Monday, November 12, 2007

Children, ADHD and Ritalin

This evening the BBC1 Panorama programme is showing a documentary on the prescription of Ritalin to children diagnosed with Attention Deficit Hyperactivity Disorder.

This seems an appropriate time to reproduce an article of mine that was published in Open Mind magazine (issue 123, October/September 2003) four years ago.

Always on the Go

A psychologist I know gives her last lecture of each year on a paper entitled ‘The aetiology and treatment of childhood’. It describes a worrying condition, with symptoms like short stature, emotional immaturity and a reluctance to eat vegetables – or ‘legume anorexia’. The good news is that when sufferers are investigated 10 years later they have almost all got better.

Yes, it’s a joke – a clever American satire on the way professionals turn normal human behaviour into a medical problem. But a lot of notes get taken before her students realise this.

Inspired by my friend, we could invent another spoof diagnosis. Let’s imagine a condition which largely affects boys between the ages of 6 and 12, and manifests itself in symptoms like not doing homework, fidgeting and being ‘always on the go’.

Unfortunately, this one is not a joke. It is a shorthand description of Attention Deficit Hyperactivity Disorder (ADHD), the most commonly diagnosed psychiatric condition in American children today. There is more to diagnosing it, but not a great deal. Children must display these behaviours in more than one setting (say, at home and at school) and they must be evident before the child is seven. It is often diagnosed by teachers or school counsellors with no medical training.

In the USA, at least 10 per cent of children – 5 or 6 million out of 50 million – are taking medication to treat ADHD; 90 per cent of them boys. In some classroom in prosperous New England states, as many as one boy in three can be on drugs.

Not only are the numbers diagnosed enormous, they are rising rapidly. The most commonly prescribed treatment for ADHD is methylphenidate, better known under its brand name Ritalin. Back in 1988, one million American children were taking it: in 1975 the figure was 150,000.

The same trend can be seen this side of the Atlantic. Department of Health figures show that National Health Service prescriptions of Ritalin in England rose from 2,600 in 1992 to 186,000 in 2000.

ADHD is no joke at all when you know more about the medication used to treat it. Besides Ritalin, children can be prescribed dextroamphetamine (Adderall or Dexedrine) or methamphetamine (Desoxyn or Gradumet). These drugs share an ability to calm children down and make them more manageable in classroom settings.

To some, it is paradoxical that drugs known as stimulants make ADHD children calmer. They see it as proof there is something different about their brains. But the American psychiatrist Peter Breggin says this effects has long been known. He describes what happens when ADHD medication is given to laboratory animals:

instead of struggling to escape a cage, the animal will sit relatively still, carrying on rote, useless behaviours, such as grooming, chewing on its paws, or staring into the corner. If the drugged animal does move about, it will pace a restricted area in a purposeless manner.[1]

To Breggin, the therapeutic effect of Ritalin and its rivals is better seen as an adverse reaction. He quotes a study where more than half the children treated displayed obsessive-compulsive behaviour. They played the same game over and over again, or exhausted themselves raking up leaves. It is nice when children want to help in the garden, but when, as in a case I have heard Breggin describe, a boy waits under the tree for a leaf to fall, something is very wrong.

Sometimes the side-effects are more serious: children become ‘zombie-like’ or suffer from hallucinations. Often they will end up taking cocktails of drugs to treat these reactions. And there can also be serious effects on physical health: high blood pressure, palpitations, stomach cramps, blurred vision and much else.

Why are so many children being diagnosed with ADHD and put on drugs? Or, as the Washington writer Mary Eberstadt asks:

How has it come to pass that in fin-de-si├Ęcle America, where every child from preschool onward can recite the “anti-drug” catechism by heart, millions of middle- and upper-middle-class children are being legally drugged with a substance so similar to cocaine that, as one journalist accurately summarized the science, “it takes a chemist to tell the difference”?[2]
One explanation is that America has got it right. Perhaps millions of children across the world are suffering from ADHD but going untreated. But if this were the case, as Leonard Sax points out, you would expect American children to be racing ahead in their school work. As it is, ‘France, Germany, and Japan continue to maintain their traditional lead over the United States in tests of math and reading ability’.[3]

It is the same with juvenile crime. ADHD is diagnosed more often in Britain than the rest of Europe. But a recent survey found that ‘the United Kingdom arrests a higher proportion of young people than the average for the countries of the Council of Europe for all categories of crime except rape and murder’.[4]

If we set aside the idea that ADHD is a real condition, there are many other explanations for the rise of the diagnosis. Some say that children’s behaviour really is getting worse and emphasise the role of chemical additives in food. They claim great improvements from a change in diet.

