Each year, the drug Ritalin is currently being prescribed to an estimated 4 million American schoolchildren diagnosed with attention deficit disorder/attention deficit hyperactivity disorder.
But some parents feel that schools and medical professionals are labeling kids too quickly with ADD/ADHD and then prescribing Ritalin. The matter is now before the courts in a class-action lawsuit. Lawyers for the plaintiffs allege that Novartis, the makers of Ritalin, over-promoted the diagnosis of ADD/ADHD to boost drug sales and that the company failed to adequately warn the public of Ritalin's impact on children's cardiovascular and nervous systems. The company denies the allegations.
Joining us today for an online chat was Dr. Peter Breggin. Breggin, a medical consultant to the plaintiffs in the lawsuit, is the author of Talking Back to Ritalin and Reclaiming Our Children: The Healing Solution for a Nation in Crisis.
Moderator at 9:23am ET
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Moderator at 12:58pm ET
Welcome Dr. Peter Breggin.
Dr. Peter Breggin at 1:01pm ET
Hello. This is my very first online chat, so it's an inauguration for me and anyone who's listening. I'm Peter R. Breggin, MD. I am a psychiatrist in private practice in Bethesda MD where I've been located since I left the National Institute of Mental Health in 1968.
Moderator at 1:01pm ET
How exactly is ADD/ADHD diagnosed?
Dr. Peter Breggin at 1:07pm ET
The diagnostic manual created by the American Psychiatric Association is the basis for the diagnosis. It divides ADHD into 3 different aspects. One is hyperactivity, another is impulsivity, and a third is inattention. If you actually look at the criteria under these categories, it's a list of behaviors that annoy teachers or disrupt classrooms.
For example, under hyperactivity, the first criteria is "often fidgets with hands or feet or squirms in seat." Under impulsivity, the first criteria "often blurts out answers before questions have been completed," which to me means he could do well on Jeopardy. And the third, inattention, has for it's first criteria, "often fails to give close attention to details or makes careless mistakes."
Clearly this is not a biological disorder, but a list of behaviors that put children in conflict with adults. Even if the evaluator does many different tests lasting many hours, the diagnosis still comes back to these "fake" criteria. I call them "fake" because they really reflect conflicts between parents and children and teachers and children.
Jarod Cooper from proxy.lucent.com at 1:07pm ET
Has there been any research done on the effect that Ritalin may have on adults who were medicated with as children?
Dr. Peter Breggin at 1:10pm ET
Ritalin and other stimulants suppress growth of all origins of the body by disrupting growth-hormone cycles and that is likely to have a lasting effect. And animal studies show that amphetamines such as Adderall and Dexedrine cause brain-cell death and that Ritalin causes permanent brain disfunction at regular clinical doses. There are very few long-term studies.
One good study from the University of California School of Education by Nadine Lambert followed children given Ritalin and other stimulants and found increased cocaine and nicotine abuse in young adulthood. Some children develop tics and on rare occasion they become permanent. Some develop severe mental disorders such as depression and obsessive-compulsive disorder, and it can take time to recover. Some of the school shooters such as P.J. Solomon of Conyers GA were taking Ritalin, and clearly his acts have a lasting effect on the rest of his life.
Moderator at 1:13pm ET
In your estimation, how many children are actually afflicted with ADD/ADHD and in need of treatment? How do your numbers compare to the number of kids being medicated?
Dr. Peter Breggin at 1:15pm ET
I do not believe that ADHD is a valid diagnosis. And I believe that medicating children is not the way to handle our conflicts with them as parents and teachers. However, even by the standards of most ADHD advocates, our children are heavily overmedicated. A recent study out of Duke University showed that more than 7% of children were receiving stimulants. Another study out of Virginia showed that 10% of children were receiving stimulants in school, and probably a greater number if you included children medicated before coming to school. In addition, a study in the Journal of the American Medical Association (JAMA) has shown a 3-fold increase in Ritalin subscriptions to toddlers, ages 2 to 4, and hardly anyone thinks that's justified.
So by almost any standard, we are far overmedicating our children. The International Narcotics Control Board of the World Health Organization (WHO) has warned that the US has an epidemic of excessive Ritalin prescription, and emphasizes that stimulants are highly addictive. The US Drug Enforcement Administration (DEA) has also warned that Ritalin is excessively prescribed and is being abused by children and young adults. They have emphasized that Ritalin is not as safe a drug as advocates claim. In Talking Back to Ritalin, I document the many adverse affects from stimulant-caused mental disorders to growth suppression, heart problems and addiction.
