Pubdate: 4 Dec 1999
Source: British Medical Journal (UK)
Copyright: 1999 by the British Medical Journal.
Contact:  http://www.bmj.com/
Issue: BMJ 1999; 319:1456 (4 December)
Article at: http://www.bmj.com/cgi/content/full/319/7223/1456/c
Author: Fred Charatan, Florida

US EDUCATION BOARD ADVISES AGAINST DRUGS FOR BEHAVIOURAL PROBLEMS

A US board of education has passed a resolution urging teachers to use
discipline and instruction to overcome problem behaviour in the classroom,
rather than encouraging parents to seek drug treatment for their children.

The resolution passed by Colorado Board of Education carries no legal weight
but sounds a warning on the growing use of drugs such as Ritalin
(methylphenidate hydrochloride) to deal with disruptive behaviour in
schools. Board members supporting the resolution believed that many violent
crimes committed by school students are committed by young people taking
psychotropic drugs. In the massacre last spring at Columbine High School in
Littleton, Colorado, one of the teenage shooters, Eric Harris, had been
taking the antidepressant Luvox (fluvoxamine).

The board's action, believed to be the first in the United States, is sure
to intensify the debate over the use of psychotropic drugs in conditions
such as attention deficit hyperactivity disorder (BMJ 1998;317:1545). An
estimated 2.5 million children in the United States are now taking drugs for
this type of problem.

Dr Peter Breggin, director of the International Centre for the Study of
Psychiatry and Psychology, a non-profit research organisation in Bethesda,
Maryland, believes that doctors are overprescribing psychotropic drugs.
"It's a tremendous mistake to subdue the behaviour of children instead of
tending to their needs," he said. He is convinced there is a direct link
between the drugs and violent acts.

The use of psychotropic drugs in children with attention deficit
hyperactivity disorder was examined last May in the Journal of the American
Academy of Child and Adolescent Psychiatry. A review of a sample of nearly
1300 children in four US communities showed an overall rate of the disorder
of about 5%, based on formal diagnostic criteria. Results showed that fewer
than one in eight children with the disorder received stimulant drugs.
Reassuringly, the researchers concluded that children with the disorder were
more likely to receive other forms of treatment than to receive stimulants.

Dr Stephen Stahl, a professor of psychiatry at the University of California
in San Diego said: "If a kid is acting out in class and a stimulant like
Ritalin calms him down, it would be immoral not to give him the medicine."
He cautioned, however, against giving such treatment in isolation, "as an
excuse to avoid tough decisions, or talking with teachers and doctors to
learn what's going on."
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