawal reaction when their child gets upset
after missing even a single dose. They will mistakenly believe
that their child needs to be put back on the medication.3
MORE FACTS WITHHELD FROM
PARENTS
Parents are not told that
methylphenidate, as a stimulant, can cause the very disorders
it is supposed to cure-inattention, hyperactivity, and
aggression. When the child becomes worse while taking the
medication, he or she is likely to be given higher doses of
the drug, or an even stronger medication, such as the
neuroleptics thioridazine (Mellaril) or haloperidol (Haldol).
This can result in a vicious circle of increasing drug
toxicity (side effects of methylphenidate are further
discussed and documented in Breggin, 1991).
Rarely are parents informed
that methylphenidate can cause permanent disfiguring tics. One
of us (PB) has recently consulted in the case of a young boy
in whom routine dosage produced disfiguring muscle spasms and
tics of the head, neck, face, eyes, and mouth.
Parents are sometimes told that
methylphenidate can suppress growth (height and weight), but
the explanation is usually given in a manner calculated not to
frighten them. Much of the brain's growth takes place during
the years in which children are given this drug; but doctors
don't tell parents that
there are no studies of the effect of this growth inhibition
on the brain itself. If the child's body is smaller, including
his head, what about the contents of his skull? And if size
can be reduced, what about more subtle and perhaps
immeasurable brain deformities?
Parents are infrequently
informed that like any form of speed, methylphenidate can
often make children anxious and sometimes cause them to behave
in ways that seem "crazy." Most surely, parents will
not be told about any danger of permanent brain damage from
long-term exposure to methylphenidate.
While no consistent brain
abnormalities have been found in children labelled ADHD, one
study has found brain shrinkage in adults labelled ADHD who
have been taking methylphenidate for years (Nashrallah et al.,
1986). The authors of the study suggested "cortical
atrophy may be a long-term adverse effect
of this [methylphenidate] treatment."
Finally, parents will not be
told by their doctor that there are almost guaranteed non-drug
methods to improve the conduct of nearly all so called DBD
children-through more interesting, engaging schools and
through more rationally managed, loving family relationships.
IS ADHD AN AMERICAN DISEASE? A
BOYS' DISEASE?
ADHD is rarely diagnosed in
countries with more evident concern for children, such as
Denmark, Norway, and Sweden, where psychiatric drugs of any
kind are much more rarely given to children. A doctor working
in England's National Health Service is not allowed to give
methylphenidate in routine practice because it is not on the
approved drug list. The doctor could prescribe amphetamines,
which have a similar effect, but this is discouraged and
relatively rarely done.
Males are far more frequently
given DBD diagnoses than females. According to the DSM-IV,
ADHD occurs in boys up to four to nine times more frequently
than in girls and Conduct Disorder is "much more common
in males" in whom the rates vary from 6% to 16%. Aside
from feeling bored or in conflict with adults, why would boys
ordinarily tend to act resentfully and rebelliously toward the
authority of their mothers and female teachers? The simplest
answer is that they are trained to be that way toward women in
general. In fact, most grown men in the world today resent
being told what to do by women.
A multiplicity of factors
contribute to the conflicts and confusion in little boys: How
boys are trained to suppress their tender
("feminine") side and encouraged to be competitive,
dominating and hostile toward women; how these lessons are
imprinted through TV and the entertainment media, and
reinforced in sports and on the playground, as well as in the
family and almost everywhere else in society.
In our modem society, in which
girls receive increasingly confusing messages about
assertiveness, more and more young girls are being diagnosed
with one or another DBD. Often they are girls with special
gumption.
CHILDREN WITH ATTENTION DEFICIT
DISORDERS (CHA.D.D)
Founded in 1987, Children with
Attention Deficit Disorders (CH.A.D.D.) is an organization of
parents who have children labelled with attention deficit
disorders. CH.A.D.D.'s official policy views these children as
suffering from genetic and biological problems. In the words
of CH.A.A.D. president Sandra
F. Thomas (1992), "Our kids have a neurological
impairment that is pervasive and affects every area of their
life, day and night."
CH.A.D.D. leaders claim that
their children's emotional upset and anger is in no way caused
by family conflicts, poor parenting, inadequate schools, or
broad social stressors. A recent CH.A.D.D. brochure,
Hyperactive? Inattentive? Impulsive?, headline announces:
"Dealing with parental guilt No, it's not all your
fault" (CH.A.D.D., undated). After stating that ADHD is a
neurological disorder, the brochure goes on to explain:
"Frustrated, upset, and anxious parents do not cause
their children to have ADD. On the contrary, ADD children
usually cause their parents to be frustrated, upset, and
anxious." (p. 1)
There could be no better
example of child-blaming and parental exoneration.
CH.A.D.D. has followed the
model of its adult counterpart, the National Alliance for the
Mentally Ill (NAMI) (Breggin, 1991). NAMI parents usually have
grown offspring who are severely emotionally disabled, and
they promote biochemical and genetic explanations, drugs,
electroshock, psychosurgery, and
involuntary treatment. NAMI also tries to suppress dissenting
views by harassing professionals who disagree with them (Breggin,
1991). Now NAMI has developed an affiliate, NAMI-CAN-the
National Alliance for the Mentally Ill; Child and Adolescent
Network (Armstrong, 1993). NAMI-CAN, like CH.A.D.D. believes
in BBBD-biologically based brain diseases.
