Pubdate: Thu,  4 Oct 2001
Source: Boulder Weekly (CO)
Copyright: 2001 Bolder Weekly
Contact:  http://www.mapinc.org/media/57
Website: http://www.boulderweekly.com/
Author: Pamela White

THE CHEMICAL VEIL - RITALIN NATION

Some Say Ritalin Helps. Others Are Addicted. Critics Say Teachers Use Drugs
Rather Than Discipline.

In many ways, Tom is the quintessential American boy. He's also a troubled
child. Tom skips school almost as often as not. On any given weekday, he's
as likely to be found fishing, smoking, and lying on his back staring at the
sky as he is to be found in the classroom. When he is at school, he can be
difficult, disrupting the classroom with puerile pranks and driving his
teacher to distraction.

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Unresponsive to discipline, Tom can't focus on homework or chores and
doesn't excel in school. In fact, he doesn't do much of anything he doesn't
want to do, much to the consternation of his aunt, who is his legal
guardian.

Still, he's a compassionate boy by all descriptions, quick to care and full
of imagination.

Worried, his aunt wonders what can be done to help him. She has tried strict
rules. She has tried corporal punishment. She has prayed.

Fortunately for Tom, he's a fictional character. If Tom Sawyer were alive
today, some observers say, he would likely find himself entangled with the
juvenile justice system and would likely be taking any one of a number of
psychiatric drugs used to treat Attention Deficit Disorder and its twin,
Attention Deficit and Hyperactivity Disorder.

More than six million children in the United States are given prescription
psychiatric drugs for ADD/ADHD. Chief among those is Ritalin and its sister
drugs Adderal and Concerta. Some doctors have prescribed Ritalin, which is
only now being tested for use in kids under six, to children as young as age
one.

According to the Journal of the American Medical Association, the number of
children taking psychiatric drugs increased by 200 to 300 percent between
1991 and 1995 alone. In 2000, doctors wrote about 20 million prescriptions
each month for Ritalin and related drugs.

While some parents and physicians believe these drugs help children function
normally, critics claim parents, educators, and doctors use the drugs as a
quick-fix for problems better solved by discipline and improved parenting
skills, in the process creating a generation of chemically damaged,
drug-dependent children. Some medical and legal professionals have gone so
far as to call ADD/ADHD a "made-up" diagnosis designed to market drugs.

Ritalin has been at the center of this controversy for two decades. In the
United States it continues to be a subject of fierce disagreement in the
medical community, in schools, and in America's homes.

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Mommy's Little Helper

Pam Wallen was at her wit's end. Her 3-year-old son Bryce was out of
control. He didn't respond when she spoke to him directly. He climbed onto
counters, couldn't stop moving. He was out of control.

His behavior was so unmanageable Wallen was afraid she might lose her temper
and hurt him.

"Being a single mom, I said, 'I can't take this anymore,'" recalls Wallen, a
resident of Adams County.

Wallen took her son to a clinic, where a doctor listened to her frantic
description of her son's behavior and watched as Bryce played with toys on
the floor. In short order, Wallen was walking out the door, a prescription
for Ritalin in her hand.

When Bryce first began taking Ritalin, Wallen heaved a sigh of relief.

"It was a godsend," she says.

Bryce, a compassionate child, became responsive, calmer.

Wallen, having been diagnosed with attention deficit disorder herself by the
same clinic a short time later, was put on Ritalin as well. She was also
given parenting classes.

Still, Wallen's relief was tempered with concern. Each day as her son's dose
began to wear off, Bryce became angry and frustrated. As his body adapted to
the drug, he needed higher doses to maintain the same results.

By the beginning of first grade, the doctor wanted to put Bryce on the same
dose Wallen was taking despite his young age. Wallen resisted. In addition
to suffering lows between doses, Bryce had begun to develop tick -
uncontrollable head jerks and sudden blurted sounds - consistent with rare
Tourette's syndrome.

The doctor opted to take Bryce off Ritalin and put him on antidepressants
instead. They tried Clonadine and Wellbutrin, which made Bryce pass out at
school. Switching drugs also left the 6-year-old boy deeply depressed.

