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Putting Power Back In Parental Hands
 
Posted April 28, 2003

By Kelly Patricia O Meara

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.