Moderator at 1:22pm ET
Is Ritalin the most widely prescribed drug for ADD/ADHD?
Dr. Peter Breggin at 1:24pm ET
For many years Ritalin has been by far the most widely-prescribed drug, sometimes in its generic form, methylphenidate. It is now being replaced by Adderall, which is a form of amphetamine. We have even more animal research showing permanent brain damage from amphetamines than from Ritalin, a drug that is classified as amphetamine-like. Now there's a new product coming out which is basically a one-a-day dose of Ritalin. That will be even more dangerous because it encourages the quick fix mentality. Also, when a drug acts for a longer period of time, it's more dangerous because if it has a harmful effect, it can't be quickly cleared out of the body.
Betty from ee.missouri.edu at 1:26pm ET
What are the FDA and NIH stipulations for including children in drug trials?
Dr. Peter Breggin at 1:28pm ET
The FDA has approved Ritalin for use in children 6 years and older. The NIMH is currently planning to do studies involving hundreds of 2-4 year-old children. I believe that this is child abuse and should not be allowed. I urge conscientious individuals to write to their congressmen and senators and to the director of NIMH protesting giving these drugs to young children. Basically the government is doing the drug companies' dirty work by trying to prove that it is good to give these drugs to little tiny children.
A. McDonald at 1:30pm ET
I have a friend who successfully treated her child's ADD with the Dr. Feingold Diet. How much research is being done to explore a link between ADD and the increased amount of preservatives and other things in our food?
Dr. Peter Breggin at 1:33pm ET
There's no scientific evidence that children diagnosed with ADHD have a physical disorder. Therefore, I believe it is faulty to try treating it as if it's caused by a food allergy, too much sugar, or additives. Certainly, a good diet of healthy food will improve a child's quality of life, but it's a mistake to equate that with treating this fraudulent disorder. However, in order to impose a Feingold Diet requires paying a great deal of attention to your child, including all of your child's daily activities inside and outside the home. It requires a rigorous program of discipline for you and your child. I believe this is why these fad solutions actually end up helping parents and children in regard to the child learning self-control.
firstname.lastname@example.org from z064001102.hou-tx.dsl.cnc.net at 1:34pm ET
What sort of effect does Ritalin have on the cardiovascular system?
Dr. Peter Breggin at 1:36pm ET
Ritalin, Adderall, and all stimulants cause cardiovascular problems and on occasion cardiac arrest. Stimulants disrupt the rhythm of the heart. Animal studies show they weaken heart muscle. Addicts who abuse stimulants can develop severe cardiac disease. Children develop hypertension. Scientists in the black community where hypertension is a particular problem have warned about exposing African-American children to these drugs. Finally, we have had recent reports of sudden death from Ritalin. And I'm a medical expert in one of them.
Moderator at 1:37pm ET
If you don't believe in the use of medications, what are alternatives are available for parents?
Dr. Peter Breggin at 1:38pm ET
I discuss alternatives in great length in two of my recent books, Talking Back to Ritalin (1998) and Reclaiming Our Children (2000). In addition, in my book Your Drug May be Your Problem (1999), my co-author David Cohen and I have a chapter on how to withdraw children from stimulant drugs. In deciding what to do with your child's problems, you first of all need to find out what they really are. Diagnosing doesn't help. You need to find out if your child is undisciplined at home and/or at school, if your child feels anxious or distressed at home or school. If the problem is largely at home, where your child is out of control or very upset, then there's very good news. You as a parent, if you improve your parenting skills, will invariably be able to improve your child's self-control and conduct. The power is in our hands as parents, not in the child's brain. There are many good books and workshops available on parenting.
If the problem is in school but not at home, you have a more complicated situation. Schools can be very unresponsive to the needs of children. You should explain to the school that you do not favor medication, that there are many doctors who are against giving stimulants to children, and that you want to work with the school in engaging your child's interests and imagination. You should explain to the school that you will obtain any necessary psychological evaluation privately, and that you don't want the school evaluating your child except with tests given routinely to all children. Furthermore, a change of teachers or schools often completely solves a child's school problem.