"He would come home from school and say, 'Mommy, why did God put me on this
Earth? I'm stupid and dumb, and I don't want to be here,'" Wallen says.

For Wallen, Bryce's emotional turmoil was the last straw.

"Finally I said, 'That's it. I'm done,'" Wallen says. "I didn't want him on
any synthetic drug at all."

Left with few options, Wallen decided to try alternative therapies such as
chiropractic and herbal medicine combined with tough discipline. Her
decision left her facing opposition from an unexpected quarter: her son's
teacher.

Bryce's second-grade teacher repeatedly demanded Wallen put her son back on
Ritalin, despite the negative side-effects.

"She was just a total witch to me, and then she and I kind of had a battle,"
Wallen says. "She wanted him to be doped up. She said, 'Take him back in,
and get him back on his Ritalin.'"

Wallen refused, seeking the help of a child advocate through Adams County.

"I said, 'No! I'm not going to get him doped up just so that you can cope,'"
Wallen recalls. "That's what these teachers want. They want the kids to sit
there and be good little boys and girls and raise their hands."

Now, four years later, Bryce is drug-free and functioning as well as or
better than he did on Ritalin, Wallen says. He has been getting help with a
learning disability and is making progress. However, his growth is stunted
from three years of Ritalin use, and he continues to suffer from a mild case
of Tourette's which may be permanent.

Wallen's experience, including her difficulty with her son's teacher, is not
atypical. In some cases, teachers have required parents to put their
children on drugs, prompting critics to call Ritalin "the teacher's drug."

In July, Minnesota became the first state to prohibit schools from requiring
or even requesting parents put their children on drugs. In October,
Connecticut will begin to enforce an even stricter law, which prohibits
school staff members and teachers from discussing drug treatments with
parents. Similar bills have been introduced in Arizona, New Jersey, New
York, Utah, and Wisconsin.

Mary Beth Rensberger, health services coordinator for the Boulder Valley
School District, said BVSD teachers do observe children's behavior and
record it. Sometimes a teacher will suggest parents get a child evaluated
based on their observations, Rensberger said. However, she has never seen a
teacher directly recommend medication.

But it's not just teachers trying to modify children's behavior with drugs.
Parents often come to the doctor's office requesting medication for their
kids. Sometimes they're concerned about hyperactivity or other behavioral
problems. Sometimes they're worried about their child's performance in
school and are trying to find a quick way to improve a child's grades.

In an age of increased competition and decreasing interaction between
parents and children, some doctors fear Ritalin may have become a shortcut
for parents who are desperate for their children to achieve.

Affluent communities have among the highest medication rates, with the
United States consuming 90 percent of the world's Ritalin supply. A study by
Gretchen LeFever, published in the American Journal of Public Health, found
that Ritalin use among children had risen from 900,000 users in 1990 to 5
million by 2000. Although only an estimated 3 to 5 percent of
elementary-school children are likely to have ADD/ADHD, LeFever found that
six times as many fifth-graders in the wealthy community of Virginia Beach
were on the drug. LeFever speculated that parents were using Ritalin to
force children to "pay attention."

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The Case Against Ritalin

Dr. Mary Ann Block said physicians often rush to a diagnosis of ADD/ADHD,
failing to screen for other underlying medical conditions.

Author of two books on the subject - No More ADHD and No More Ritalin -
Block said food allergies, thyroid problems, and diet are often the
underlying causes of behaviors associated with ADD/ADHD.

"There is no such thing as ADD/ADHD," Block said. "It's a made-up diagnosis.
I'm not saying some children don't have attention or behavior problems. They
do. But it's an educational or medical problem. Now we're giving these kids
a controlled substance."

The underlying conditions in Mark Jackson's case was sugar intolerance and
poor parenting. Jackson, 38, smoked marijuana with his parents when he was 7
and even tried cocaine as a child. He was diagnosed with ADHD after causing
"lots of trouble in school."