Others point to drug companies’ financial support for groups of parents of ADHD children. These publicise the diagnosis and challenge the media when they question its validity. And it is a good investment: in 2001, American companies made $600 million in profits on ADHD drugs.

But marketing a product is not as easy as that. If it were, we would all be millionaires. So there must be something about modern American and British society that makes it so receptive to the idea of ADHD.

A clue to what it might be lies in the figure we gave earlier: 90 per cent of the children prescribed Ritlalin are boys. What has changed for boys in recent decades?

One development has been the rise of feminism. At one time boys were pretty much expected to fidget and lose things. If you said a boy was ‘always on the go’ in the 1950s, it was praise. The feminist demand was for girls to be treated with the same indulgence as their brothers. They should have the same freedom to play out, tear their clothes and get dirty.

Today, things are different. So entrenched is the belief there are no intrinsic differences between boys and girls that few professionals would dare say ‘boys will be boys’ when discussing a client. Yet the same people, as parents, will say to one another: ‘You know, boys are different.’

And if they are different, perhaps they should be treated differently. Penny Holland has just published a book suggesting that banning play with guns in schools and nurseries does more harm than good. She told the Guardian:

We noticed an impact on the half a dozen boys who were persistently interested in weapons and superhero play. We started to notice the effects of our constant negative attention. They became more withdrawn – and set on a behaviour train. They became dispirited.[5]
And playing in the street has been redefined as ‘anti-social behaviour, with all sorts of police and council powers developed to deal with it. Yet you do not have to be so old to remember your mother asking you as a child, ‘Why are you indoors on a nice day like this?’

If boys’ energy is finding fewer outlets at home, the position in school is worse. Although there is little research to back the idea, it is now agreed between all parties that education is the key to improving Britain’s economic performance. The result has been a grinding emphasis on basic skills and government targets.

Margaret Hodge, now Minister for Children, announced in 1999 that ‘the days of toddlers colouring, cutting and pasting are over’. Meanwhile, league tables of older children’s test results are printed in every newspaper, and GCSE and A-level results are treated as a barometer of the nation’s health.

When you add to this the fact that the government wants half of all children to go to university – and how few children from poor homes get there – it is clear that it is almost impossible for a middle-class child to step off this conveyor belt. A great number of children with no aptitude for it are forced to study until they are 21. No wonder they have behavioural problems.

Over the same period, schools have become less structured, with more onus put on individual pupils to organise themselves. Recent research from the Office for Standards in Education says this does not suit boys. They do better when teachers set clear limits and in schools with good discipline, close monitoring and a sense of community.[6]

Of course, some children’s behaviour is difficult and the parents do need help – although it would be a relief to see some alternative to the chemical cosh of Ritalin. But it is clear that the ADHD diagnosis is hoovering up all sorts of boisterous, bored and unhappy children. It is not their brains that are faulty, but the way we adults treat them.

References
  1. P. Breggin (2001). What people need to know about the drug treatment of children. In C. Newnes, G. Holmes & C. Dunn (Eds.) This is madness too. Ross-on-Wye: PCCS Books.
  2. M. Eberstadt (1999). Why Ritalin rules. Policy Review, 94, April–May, Washington DC: Heritage Foundation.
  3. L. Sax (2000). Ritalin: Better living through chemistry? The World and I, November, pp. 287–299.
  4. G. Buckland & A. Stevens (2001). Review of effective practice with young offenders in mainland Europe. Canterbury: European Institute of Social Sciences.
  5. P. Curtis (2003). Why toy guns are back in the classroom. The Guardian, 12 July. (Penny Holland’s book, We don’t play with guns here, is published by Open University Press).
  6. Office for Standards in Education (2003). Boys’ achievement in secondary schools. London: Ofsted.

