ADD, ADHD and Ritalin19.09.2008
by D'Astolfo - Connie
Peter R. Breggin M.D. Testimony, September 29, 2000
Before the Subcommittee on Oversight and Investigations
Committee on Education and the Workforce
U.S. House of Representatives
I appear today as Director of the International Center for the Study of Psychiatry and Psychology (ICSPP), and also on my own behalf as a practicing psychiatrist and a parent.
Parents throughout the country are being pressured and coerced by schools to give psychiatric drugs to their children. Teachers, school psychologists, and administrators commonly make dire threats about their inability to teach children without medicating them. They sometimes suggest that only medication can stave off a bleak future of delinquency and occupational failure. They even call child protective services to investigate parents for child neglect and they sometimes testify against parents in court. Often the schools recommend particular physicians who favor the use of stimulant drugs to control behavior. These stimulant drugs include methylphenidate (Ritalin, Concerta, and Metadate) or forms of amphetamine (Dexedrine and Adderall).
My purpose today is to provide to this committee, parents, teachers, counselors and other concerned adults a scientific basis for rejecting the use of stimulants for the treatment of attention deficit hyperactivity disorder or for the control of behavior in the classroom or home.
I. Escalating Rates of Stimulant Prescription
Stimulant drugs, including methylphenidate and amphetamine, were first approved for the control of behavior in children during the mid-1950s. Since then, there have been periodic attempts to promote their usage, and periodic public reactions against the practice. In fact, the first Congressional hearings critical of stimulant medication were held in the early 1970s when an estimated 100,000-200,000 children were receiving these drugs.
Since the early 1990s, North America has turned to psychoactive drugs in unprecedented numbers for the control of children. In November 1999, the U.S. Drug Enforcement Administration (DEA) warned about a record six-fold increase in Ritalin production between 1990 and 1995. In 1995, the International Narcotics Control Board (INCB), a agency of the World Health Organization, deplored that "10 to 12 percent of all boys between the ages 6 and 14 in the United States have been diagnosed as having ADD and are being treated with methylphenidate [Ritalin]." In March 1997, the board declared, "The therapeutic use of methylphenidate is now under scrutiny by the American medical community; the INCB welcomes this." The United States uses approximately 90% of the world's Ritalin.
The number of children on these drugs has continued to escalate. A recent study in Virginia indicated that up to 20% of white boys in the fifth grade were receiving stimulant drugs during the day from school officials. Another study from North Carolina showed that 10% of children were receiving stimulant drugs at home or in school. The rates for boys were not disclosed but probably exceeded 15%. With 53 million children enrolled in school, probably more than 5 million are taking stimulant drugs.
A recent report in the Journal of the American Medical Association by Zito and her colleagues has demonstrated a three-fold increase in the prescription of stimulants to 2-4 year old toddlers.
II. Legal Actions
Most recently, four major civil suits have been brought against Novartis, the manufacturer of Ritalin, for fraud in the over-promotion of ADHD and Ritalin. The suits also charge Novartis with conspiring with the American Psychiatric Association and with CHADD, a parents' group that receives money from the pharmaceutical industry and lobbies on their behalf. Two of the suits are national class action suits, one is a California class action and one is a California business fraud action. The attorneys involved, including Richard Scruggs, Donald Hildre, and C. Andrew Waters have experience and resources generated in suits involving tobacco and asbestos. That they have joined forces to take on Novartis, the American Psychiatric Association, and CHADD indicates a growing wave of dissatisfaction with drugging millions of children.
The suits and the contents of the complaints are based on information first published in my book, Talking Back to Ritalin (1998), and I am a medical expert in these cases.
III. The Dangers of Stimulant Medication
Stimulant medications are far more dangerous than most practitioners and published experts seem to realize. I summarized many of these effects in my scientific presentation on the mechanism of action and adverse effects of stimulant drugs to the November 1998 NIH Consensus Development Conference on the Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder, and then published more detailed analyses in several scientific sources (see bibliography).
Table I summarizes many of the most salient adverse effects of all the commonly used stimulant drugs. It is important to note that the Drug Enforcement Administration, and all other drug enforcement agencies worldwide, classify methylphenidate (Ritalin) and amphetamine (Dexedrine and Adderall) in the same Schedule II category as methamphetamine, cocaine, and the most potent opiates and barbiturates. Schedule II includes only those drugs with the very highest potential for addiction and abuse.