The doctor put him on Ritalin, which he took until age 23.

The Ritalin helped, Jackson said. But his body gradually built a tolerance
for the drug, and he was forced to take larger and larger doses over time. A
succession of doctors switched him from one drug to another - Ritalin,
Wellbutrin, Zoloft, Effexor - and Jackson suffered a range of side effects
that included everything from severe headaches to kidney problems to
feelings of suicide.

"None of these people ever once asked about my diet," Jackson said.
"Everyone around me wanted to treat my symptoms. No one wanted to look at
the cause."

Jackson eventually went off all medications.

Three months ago, he completely changed his diet.

"I've never felt more energized or positive."

Rob Johnson, a Boulder chiropractor, comes by his opposition to Ritalin
through first-hand experience. At age 17, he came down with an infection and
was placed on antibiotics. Rather than helping him, the antibiotics made him
sicker. In addition to developing a number of serious medical conditions,
Johnson found he could no longer concentrate. His short-term memory was
severely compromised, as well. In response, his doctors diagnosed him with
ADD and wanted to put him on Ritalin.

"They wanted to put me on a drug to help me do the things I could do
before," Johnson said.

Johnson rebelled, researching the drug in his spare time. His research led
him to reject the doctors' treatment plan. He turned to chiropractic
treatment instead, and went on to become a chiropractor himself as a result.

"The diagnosis of being ADHD is actually very, very, very vague," Johnson
said.

Diagnosis is most often reached through evaluation using a check-list of
behaviors that include traits like inability to sit still, forgetfulness,
inability to focus clearly on things the child finds uninteresting, and
falling asleep while reading.

"A lot of that is normal kid behavior," Johnson said. "We're trying to take
round children and put them in square holes. Kids are not allowed to be
kids."

A schedule II controlled substance like morphine, cocaine, methadone, and
opium, Ritalin - the brand name for methylphenidate hydrochloride - is a
stimulant like methamphetamine. Although Ritalin has been around for more
than 50 years, scientists understand little about how the drug affects the
human brain. Potentially addictive, Ritalin can produce a laundry list of
side effects ranging from nervousness, insomnia, loss of appetite and skin
problems to suppressed growth, rapid heartbeat, cardiac arrhythmia, and
Tourette's syndrome.

Last year, Matthew Smith, 14, collapsed in his Michigan home and died. The
medical examiner concluded his death was the result of "heart damage brought
about by long-term use of methylphenidate."

Matthew's bereaved father told CBS: "(Matthew) said, 'I don't want to take
it. It makes me feel stoned.' He took it because we told him he needed to
take it."

Complications during withdrawal can include depression and suicide. In
addition, a study by the Food and Drug Administration indicates that Ritalin
may cause a rare form of liver cancer.

The drug can also cause abrupt psychotic episodes. Some medical
professionals and parents have suggested the use of these drugs could be
linked to the increase in school shootings. They list the following
controversial evidence:

* Eric Harris, leader of the Columbine High School duo that killed 12
students and a teacher before killing themselves, was being treated with
Luvox, a selective seratonin reuptake inhibitor used to treat
obsessive-compulsive disorder, prior to the horrific rampage.

* Shawn Cooper, 15, was taking Ritalin for bipolar disorder when he opened
fire at Notus Junior-Senior High School in Notus, Idaho. He fired two
rounds, missing students and staff.

* T.J. Solomon, 15, was taking Ritalin when he shot six classmates at
Heritage High School in Conyers, Ga.

* Kip Kinkel, 15, murdered his parents then went to his school and opened
fire on students in the cafeteria, killing two and wounding 33. He had been
prescribed both Ritalin and Prozac, which has not yet been approved for
pediatric use.

Block said she has treated thousands of children damaged physically and
mentally through Ritalin and related drugs.

"We're giving these kids speed," Block said. "We're saying they're crazy,
and we're giving them speed. To me, it's a disgrace to the medical
community."

Block points out that 80 to 90 percent of children on Ritalin are boys.

