Putting Power Back In Parental Hands
Posted April 28, 2003
Congress soon will vote on legislation that has the
psychiatric and mental-health communities agitated. Advocates of the bill say it
will return to parents the power to decide whether a child should be medicated
to get in school or stay there, and many see this measure as a warning bell for
future debate about the legitimacy of childhood psychiatric disorders.
The Individuals With Disabilities Education Act (IDEA) has been scheduled for
reauthorization in May as HR 1350. An amendment to it, the Child Medication
Safety Act, introduced by Rep. Max Burns (R-Ga.), requires no taxpayer funding
but mandates that "State educational agencies develop and implement
policies and procedures that will prohibit school personnel from requiring a
child to obtain a prescription [for a controlled substance such as Ritalin] as a
condition of attending school or receiving services."
In other words, the amendment would prohibit teachers and school administrators
from requiring a child to take a controlled substance to receive a public
education, returning the decision to parents and their physicians. Already a
handful of states have passed similar or more stringent guidelines prohibiting
schools from requiring that children be drugged to control behavior, and a dozen
more states currently are considering such legislation.
Surprisingly, opponents claim it is a battle about who will legislate rather
than what will be legislated. E. Clarke Ross, chief executive officer of
Children and Adults With Attention Deficit/Hyperactivity Disorder (CHADD), the
nation's leading nonprofit organization representing individuals with ADHD, even
tells Insight that, "We're not opposed to the intent and policy language of
the bill." Rather, according to Ross, "The question is whether the
government should enact national legislation mandating every school district in
America to go through the procedures and process of implementing this
legislation." The question, he stresses, is "whether a few highly
publicized cases are typical of thousands of people across the country - whether
the instances of abuse are so rampant that it requires a national law or
bureaucracy."
As an advocacy organization representing 20,000 dues-paying members diagnosed
with the alleged psychiatric disorder ADHD, the Ross group reported in its
yearly financial statement that last year it received more than $500,000 in
financial support from various pharmaceutical companies, including Novartis, the
makers of Ritalin, the No. 1 stimulant "treatment" for ADHD. And as an
advocacy group representing people with ADHD, the CHADD lobby supports the
mental-health community's theory that ADHD is a "real" disorder and
further reports that it "disseminates the science-based information"
about ADHD. Insight asked Ross to describe the scientific information
disseminated by CHADD to support its contention that ADHD is a brain disease.
"The surgeon general of the United States [David Satcher]," Ross
explains, "called ADHD a brain disorder with a neurological origin in his
1999 Report on Mental Health. It's not a CHADD position, it's the surgeon
general's position." While the former surgeon general did suggest that ADHD
is a brain disorder with a neurological origin, no conclusive scientific
evidence was presented in the report to support the theory.
Moreover, later in that same report the surgeon general emphasized "the
diagnosis of mental disorders is often believed to be more difficult than
diagnosis of somatic or general medical disorders since there is no definitive
lesion, laboratory test or abnormality in brain tissue that can identify the
illness." Trouble is that this statement also applies to the diagnosis of
ADHD, though CHADD did not disseminate the surgeon general's caveat as part of
the "science."
In an effort to get the "science" it favors to its membership, CHADD
also cites the 1998 National Institutes of Health (NIH) Consensus Statement that
"there is evidence supporting the validity of the [ADHD] disorder."
Again, CHADD does not mention that no science ever was cited to support this
statement. Nor did the advocacy group mention that the NIH statement was revised
after its initial publication. The original NIH Consensus Statement from the
conference reads: "We don't have an independent, valid test for ADHD; there
are no data to indicate that ADHD is due to a brain malfunction; existing
studies come to conflicting conclusions as to whether use of psycho-stimulants
increases or decreases the risk of abuse; and finally after years of clinical
research and experience with ADHD, our knowledge about the cause or causes of
ADHD remains speculative."
It also is of interest that CHADD does not include the 1995 report from the Drug
Enforcement Administration (DEA), which concludes that "there is a
considerable body of literature on the short-term efficacy of stimulant
pharmacotherapy on the symptoms of ADHD. From 60 to 90 percent of children have
been judged as positive drug responders to methylphenidate [Ritalin] medication.
However, contrary to popular belief, stimulants like methylphenidate will affect
normal children and adults in the same manner they affect ADHD children."
In short, whether diagnosed with ADHD or not, the mind-altering drug will elicit
the same effect and, according to the DEA, "behavioral or attentional
improvements with methylphenidate treatment therefore are not diagnostic
criteria of ADHD."
Finally, Insight asked Ross why it is that only the "science" that
supports the validity of ADHD is disseminated by CHADD. "It really is a
matter of belief," Ross says. "Do you want to believe the surgeon
general of the United States? He said ADHD is a valid disorder and has serious
symptoms and we don't know 100 percent of the cause of it yet. It's like
schizophrenia. Do you dismiss everything until science at some point has
definitive answers?"
Is Ross suggesting that he is aware of science to support, say, 65 percent of
the cause of ADHD? Is he admitting that there is no science to support either
the ADHD diagnosis or the diagnosis of schizophrenia? Whatever, say critics, he
raises a good question. But those who argue that ADHD and other psychiatric
diagnoses are not based in science, which according to the former surgeon
general appears to be the case, legitimately may respond by asking whether it is
right without causative proof that a disease exists to medicate children with
mind-altering drugs.
Despite the fact that documents provided on CHADD's Website declare that ADHD
not only is a "neurobiological" disorder but also a
"neurological" disorder, the bottom line apparently has little to do
with science. As Ross states, it "is a matter of belief." And that is
precisely what opponents of the alleged disorder have been saying for years -
that psychiatric diagnoses are subjective opinion unallied by science. All of
which appears to observers in Congress to be what is driving this new
legislation.
Mike Stokke, deputy chief of staff to Speaker of the House J. Dennis Hastert
(R-Ill.), tells Insight that "this is a very limited first step, and I
think it will lead to a whole line of other questions once parents figure out
that this kind of stuff is going on in schools. Some of the questions that are
involved in this issue are not things that most people contemplate when they put
their kids on drugs, and sometimes there are bad outcomes."
Stokke explains: "This bill basically says that teachers and school
personnel cannot demand that children be put on these drugs as a prerequisite to
staying in the classroom. We're trying to make it clear in places where it's
been a problem around the country, and it's been a problem in more places than I
would have ever imagined."
In case after case, Stokke continues, "when we started meeting some of
these families who have been through this problem, such as in New York, New
Jersey and Connecticut, we saw the coercive action of the state come in and say
that the teacher says you have to take these drugs. And if you don't it's child
neglect and the child is taken away from the parents. That's more than a little
beyond the pale."
Stokke concludes, "We've listened to some of the horror stories of what
happens to parents who refuse to medicate their kids [for alleged ADHD]. Many of
the parents that we talk to are people who have the means to fight back, but
what is troubling about it, and why there needs to be federal legislation, is
that there are many families out there in similar situations who don't have the
means to fight the system. The speaker [Hastert] believes that parents should
have more of a role in the kind of things that happen to their kids. There is an
alarming rise in the number of children who are being medicated for alleged
behavioral problems, and it's definitely something that should be looked at. Our
goal with this legislation is to bring some attention to this issue and to put
some people on notice."
Kelly Patricia O'Meara is an investigative reporter for Insight
magazine.
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