POWER SOURCES
CH.A.D.D. and NAMI parents have
developed enormous influence by joining forces with
biologically-oriented professionals, national mental health
organizations, and the drug industry. But where is the money
coming from to support high-pressure lobbying, media
campaigns, and upscale national conventions a hotels like the
Chicago Hyatt Regency? CH.A.D.D.'s convention program,
"Pathways to Progress," states (CH.A.D.D., 1992):
"CH.A.D.D. appreciates the
generous contribution of an educational grant in support of
our projects by CIBA-Geigy Corporation."
CIBA-Geigy manufacturers
Ritalin, the stimulant with the lion's share of the ADHD
market.
The adult counterpart of
CH.A.A.D., NAMI, has had equal success in its political
efforts. It too is closely aligned with biological psychiatry
and takes money from the drug companies.
SPOTTING ADHD
A recent CH.A.D.D. Educators
Manual was written with the collaboration of professionals,
including Russell Barkley (Mary Fowler, 1992). It makes clear
the intention to diagnose and drug children who fail to
conform to strict discipline:
"Attention Deficit Disorder is a hidden disability. No
physical marker exists to identify its presence, yet ADD is
not very hard to spot. Just look with your eyes and listen
with your ears when you walk through places where children
are-particularly those places where children are expected to
behave in a quiet, orderly, and productive fashion. In such
places, children with ADD will identify themselves quite
readily. They will be doing or not doing something which
frequently results in their receiving a barrage of comments
and criticisms such as "Why don't you ever listen?"
"Think before you
act." ' Pay attention.""
LIKE SHINING STARS
Our children relate to us
mostly through home and school. In both places we need a new
devotion to their basic needs rather than to treating presumed
psychiatric disorders. Above all else, our children need a
more caring connection with us, the adults in their lives.
This is now being realized in some
school systems as they begin to abandon the large,
factory-like facilities of the past in favor of "small is
beautiful."
There are many advantages to
smaller schools, but perhaps the most significant one is this:
They allow teachers to get to know their students well enough
to understand and to meet their basic educational and
emotional needs. At the same time, small schools and classes
meet the teachers' basic needs for a satisfying, effective
professional identity. Conflict can be more readily resolved
as it ideally should be-through mutually satisfying
solutions-rather than through medical diagnosis and
pharmacological suppression.
Some smaller, more
child-oriented schools have shown that the DBDs virtually
disappear. There is no better evidence for how the environment
powerfully shapes the behavior that results in children being
psychiatrically diagnosed.
In a July 14, 1993 New York
Times report enticed "Is Small Better? Educators Now Say
Yes for High School," Susan Chira reports:
"[S]tudents in schools
limited to about 400 students have fewer behavior problems,
better attendance and graduation rates, and sometimes higher
grades and scores. At a time when more children have less
support from their families, students in small schools can
form close relationships with teachers. "(p. 1)
Teachers in these schools have
the opportunity for "building bonds that are particularly
vital during the troubled years of adolescence."
Even students from troubled
homes respond to small, more caring schools. "They are
shining stars you thought were dull," said New York City
teacher Gregg Staples. "If you're under a lot of pressure
and stress, they help you through that," said student Joy
Grimage. "They won't put you down or put you
on hold."
Children respond so quickly to
improvements in the way that adults relate to them, that most
children can be helped without being seen by a professional
person. Instead, the professional can consult with the
parents, teachers, and other concerned adults.
Many psychotherapists, for
example, routinely practice "child therapy" without
actually seeing any children. They help their adult patients
become more loving or disciplined parents through the routine
work of psychotherapy, indirectly transforming the lives of
their children. The children "get better" sight
unseen. These therapists, many of whom work only with adults,
may not identify themselves professionally as child
psychiatrists or child therapists. But they are doing more
good for children than the professionals who diagnose and
medicate them.
Children don't have disorders;
they live in a disordered world.
When adults provide them a
better environment, they tend to quickly improve their outlook
and behavior. But, children and teenagers can eventually
become so upset, confused and self-destructive that they
internalize the pain or become compulsively rebellious. They
may need the intervention of a therapeutic-unconditionally
caring adult to help them overcome their inner suffering and
outrage. Sometimes these children can benefit from learning
how to help ease the conflicted situation. But they should
never be given the idea that they are diseased or defective,
as the primary cause of theirconflicts with their schools and
families.
Children can benefit from
guidance in learning to be responsible for their own conduct;
but they do not gain from being blamed for the trauma and
stress that they are exposed to in the environment around
them. They need empowerment, not humiliating diagnoses and
mind-disabling drugs. Most of all, they
thrive when adults show concern and attention to their basic
needs as children.
NOTES 1. Citation numbers
removed from the quote. 2. Fluoxetine (Prozac) with its
stimulant effects is also becoming a drug of abuse (Breggin,
1994a). 3. Adverse drug reactions to methylphenidate are
probably far much more common than the literature suggests (Breggin,
1991). Except when a drug is brand
new, doctors almost never report or publish negative side
effects. Many physicians do not know there is a mechanism for
informing the drug companies and the FDA. Goodman et al.
(1991. p. 78) observe "Over 40% of physicians are not
aware that the FDA has a reporting system for adverse drug
reactions . . ." In addition,
advocates of psychiatric drugs for children have proven
themselves especially unwilling to emphasize their dangerous
effects (Breggin, 1991).
[Fred A. Baughman Jr., MD: And
yet in articles in psychiatric journals, researchers still
deny the conspicuous, frequent growth retardation (height,
weight and brain size as measured on MRI brain scan) seen with
Ritalin/amphetamine treatment. In some cases it is so severe
that the children are taken to clinics for growth retardation
and are considered for treatment with growth hormone. In that
all brains scan studies of ADHD children have utilized
subjects on such medication, it can only be concluded that the
on-average 10% brain atrophy seen in ADHD subjects, but not
control subjects, is due to the medications virtually all were
on.]
