Drugs - Sedating Our Children

The National Institute of Mental Health (NIMH) estimates that attention deficit hyperactivity disorder (ADHD)¹² affects 3-5% of children under 18 years of age.¹³ In 2000, this was between 2.1 and 3.5 million children. The chart shows the estimated number of children who have ADHD and the number of children presumed to be taking Ritalin, the most popular medication prescribed for this disorder. Why were there nearly three times as many children taking this drug in 2000 as the estimated cases of ADHD?

A 1998 study by researchers Adrian Angold and E. Jane Costello found that the majority of children and adolescents who take Ritalin (and other stimulants) for ADHD do not fully meet the criteria for ADHD. The increases in the use of these medications coincided with a three-fold increase in the number of children 4-15 years old diagnosed with emotional or behavioral problems: from 6.8% in 1979 to 18.7% in 1996. Diagnoses for attention problems increased from 32% of all children diagnosed with emotional or behavioral problems to 78% in this same time period. Daniel Safer, adjunct associate professor of pediatrics and psychiatry at Johns Hopkins Medical Institutions stated in a Maryland Department of Education report on ADHD: "You don't have to be ADHD to be on stimulants. Other kids may benefit from stimulants, which are quite safe." (Dunne). An interesting comment considering methylphenidate, the stimulant in Ritalin, is classified as a Schedule II¹⁴ drug by the U.S. Drug Enforcement Agency (the same classification as amphetamines). Safer goes on to explain that the increase in children taking Ritalin is due to the expanded criteria of symptoms for ADHD and better awareness of those symptoms by doctors. And by schools. The American Psychiatric Association published a checklist of symptoms characteristic of those with ADHD. The problem: the symptoms are vague and are common in normal children also. Yet many schools rely on this checklist to identify children with ADHD.

Critics claim that schools avoid providing special services to students who may need them by insisting that the children be placed on Ritalin. Studies show that regardless of their intelligence, 12-60% of children with ADHD also have a learning disorder. David Gaffney, a social worker who specializes in ADHD treatment in Saginaw, Michigan, states: "Treating the child's ADHD with medication often does not change the underlying learning disabilities. It just makes the child less likely to be a behavior problem while he fails to learn." In 2000, a parent of a 5-year old Michigan kindergartner was encouraged by the school to place her child on Ritalin. Her doctor, however, determined that the child did not have ADHD and did not need medication. The parent was then fearful that her child would not be passed on to the next grade unless her son was put on the medication. A Federal subcommittee heard many parents of 5-7 year olds testify to similar stories in a congressional hearing on Ritalin in 2000. Some school districts warned parents that their children would be expelled if they were not put on the drug.

This case also points to another problem: the overmedication of children under 6 years old. Ritalin is not approved for children under 6 years old and yet a study published in the Journal of the American Medical Association found that the use of Ritalin with 2 to 4- year olds increased 150% from 1991 to 1995.¹⁵ Are we now able to "cure" the "terrible twos"? Do we really want to?

Some have linked the rise in the number of diagnosed ADHD cases to children's sedentary lifestyles and the modern classroom environment. Perhaps, many of these children just need to get outside and play to expend some of their natural energy? This was the theory in the 1950s, according to Patti Johnson, a Colorado State Board of Education member in 1999. Elementary school students had a short morning recess, a recess after lunch, and an afternoon recess. The theory was that children naturally have short attention spans and lots of energy. Children needed a break from time to time in order to concentrate better on academics. (How many adults can sit through a grueling 8-hour work- day without so much as a 15-minute break to chat with a co-worker? Should we expect our children to do the equivalent?) In the wake of the report A Nation At Risk¹⁶, high- stakes standardized testing became the norm. Reading, writing, and math were emphasized and music, art, gym, and recess were gradually being cut back or eliminated. Kindergartners were expected to learn to read.

Is Ritalin a useful drug? Yes. Despite being a stimulant, this drug has the opposite effect on those with ADHD. A child's hyperactivity is calmed and his ability to concentrate is increased. A study published in Experimental and Clinical Psychopharmacology in 2001, found that adolescents with ADHD who took Ritalin improved their test scores by an average of 17%, which is equal to two or three letter grades. However, researchers cautioned that Ritalin wasn't the only factor in the jump in test scores. William E. Pelham, Jr., a psychology professor at the State University of New York, stated that students in the study were placed in "a highly structured, well-run classroom, and they had been taught how to take notes and become better organized. The message is that schools need to do both" (Viadero). A study published in the December 1999 issue of Archives of General Psychology found that academic and social skills only improved in ADHD patients when combined with behavioral treatment in the home and school. Unfortunately, in 2000, one national HMO no longer approved psychotherapy for ADHD. Medication was declared the "treatment of choice."¹⁷ Are schools, doctors, and insurance companies really doing what is in the best interest of our children?

Sources: National Council for Community Behavioral Healthcare. National Mental Health Association. "Key Facts and Statistics." Retrieved July 18, 2002 from http://www.nmha.org/children/green/facts.cfm; Leonard Sax. "Ritalin: Better Living Through Chemistry?" The World and I Online, November 2000. Retrieved July 22, 2002 from http://www.worldandi.com/public/2000/November/sax.html. "Michigan ranks third in U.S. Ritalin use." Michigan Education Report, Winter 2001. Retrieved July 22, 2002 from http://www.educationreport.org. "Preschoolers in the Prozac Nursery." Retrieved July 22, 2002 from http://www.healthatoz.com/atoz/healthupdate/alert03252000.html. Chiropractic Wellness Center of Macomb. "Treatment of U.S. Children With Antidepressants Becoming More Common." Retrieved July 22, 2002 from http://www.wellnesschiro.com/children_and_antidepressants.htm. "SSRI Use Common in Children." JAMA, May 26, 1999. Debra Viadero. "Study Points to Academic Benefits For Adolescents Taking Ritalin." Education Week, June 6, 2001. Retrieved July 22, 2002 from http://www.edweek.org. Diane Weaver Dunne. "Statistics Confirm Rise in Childhood ADHD and Medication Use." Education World, December 12, 2000. Retrieved July 19, 2002 from http://www.education-world.com/a_issues/issues148a.shtml. National Institute on Drug Abuse. National Institutes of Health. U.S. Department of Health and Human Services. "Methylphenidate (Ritalin)." NIDA InfoFacts. Retrieved July 22, 2002 from http://www.nida.nih.gov/Infofax/ritalin.html. Patti Johnson. Independence Institute. "Too Much Ritalin," October 20, 1999. Retrieved July 18, 2002 from http://i2i.org/Publications/Op-Eds/HealthCare/ritalin.htm.