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A Perspective on ADHD, ADD & ODD Treatment


We used to have personality traits... now we have "symptoms".

 

The following article is from Peter R. Breggin M.D. This is his testimony of September 29, 2000
to the Subcommittee on Oversight and Investigations Committee on Education and the Workforce
of the 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)…


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…


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…


…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."

From the website: http://www.breggin.com

 

Articles and Information

Behavioral Communication of Children

Rising Ritalin Use by Phyllis Gray

A Perspective on ADHD, ADD, and ODD

What Doctors Know, The Pharmacology of Ritalin

 

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