12 comments:

Norfolk Blogger said...

The whole programme and this article ignroe the fact that some children benefit enormously from Ritalin. I'm sorry, but as a teacher I see it. I remember one fabulous boy called Jamie who whilst off Ritalin would kick, punch, thrown things, and sometimes even at the age 11 would sit under a table and cry his eyes out because he hated himself. He loather the way he behaved but could not control it. on Ritalin, he was a calm pleasant lad who was an absolute pleasure to be around. The problem was he had to wait four years to get it prescribed, by which times he had slipped so far behind with his work.

Name any drug which affects the brain (prozac, cipramil, cipralex, equasym, ritalin) and someone will come up with a blanket story that says it does not work and is an easy option, but this ignores that for many many people these drugs do work.

I have seen kids lives genuinely transformed by going on to ritalin. Not all of them, I grant you, but many. If my son needed it I wouldn't hesitate. This is because I have seen its effects, not read about it in a paper on seen a documentary.

Werner said...

Hello Jonathan,

I agree with you that misbehaviour hardly qualifies as a "disease". The idea of giving four year old children the equivalent of cocaine in order to render them compliant is the only thing that's "sick".

Anonymous said...

We need to be very careful also how these types of behaviours and the comments we make about them, can be perceived. Just like words, behaviour can very easily be misinterpreted.

Why not look at what causes any child to be prescribed Ritalin in the first place. Either the parent or the school, not the child, has identified a problem "the child is disruptive" i.e. the childs behaviour is not appropriate to the needs of the parents and or the school.

so the first step to prescribing or rather misprescribing Ritalin is either the parents or schools need to bring some kind of normailty to thier life. In the case of children who have ADHD then it is difficult to argue against the research, that Ritalin “may work” for some or even most of them. However the initial motivation for obtaining the prescription is inherently selfish stemming from the parents or schools needs, rather than the child’s and depends quite heavily on the schools and the parents perception or tolerance and assuming that the parents an schools are assessing those fairly.

The problem with "may work", is, what happens to the child if it does not work? what effects does Ratalin still have. peoples minds tend to shut off to the question at this point as it seems to our brains to be a rhetorical one and the sensible conclusion to come to is that, as the course of Ritalin has not changed the “schools or parents perception of what the childs behaviour should be like, that the problem has not been solved and no ill effects have been suffered, we will just try something else, but have they suffered other side effects?

An important question that does not seem to have been answered, or asked here, is what happens to a child who does not have ADHD and is put on Ritalin for 12 years.

Lets us say for example, that the Child was actually perfectly happy and "normal" but simply Gifted(higly intellegent), was not really disruptive at home but frustrated and therefore disruptive at school.

This child is misdiagnosed with ADHD and, god forbid, put on Ritalin for 12 years, because the initial courses did not work, because the child did not have ADHD. What permanent effects might that child suffer. No one seems to know or care and certainly the question is very much avoided.

The story about the Fabulous by called Jamie, can be perceived in many ways. Was the child disruptive or was it the people who had the control over his drugs, tolerance of Jamies “normal” behaviour potentially the problem?

I am sorry Jonathan but Jamie was more likely to be sitting under the table crying because he was suffering withdrawl symptoms from the drugs his mother was pushing down his throat because she could not handle him for whatever reason. Was Jamie unhappy and crying before he went on Ritalin, I bet he was not, just disruptive and who can ask Jamie when gets older because more than likey he was put on Ritalin when he was 3 so he will never remember how he felt before he was put on it and we all take Jamies parents word for it. It is very sick indeed.

Anonymous said...

just to add to the above, left this part out, sorry.

It is known from studies that misdiagnosed children given Ritalin will develop the very symptoms it is designed to treat. How is anyone able to then monitor the negative effects of an individuals prescription of Ritalin, when the incorrect use of the drug creates and then apparently re-confirms the incorrect diagnosis of the illness. This makes well children ill just because their parents cant handle them which may be due to problems suffered in their own childhoods or adult lives or personal problems suffered at the time, divorce, debt or they simply don’t like or want the child, etc etc. “just give him more drugs”

Anonymous said...