Animals and humans cross-addict to methylphenidate, amphetamine and cocaine. These drugs affect the same three neurotransmitter systems and the same parts of the brain. It should have been no surprise when Nadine Lambert presented data at the Consensus Development Conference (attached) indicating that prescribed stimulant use in childhood predisposes the individual to cocaine abuse in young adulthood.
Furthermore, their addiction and abuse potential is based on the capacity of these drugs to drastically and permanently change brain chemistry. Studies of amphetamine show that short-term clinical doses produce brain cell death. Similar studies of methylphenidate show long-lasting and sometimes permanent changes in the biochemistry of the brain.
All stimulants impair growth not only by suppressing appetite but also by disrupting growth hormone production. This poses a threat to every organ of the body, including the brain, during the child's growth. The disruption of neurotransmitter systems adds to this threat.
These drugs also endanger the cardiovascular system and commonly produce many adverse mental effects, including depression.
Too often stimulants become gateway drugs to illicit drugs. As noted, the use of prescription stimulants predisposes children to cocaine and nicotine abuse in young adulthood.
Stimulants even more often become gateway drugs to additional psychiatric medications. Stimulant-induced over-stimulation, for example, is often treated with addictive or dangerous sedatives, while stimulant-induced depression is often treated with dangerous, unapproved antidepressants. As the child's emotional control breaks down due to medication effects, mood stabilizers may be added. Eventually, these children end up on four or five psychiatric drugs at once and a diagnosis of bipolar disorder by the age of eight or ten.
In my private practice, children can usually be taken off all psychiatric drugs with great improvement in their psychological life and behavior, provided that the parents or other interested adults are willing to learn new approaches to disciplining and caring for the children. Consultations with the school, a change of teachers or schools, and home schooling can also help to meet the needs of children without resort to medication.
IV. The Educational Effect of Diagnosing Children with ADHD
It is important for the Education Committee to understand that the ADD/ADHD diagnosis was developed specifically for the purpose of justifying the use of drugs to subdue the behaviors of children in the classroom. The content of the diagnosis in the 1994 Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association shows that it is specifically aimed at suppressing unwanted behaviors in the classroom.
The diagnosis is divided into three types: hyperactivity, impulsivity, and inattention.
Under hyperactivity, the first two (and most powerful) criteria are "often fidgets with hands or feet or squirms in seat" and "often leaves seat in classroom or in other situations in which remaining seated is expected." Clearly, these two "symptoms" are nothing more nor less than the behaviors most likely to cause disruptions in a large, structured classroom.
Under impulsivity, the first criteria is "often blurts out answers before questions have been completed" and under inattention, the first criteria is "often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities." Once again, the diagnosis itself, formulated over several decades, leaves no question concerning its purpose: to redefine disruptive classroom behavior into a disease. The ultimate aim is to justify the use of medication to suppress or control the behaviors.
Advocates of ADHD and stimulant drugs have claimed that ADHD is associated with changes in the brain. In fact, both the NIH Consensus Development Conference (1998) and the American Academy of Pediatrics (2000) report on ADHD have confirmed that there is no known biological basis for ADHD. Any brain abnormalities in these children are almost certainly caused by prior exposure to psychiatric medication.
V. How the medications work
Hundreds of animal studies and human clinical trials leave no doubt about how the medication works.
First, the drugs suppress all spontaneous behavior. In healthy chimpanzees and other animals, this can be measured with precision as a reduction in all spontaneous or self-generated activities. In animals and in humans, this is manifested in a reduction in the following behaviors: (1) exploration and curiosity; (2) socializing, and (3) playing.
Second, the drugs increase obsessive-compulsive behaviors, including very limited, overly focused activities.
Table II provides a list of adverse stimulant effects which are commonly mistaken as improvement by clinicians, teachers, and parents.
VI. What is Really Happening
Children become diagnosed with ADHD when they are in conflict with the expectations or demands of parents and/or teachers. The ADHD diagnosis is simply a list of the behaviors that most commonly cause conflict or disturbance in classrooms, especially those that require a high degree of conformity.
By diagnosing the child with ADHD, blame for the conflict is placed on the child. Instead of examining the context of the child's life-why the child is restless or disobedient in the classroom or home-the problem is attributed to the child's faulty brain. Both the classroom and the family are exempt from criticism or from the need to improve, and instead the child is made the source of the problem.