"The same behaviors that make a man successful in life are the same
behaviors that we don't tolerate in three-, four- , five- and
six-year-olds," Block said. "We expect too much from our children. We expect
it too soon. We shouldn't be drugging them into submission so they'll sit
still in reading circle."

Because the side-effects for psychiatric drugs are potentially serious,
parents should take care before agreeing to put their children on drugs,
Block said. She points to an FDA study which found that fewer than one
percent of doctors take time to read through drug inserts and understand the
potential side-effects.

"It's public beware," she said.

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A "Miracle" Drug

Retired CU Professor Amy Vandersall has struggled with severe clinical
depression most of her life. Forced to retire early because of her
condition, Vandersall has tried just about every psychiatric drug available
for depression as well as electroshock therapy, which she endured eight
times. Most of the drugs gave her disabling migraines. The electroshock
treatments left her feeling traumatized.

"I wasn't well at all," Vandersall said. "I remember I was just so down."

Despite the drugs and treatments, Vandersall could barely function. It would
take her 45 minutes to make herself a cup of tea and bowl of cereal in the
morning. Her psychiatrist had suggested Ritalin in the past, but Vandersall
had rejected the idea.

"I resisted it for a long time because of the stigma," Vandersall said. "I
told her I didn't want to get addicted."

With no options remaining, Vandersall finally consented to try Ritalin.

"It was like a miracle," she said. "I took Ritalin when I got up in the
morning, and all of a sudden everything didn't seem so overwhelming."

Closely supervised by her psychiatrist, Vandersall has been taking Ritalin
daily for five years.

"It's a godsend," Vandersall said. "It's just incredible."

Dr. Daniel G. Amen, founder of The Amen Clinic in California, said many
people are helped dramatically by Ritalin. However, ADD/ADHD isn't one
thing-it's many conditions. Ritalin isn't the right drug for all of those
conditions, he said.

In addition, about 90 percent of ADD/ADHD diagnoses are made by family
practitioners, not specialists, resulting in misdiagnoses and ill-considered
prescriptions. Amen said its possible that claims of Ritalin overuse and
bogus diagnoses result from treatments prescribed by doctors who aren't
informed enough to properly evaluate patients for ADD/ADHD.

He offers this advice for parents concerned about psychiatric disorders in
their children: "Take them to the best specialist you can find."

Amen, who studies ADD/ADHD and the effects of drugs using brain scans, said
claims that ADD and ADHD aren't real disorders are "really stupid."

"It's not new," said Amen, author of Healing ADD. "It's not a fad. ADD is a
real disorder. It's a brain disorder, a medical disorder."

But to depend only on a drug to treat ADD/ADHD is also wrong, Amen said.
Exercise, diet, the right environment and solid parenting are also necessary
to successfully treat the disorders, he said.

And successful treatment is important. Left untreated, 35 percent of
ADD/ADHD children never finish high school, he said. About 52 percent will
abuse drugs. In addition, ADD/ADHD is statistically over represented in
prison and jail populations than in the population at large. Studies have
found that 25 to 50 percent of inmates have ADD/ADHD, compared to three to
five percent of the general population.

"I'm not saying Ritalin is the answer," Amen said. "It's part of the
answer."

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The Drug Trade

Peter Breggin, a psychiatrist and founder of the Center for the Study of
Psychiatry and Psychology, said the entire diagnosis of ADD/ADHD is "just a
fabrication."

"The entire (diagnostic checklist) is nothing more than a list of behaviors
that annoy teachers," said Breggin, author of Talking Back to Ritalin.

Breggin, who recently faced off with Amen on a Fox news broadcast, said: "I
don't think any children should be put on Ritalin. Drugging kids with
psychiatric problems is not the answer."

The drugs crush spontaneity in children, while parents and teachers get off
the hook, he said.

"It's a justification for teachers to feel comfortable putting kids on
drugs," Breggin said. "It's a justification for doping children."

But it's also a big industry. The payoff for the mental-health and
pharmaceutical industries is enormous, Breggin said.

Last year, sales for Ritalin and related drugs topped $758 million, a
13-percent increase over 1999. Breggin expects profits to continue to climb
as new forms of the drug are developed.