Anonymous wrote:
"It is known from studies that misdiagnosed children given Ritalin will develop the very symptoms it is designed to treat."

Citation please or an apology for an inflammatory, inaccurate statement.

Thanks,

Michael Levin, MD
a child psychiatrist, by the way.

Anonymous said...

Dear Mr Levin

Sorry It has taken so long to reply.

I am not sure why it is an inaccurate statement, as you only have to ask a few poeple or read a few articles to find these studies google is a wonderful thing.

I accept most of the studies are carried out by Psycologists, who to Psychiatrists are second rate nobody's, however it is important here to point out Child Psychiatrists have a financial incentive to get as many kids on ritalin as possible, they write the prescriptions. It must be a coincedence that the majority of anti-ritalin studies are done by psychologists and pro-ritalin, by Psychiatrists.

I think I know who's opinion I would rather trust.

I quote "The segment quoted clinical psychologist Jack Leeb's opinion that "[Ritalin] is possibly misprescribed 50 or 60% of the time."

from an earlier posting "It is important to remeber that Ritalin does help some children" I am not sure but for the purposes of this debate, I will accept that. However what about all those kids lives that misprescription has ruined. Misdiagnoses made by Psychiatrists. 50 or 60 % of the time does not represent a minor problem either. This in fact represents a majority of prescriptios are of no help at all and in fact carry with them serious side effects for children misdiagnosed. what is also important to point out is, there appears to be some misunderstanding of what side effect means, in the context of my argument this is "what are the ill effects suffered by a child who has been placed on ritalin for 12 years but was not in fact ADHD or ADD, studies, (as above), show that this happens nearly 60% of the time."

perhaps Mr Levin MD (a child Pschiatrist by the way), you could answer that question for us????

Perhaps you could apologise for all the innocent childrens lives that have been ruined by misprescirptions made by psychiatrtists all over the world.?

Anonymous said...

to add to the above

anonymous(A lawyer by the way)

Anonymous said...

sorry Mr Levin I will apologise before you ask, for an inaccurate statement in my last comment, I said that 50-60 % of misdiagoses are made by Psychiatrists, well this in fact is probably not the case even if 60 % is the correct figure.
More often that not, I would guess, as I am not an expert, that misdagnoses occurs as a result of the parents or schools giving poor info to Psichiatrists and you guys take all the blame because you wrote the prescription this is what I was trying to get at in my first posting back in 2007. The reality was, I am not sure if it is the same now though, but in the 70's the incentive to psychiatrists to sell ritalin left it open, as in every other industry, to rogues. Sharp practice and manipulating vulnerable parents into signing a death warrant for thier children in order to make money peddling legal narcotics to children.

my question to you was a rhetorical one, as you could probably guess, I can answer it for you from personal experience. Hence my (perhaps, although not entirely, misguided) agression towards Psychiatrists. I think in my case though it was also my Parents fault I was misdiagnosed.

The ill effects are numerous and everlasting, you may ask well you are a lawyer you turned out OK. Perhaps that may seem OK to some people. However before I was put on Ritalin I was identified as highly gifted.

Fortunately for me, I was not put on Ritalin aged 3 I was put on it aged 7 1/2 and I had 1 1/2 years school reports to compare behaviour and grades. Seems very strange to me that as soon as I started Ritalin my grades went from above excellent to average within one school term and my behaviour in class began to deteriorate, I went from the most promising scholar in the whole school to Joe average in 3 months. Becasue I was not put on it age 3 like kids in USA, the Psychiatrist could not say I was "Twice exceptional" like 140 000 gifted chldren in the USA who are now also Joe Average becasue they were put on Ritalin but because they were put on it at age 3 there is no way for anyone to compare the grades, so to cover it up Psychiatrists call them twice exceptional which means they are gifted but also have learning disabilities the psychiatrists suggest they were born this way but they all no better than that.