The medicating of the child then becomes a coercive response to conflict in which the weakest member of the conflict, the child, is drugged into a more compliant or submissive state. The production of drug-induced obsessive-compulsive disorder in the child especially fits the needs for compliance in regard to otherwise boring or distressing schoolwork.
VII. Conclusions and Observations
Many observers have concluded that our schools and our families are failing to meet the needs of our children in a variety of ways. Focusing on schools, many teachers feel stressed by classroom conditions and ill-prepared to deal with emotional problems in the children. The classroom themselves are often too large, there are too few teaching assistants and volunteers to help out, and the instructional materials are often outdated and boring in comparison to the modern technologies that appeal to children.
By diagnosing and drugging our children, we shift blame for the problem from our social institutions and ourselves as adults to the relatively powerless children in our care. We harm our children by failing to identify and to meet their real educational needs for better prepared teachers, more teacher- and child-friendly classrooms, more inspiring curriculum, and more engaging classroom technologies.
At the same time, when we diagnosis and drug our children, we avoid facing critical issues about educational reform. In effect, we drug the children who are signaling the need for reform, and force all children into conformity with our bureaucratic systems.
Finally, when we diagnose and drug our children, we disempower ourselves as adults. While we may gain momentary relief from guilt by imagining that the fault lies in the brains of our children, ultimately we undermine our ability to make the necessary adult interventions that our children need. We literally become bystanders in the lives of our children.
It is time to reclaim our children from this false and suppressive medical approach. I applaud those parents who have the courage to refuse to give stimulants to their children and who, instead, attempt to identify and to meet their genuine needs in the school, home, and community.
Table I: Harmful Effects Caused by Ritalin, Dexedrine, Adderall and Similar Stimulants
Table II: Harmful Stimulant Effects Commonly Misidentified as 'Therapeutic' or 'Beneficial' for Children Diagnosed with ADHD.
Description of ICSPP
This report draws on hundreds of published scientific studies. I have provided the committee with two sources for the specific citations: My scientific presentation to the NIH Consensus Development Conference and my peer-reviewed scientific paper that expands on it. My book, Talking Backing to Ritalin (1998), also elaborates on many of these issues and provides many scientific citations. A more recent book, Reclaiming Our Children: A Healing Solution to a Nation in Crisis (2000), further describes the harm done by drugs and proposes solutions for teachers, parents, and other adults who want to retake responsibility for our children.
American Academy of Pediatrics. (2000a). Practice guideline: Diagnosis and evaluation of a child with attention-deficit/hyperactivity disorder. Pediatrics, 105, 1158-70. Also available at http://www.aap.org/policy/ac0002.html
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, Fourth Edition (DSM-IV). Washington, D.C.: author.
Breggin, P. (1998). Talking back to Ritalin: What doctors aren't telling you about stimulants for children. Monroe, Maine: Common Courage Press.
Breggin, P. (1999a). Psychostimulants in the treatment of children diagnosed with ADHD: Part I: Acute risks and psychological effects. Ethical Human Sciences and Services, 1 13-33.
Breggin, P. (1999b). Psychostimulants in the treatment of children diagnosed with ADHD: Part II: Adverse effects on brain and behavior. Ethical Human Sciences and Services, 1, 213-241.
Breggin, P. (1999c). Psychostimulants in the treatment of children diagnosed with ADHD: Risks and mechanism of action. International Journal of Risk and Safety in Medicine, 12, 3-35. By special arrangement, this report was originally published in two parts by Springer Publishing Company in Ethical Human Sciences and Services (Breggin 1999a&b).
Breggin, P. (2000). Reclaiming our children: A healing solution for a nation in crisis. Cambridge, Massachusetts: Perseus Books.
Lambert, N. (1998). Stimulant treatment as a risk factor for nicotine use and substance abuse. Program and Abstracts, pp. 191-8. NIH Consensus Development Conference Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder. November 16-18, 1998. William H. Natcher Conference Center. National Institutes of Health. Bethesda, Maryland.
Lambert, N., & Hartsough, C.S. (in press). Prospective study of tobacco smoking and substance dependence among samples of ADHD and non-ADHD subjects. Journal of Learning Disabilities.
Zito, J.M., Safer, D .J., dosReis, S., Gardner, J.F., Boles, J., and Lynch, F. (2000). Trends in the prescribing of psychotropic medications to preschoolers. Journal of the American Medical Association , 283, 1025-1030.
Peter R. Breggin, MD
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Ithaca, New York 14850
Phone 607 272 5328
Fax 607 272 5329