Breggin is a medical consultant in a lawsuit against the pharmaceutical
industry. The law firm of Waters & Kraus has filed a lawsuit in Texas
against the American Psychiatric Association and Novartis, the company which
manufactures Ritalin. Dickie Scruggs, the attorney portrayed in the film The
Insider for his lawsuit against the tobacco industry, last year filed
similar lawsuits in other states.

The suits alleged the defendants conspired to promote the use of Ritalin in
children. Scruggs told U.S. News & World Report last fall when he filed
suits in California and New Jersey that 90 percent of children who've been
prescribed Ritalin shouldn't be taking the drug. Similar suits have been
filed in Florida and Puerto Rico.

The pharmaceutical industry is doing what it can to keep sales high. This
fall, companies competing with Ritalin for sales are taking their case to
parents in the form of high-cost advertising campaigns in magazines and on
television. In the back-to-school issue of last month's Ladies Home Journal,
readers found three full-page ads pushing psychiatric medications for
children. The move breaks a 30-year agreement between the drug industry and
the Drug Enforcement Administration to not advertise controlled substances.

As the creation and manufacture of such drugs has skyrocketed, so has
illegal use of the drugs. An Associated Press report estimated that one in
five college students uses Ritalin or related drugs recreationally. In a
1997 Indiana University survey, 7 percent of 44,232 students responding said
they'd used Ritalin recreationally at least once the previous year. About
2.5 percent reported they'd used it at least once a month or more.

The Drug Enforcement Agency reports that methylphenidate is one of the most
frequently stolen prescription drugs. One study found that drug-related
emergency room admissions for patients ages 10 to 14 were just as likely to
involve methylphenidate as cocaine. Nearly 75 percent of those involved
recreational use of the drug.

Kelly, a 19-year-old sophomore at CU, said she sees lots of CU students
using Ritalin illegally. A friend of hers turned a prescription for Ritalin
into a dorm-room industry, selling pills for $5 each. Another woman stole
her little brother's pills when she was home for vacation, brought them to
CU and sold them to her fellow students.

Students sometimes crush and snort the pills for a buzz that's reportedly
similar to cocaine . Some take it in conjunction with alcohol, Kelly said.
Others take it to help them study.

"A lot of people would buy it when they had long papers to write or finals
to study for," Kelly said.

Although she has heard of people having a hard time on the drug, she doesn't
know anyone personally who has suffered adverse affects beyond profuse
sweating.

"I just can't believe how many people use it," Kelly said.

Sean, 19, studies part-time at CU. He recalls students using Ritalin in the
same fashion at his high school.

"It's everywhere. Kids grind up the Ritalin and snort it," Sean says.

CU police spokesman Tim McGraw said he can't recall an arrest or complaint
at CU that involved Ritalin. The fact that Ritalin is legal with a
prescription could make it harder to track, he said.

Usually drug tips come to the CU police from students whose roommates are
dealing or from resident advisers who've become aware of drug-related
activity in residence halls.

"It doesn't mean it's not there," McGraw said. "It means is hasn't come to
our attention."

Alcohol is still the biggest drug on the CU-Boulder campus, McGraw said.

Sgt. Mike Diamond, spokesman for the Boulder County Drug Task Force, said
the task force has handled a few cases involving Ritalin, but it's not the
drug of choice in this area. Ecstasy and methamphetamine are more prevalent,
he said.

Dealing with Ritalin abuse is more tricky, Diamond said, because the officer
must first prove that the suspect is possessing the drug illegally.

Federal officials in Denver said they could not recall a federal case
involving the illegal use or distribution of Ritalin in this area.

While some critics would go so far as to see more controls imposed on the
use of Ritalin, others want the drug removed from the market altogether.

Meanwhile, people like Vandersall - whose lives have been improved by the
drug - want to continue taking it.

"The abuse of something is not a reason to get rid of it," Vandersall said.

Says Amen: "When it's the right medication for somebody, it's like a
miracle."
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