If you give a gifted child or any normal child chitalin you are going to calm them down. This is what it does not hyperactive children so why do Psychitrists deny it has any lasting ill effects on normal chidren. If it permanently affects the behaviour of one child then it is reasonable to assume, considering all of the evidence that it is also permanently going to change the behaviour of a normal child.

when I was 17, following numerous tests, they said "sorry, your son does not have adhd and never did, the reason why he has underachived all his life is because he was misprescribed ritalin, there is no cure and there is nothing anyone can do about it sorry. he may or may not turn out OK at some point in the future, goodbye"

The fact that I am a lawyer means nothing, I could have been a NASA scientist or anything I wanted to be but had to settle for Law becasue my grades were not good enough to do anything else.

Living with permanent depression is no barrell of laughs either, the cure for which, just happens to be another drug made and prescribed by the same people who messed me up in the first place.

Thanks Mr Child Psychiatrist. I am glad you could make a few quid by causing misery in my life and not only from my initial misery but from treating me for the misery you caused me.

continued......

Anonymous said...

continued .....

in many cases the Psychiatrists have the perfect money-making circle of deception. Once a misdiagnnoses occurs and a casue of action arises as a result, ie. a law suit is capable of being taken against the Psychiatrist and/or manufacturer, the Psychiatrists goes to work on the parents again, prays again on thier vlunerabilities and say sto parents dont tell your children about this misdiagnoses because most children diagnosed turn out fine in later life and if you tell them they will hate you for it! most parents dont even tell thier children they were misdiagnosed and they never know that the reason they have underachived and blame put on them was becasue someone is covering up mistakes so that they dont look bad. They could have been the next Einstein but instead they are happily sucking on PROZAC, packing boxes in a factory for the next 55 years of thier life never the wiser. The Psychiatrists know that 80 % of those misdiagnosed will become chemical dependants i.e. drug addicts, this again creates the perfect defence for them because if someone is on drugs how is anyone to know that it was Ritalin or the drugs that is making them like that. Therefore in 80% of cases the Psychiatrist only has to con the parents until the child ends up on drugs and they are off scott free, the other 20 % turn out fine, the parents never told them and no one is the wiser.

I am one of the lucky ones, in some respects at least, one day when he was drunk my father told me everything, I was 28 at the time, much too late to do anything about it though, to fix me!, not sue the drug company!. I was always made out that it was me that was simply lazy even though my parents knew it was because of the Ritalin. The Psychiatrist tricked them by praying on my parents fear that the child would hate them. The result being the child never knows and the Psychiatrist and the drug company avoid an expensive law suit.

Some of you guys are pretty sick??, and these are the people messing about inside our childrens heads. We need to be sure that it is the child we are trying to help and not just trying to make dealing with our children easier. It will because of thier very profession, be almost impossible to identify a rogue psychiatrist, there will not be many, but the descision these people make will affect our children for the rest of thier lives.

Psichiatrists have no real incentive at all to properly diagnose mental illness becasue thier is little or no punishment for them making a misdiagnoses as it is almost impossible to sue in alot of mental illness cases because it is about someones head and there are too many things with the passage of time, throughout the childs life that may have had an adverse affect on the child. So it is almost always impossible, they would make you think anyway, to know if it was the misprescription that made them ill. The Psychitists inevitably blame poor parenting in later years and because the psychiatrist had already identified the vulnarabilities of the parents when first duping them into drugging thier children i.e. they knew those parents would end up divorced and were dysfunctional, they already had thier defence to later legal action before they began. These guys are not called headshrinkers for nothing.

continue ...

Anonymous said...

continued...
I know what some may be thinking, you are paranoid, perhaps I am, but can you blame me for thinking the Psychiatrist who put me on it was bent, and conspiracy theorists for thinking it is just a money making scam and one designed to dumb down intelligent children.

I quote

"the American psychiatrist Peter Breggin says this effect has long been known. He describes what happens when ADHD medication is given to laboratory animals:
instead of struggling to escape a cage, the animal will sit relatively still, carrying on rote, useless behaviours, such as grooming, chewing on its paws, or staring into the corner. If the drugged animal does move about, it will pace a restricted area in a purposeless manner.[1]

To Breggin, the therapeutic effect of Ritalin and its rivals is better seen as an adverse reaction. He quotes a study where more than half the children treated displayed obsessive-compulsive behaviour. They played the same game over and over again, or exhausted themselves raking up leaves. It is nice when children want to help in the garden, but when, as in a case I have heard Breggin describe, a boy waits under the tree for a leaf to fall, something is very wrong.