Do not accept blaming your child's brain; instead, insist that the school work with you to find ways to solve your child's education problems. And finally, if your child is out of control in class, you need to visit the classroom and spend time there, both to observe your child and to invest the classroom with your authority. Very likely your child is undisciplined at home, and if you get good advice on how to handle that problem, it will carry over into school.
Matt L. from inf.uiowa.edu at 1:44pm ET
When a physician is diagnosing ADD/ADHD, should a complete evaluation by a pediatric psychologist be routine?
Dr. Peter Breggin at 1:47pm ET
Hold on to your hat, because I'm going to say something that may be hair-raising! You should not have your child evaluated by medical specialists of any kind for emotional or psychological problems unless you can be certain that they don't believe in psychiatric drugs. To take your child to any medical doctor with even a hint of a behavioral problem, nowadays the vast majority of time will result in a knee-jerk prescription of stimulant medication.
The more experienced and specialized the physician or mental-health specialist holds themselves out to be, the more likely they are professionally and financially invested in making the ADHD diagnosis and in prescribing drugs. Before seeking professional help, screen people by phone to make sure that they will help you in regard to the kind of parenting and teaching your child is receiving, and that they favor psychological and educational approaches, rather than medical ones.
Michael from techdata.com at 1:48pm ET
Does ADD/ADHD go away as a child gets older?
Dr. Peter Breggin at 1:50pm ET
Since ADHD is not a valid disorder, it is not possible to give a scientific response to the question. However, in general, if a child is distressed and in conflict with the adults in his/her life, it is important to help that child before these problems continue into adulthood. However, doctors have no scientific basis for frightening parents by telling them that their children will have a "bad outcome" in adulthood if they are not medicated. In fact, studies that show a "bad outcome" for children diagnosed with ADHD were conducted on children who were given stimulants at a research clinic. Therefore, the correct conclusion is that taking stimulants as a child may lead to a "bad outcome" in adulthood.
Dr. Peter Friedrichs from netwurx.net at 1:51pm ET
Is it possible many of these children have nervous system dysfunction that when corrected, they can resume a more normal behavior?
Dr. Peter Breggin at 1:53pm ET
No, there is no evidence that children routinely diagnosed with ADHD have any neurological disorder. Many of them, in fact, seem to be superior in terms of their physical or mental endowment, and that is precisely what gets them into trouble. When on rare occasion there is a neurological problem such as a head injury, the diagnosis is head injury rather than ADHD, and most certainly the neurologically impaired child should not have additional brain dysfunction imposed through stimulant drugs.
Medical doctors have for a hundred years tried to claim that behavioral problems in children are biological and genetic because as medical doctors that's the only way we can be in charge of the field. But in those hundred years, we have never proven that any of the behavioral problems that children have are biological in nature.
Moderator at 1:54pm ET
Dr. Breggin do you have any final thoughts to share?
Dr. Peter Breggin at 1:59pm ET
America is the first society to ever turn to the mass drugging of its children as a solution to the conflicts that inevitably arise between the generations. It is difficult to be a child. Childhood is filled with frustration, disappointment, abuse and trauma. It is difficult to be a parent, especially in this modern age where parents are often raising children on their own or while working. It is difficult to be a teacher in large, overcrowded classrooms that lack teaching assistants and volunteers and that lack the kind of exciting technologies that capture the attention of children.
But in facing the difficulties of parenting and teaching, we must not in our frustration falsely blame the brains of children in order to exonerate ourselves of responsibility. Instead, we must redouble our efforts to become the kind of parents and teachers that our children need, and we must use our influence to improve family life and school life in America. By contrast, when we tell a child that the child has ADHD, a biochemical imbalance, cross-wired in his/her brain, a genetic defect, or some other fabricated biological dysfunction, we saddle that child with an identity that will burden that individual for the rest of his/her life.
We disempower children by telling them that they can't control themselves or can't learn; we disempower ourselves as adults by saying we can't reach any particular child, and we actually end up in our frustration damaging the brains of our children to make them more docile and more manageable. That is all we can accomplish with the drugs —crushing the spontaneity of our children.
Instead we should take responsibility for empowering our children to live as full lives as possible with an intact brain. If you have further questions, please turn to my website www.breggin.com. The website describes our national organization, the International Center for the Study of Psychiatry and Psychology, which is holding it's annual conference in New York City at the Roosevelt Hotel 22-24 September.
Moderator at 2:01pm ET
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