Sometimes the side-effects are more serious: children become ‘zombie-like’ or suffer from hallucinations. Often they will end up taking cocktails of drugs to treat these reactions. And there can also be serious effects on physical health: high blood pressure, palpitations, stomach cramps, blurred vision and much else." (this is quoted from BBC1 Panorama programme)

Yes some children probably do need Ritalin, but becasue the effects are not physical, parents do not place as much importance on the ill affects, it is like society in generals' attitude towards mental illness, they know it exists, but because you cant see it they ignore it when it is easier to do so.

Parents need to treat making a descision to put thier child on ritalin as seriously as they would if thier child needed life altering surgery, i.e they have in infection in thier leg, the leg can be saved but the doctor thinks it could risk the life of the child of it is not amputated right away. You also need to consider though that a Physician is more likely to care about getting it wrong for exactly the same reason your missing leg will be noticed more than permanent depression and it is much easier to prove you missing leg was the doctors fault. I bet you this line of thinking would drastically reduce the number of misdiagnoses. it is like a plane crash, it is no one persons fault when a misdiagnoses occurs, it is a critical chain of events, the ommission of any of which would result in the misdiagnoses being avoided.

you need bad parents, a rogue phsychiatrist and a very active child, and these are just a few. The problem is it is happening in 60 % of cases and something is suspucious about that and that is what fuels conspiracy theories.

it is legalised drug dealing and the drugs being peddled to our nations children are not very different from those which are demonised as being personality altering and life destroying. Even cocaine has it uses in treating mental illness but give it to the wrong person everyday for 12 years, they are not going to be OK. The same applies to many drugs used to treat mental illnesses.

Parents take note!!!!

Anonymous said...

continued ....

and to finally answer your request for an apology for an incorrect statement, it was not incorrect, I have quoted from personal experience and the experices of many other children that suffered at the hands of greedy doctors

there was nothing wrong with me the Psychiatrist has admitted it and in mine and many other cases like it, (those who were not misdiagnosed at 3 years old). They have had to bite the bullett. This is why they must all now be identified before age 7 so that you will never know, because there will be no academic comparison to make later in life.

It is also important here to mention that in mine and other cases the childrens doses of Ritalin were increased because the children began to display the very signs the drug was designed to treat. The parents had identified problems but they had no problems at school, all of a sudden they start having problems at school and the problems at home increase, what happens then should be oh-dear we have made a mistake. but instead the childs dose in many case is in fact increased further worsening the problem.

it is again the perfect circle of deception fueling conspiracy theories - any hint of problems by the parents, put them on ritalin age 3 and when they get to school they will be disruptive children even if they were perfectly normal before hand.

The school therefore confirms the diagnoses but because of the childs behaviour the dose is increased not stopped because it is seen as having not worked sufficiently.

the child remians on ritalin for 12years and is in some cases ok but in most messed up for life and never the wiser, they simply think they are losers and were born that way.

Anonymous said...

continued....

I remember at 12 years old, I attended extra school, a school for gifted children, I hated it, and cried all the time just like little Johnie. I left that school and became happier shortly after.

For years I thought it was because I did not fit in with the other children but I now know that this was when my parents had started to ween me off it and it was just withdrawl symptoms....nice!!!

where the conspiracy therorists are slightly wrong is that it does not dumb down the children in that sense, it never took away my IQ it was and has always been the same, what it did was make me very lazy, just like in Breggins findings, on the children, not the rats... Zombie like but I have never suffered from halucinations but definitely heart palpitations, stomoach cramps and blurred vision. but until I read this panorama article I never knew these were because of Ritalin. It is enfuriating and there is nothing I can do about it. I have to live with someone elses mistakes for the rest of my life and because of the amount of power held by the Pharmacuetical companies both in money and with the help of Psychiatrists knowledge of how to manipulate the human mind it is like shooting goldfish in a bowl with a shotgun. my only resort is to pay them more money to give me more drugs( and they are laughing at me right now...) and complain on blogs like this and appear as a crazed lunatic hellbent on conspiracy which no one takes any notice of.

I cant get help from anyone, because no-one realy wants to admit there is a problem.