Readin', Ritalin, and 'Rithhmetic
VICKERS, MELANA ZYLA
Readin', Ritalin and 'Rithmetic Education's new three R's. BY MELANA ZYLA VICKERS EVERY DAY AT LUNCH HOUR last year, Karen Gayhart busied herself piling up the green, plastic pill trays at the...
...In a fact sheet on "medical management," CHADD warns that inadequate treatment of attention deficit disorders can lead to "grave consequences," including "academic failure, and a possible increase in the risk of later antisocial and criminal behavior...
...We haven't had one teacher prescribe drugs...
...The Connecticut law and others like it effectively prevent teachers from recommending directly to parents that a child be seen by a doctor or medicated for an attention deficit disorder...
...People with experience in the issue need to study it, [legislators can't] just sit down and write legislation just because some parents want it," argues Nancy Stanley, associate executive director of the Michigan Association of School Administrators...
...And where there's a diagnosis, prescriptions aren't far behind...
...As a stimulant, Ritalin may well help kids "pay attention and stay task-focused," but that's all...
...Is it because they've heard the studies suggesting Ritalin may cause long-term, genetic-level brain changes in children...
...But something is amiss...
...This year, Gayhart handles only two trays...
...Such recommendations are left to school mental-health experts or the parents themselves...
...It's because kids are taking morning doses that last longer," says Gayhart, explaining they don't need to top off at lunch...
...She has found that while the use of drugs for ADHD "may reduce hyperactivity, there's no indication the child will learn any more effectively...
...The laws also restrict child-welfare workers from intervening to force parents to keep kids on the drugs...
...All of this despite the fact that the condition which the drugs are meant to treat is the subject of heated dispute among medical professionals, and that the drugs' benefits are limited at best...
...Not all school officials agree with the restrictions...
...Its symptoms are the same as those for childhood depression, anxiety, chronic stress, and abuse...
...There needs to be a lot more done than putting a child on medication and thinking the problem is solved," says Winkler...
...Are we really prepared to redefine childhood as an ailment, and medicate it until it goes away...
...The Connecticut municipality of Meriden is risking state financial penalties by so far failing to implement the state law...
...In Michigan, where a similar package of laws is weaving its way through the legislative process, school superintendents are voicing opposition...
...The doctor will accept the conclusion, figuring the school officials spend more time with the kid than he or she does...
...The results: ADHD children who take Ritalinlike drugs are just as likely as unmed-icated ADHD children to be suspended or expelled from school or to repeat a grade...
...The experience at Great Neck Middle School neatly illustrates how, nationwide, the drugs used to treat children's Attention Deficit Hyperac-tivity Disorder (ADHD) have gone from popularity to infamy to stealth...
...It's that apparent convenience for the school system that is objectionable to an increasing number of state politicians...
...But the absence of educational benefits will surprise the tens of thousands of parents influenced by the claims of CHADD, the main advocacy group for Children and Adults with Attention-Deficit/Hyperactivity Disorder...
...Republicans in the state legislatures of Connecticut, Michigan, and Virginia have pushed laws restricting their public-school systems from pressuring parents to put their rambunctious children on psychostimulants...
...Preschool children were being given the drug, news reports said, and some parents were complaining of pressure from schools to put their children on the drugs...
...Her findings, published in January, dovetail with one of the less-noticed conclusions of the NIH experts—that while drug treatment improves core symptoms of ADHD, "there is little improvement in academic achievement or social skills...
...Scooping out little, round Ritalin or Adderall pills one at a time, she and other clinic workers quickly emptied four of the 30-dose trays into the hands of the adolescents lining up at the office door...
...In 1998, doctors made 2.3 references to psychotropic drug treatment per doctor visit, she notes...
...The disorder—estimated by a panel of experts convened by the National Institutes of Health to affect 3 to 5 percent of school-age children—has among its core symptoms "develop-mentally inappropriate levels of attention, concentration, activity, dis-tractibility, and impulsivity" that can impair a child's functioning at home, school, and with peers...
...Nope...
...Attention Deficit Hyperactivity Disorder has become the most commonly diagnosed mental health condition among children in the United States, and over 80 percent of the children so diagnosed take drugs as treatment...
...Take Gretchen LeFever, a psychologist and researcher at Eastern Virginia Medical School...
...Melana Zyla Vickers is a columnist for TechCentralStation.com...
...It's doctors, primarily in high-income white areas and low-income minority areas of the country, who write the scripts...
...Is that because some of the students' parents, teachers, and doctors have backed away from the drugs, recoiling from the now-familiar news that their community is among those that lead the nation in dispensing psychostimulants to children...
...Or because they've read the Drug Enforcement Administration warning that high doses of such drugs "often produce agitation, tremors, euphoria, tachycardia, palpitations and hypertension" or that "psychotic episodes, paranoid delusions, hallucinations and bizarre behavioral characteristics similar to amphetamine-like stimulant toxicity have been associated with methylphenidate (Ritalin) abuse...
...True, if facile...
...It has no long-term benefits, or broader immediate consequences other than side effects...
...Politicians in Minnesota, New York, Texas, and Wisconsin are following suit...
...Sometimes a school sends a note to the pediatrician, and the pediatrician interprets it as the school concluding the kid has ADHD," says LeFever, the Virginia Beach researcher...
...LeFever has now gone back and studied about 1,000 children in the area in an effort to evaluate the drugs' effect on learning...
...After USA Today and other newspapers published stories in recent years about parents being pushed by teachers to put children on Ritalin or risk intervention by local child protective services, the politicians pushed back...
...Physicians and the public are becoming more comfortable with treating a variety of ailments medically and are becoming more comfortable with drugs," LeFever says...
...She and colleagues pointed out that in the Virginia Beach area in 1995-96, a whopping 20 percent of white, male fifth-graders were taking drugs for ADHD...
...There is no diagnostic test for Attention Deficit Hyperactivity Disorder, according to the NIH panel...
...And it appears from national data that once a knot of parents and doctors in a community reach consensus about the benefits of Ritalin, others quickly follow...
...And the vast majority of teachers and pediatricians are probably counseling them with the best interests of the children at heart...
...But rather than decline in the face of such uncertainty and controversy, Ritalin use has exploded: 17,618 kilograms of Ritalin and like drugs will be produced this year, up from 14,957 kilos in 2000 and 3,708 kilos in 1992...
...Carol Flach, who supervises close to 100 nurses in the district, sees the trend in all her schools: Some parents may have stopped giving their children the drugs, she says, but most of the noontime change is attributable to extended-release versions of the drugs...
...Soon after finding their way into parents' medicine cabinets, though, the drugs met with a firestorm of controversy when reporters and politicians noticed that the number of prescriptions for ADHD drugs was approaching 20 million per year...
...Through the 1980s and early 1990s, many parents who had their difficult-to-control children diagnosed with ADHD reached for drugs such as Ritalin, which appeared in short-term clinical trials to alleviate the symptoms of the disorder...
...But medicating the children "is a quick fix with no real thought process involved...
...Two potential brakes on the drugs' spread—one legal, one in public-health research—have nonetheless begun to get traction...
...In this public school serving an affluent section of the city, roughly 10 percent of the students were taking highly addictive, mind-altering prescription drugs every morning, noon, and night...
...Since Ritalin and the other drugs aren't proven to benefit learning, they're at best discipline in pill-form, a means of keeping children from acting up at school...
...BY MELANA ZYLA VICKERS EVERY DAY AT LUNCH HOUR last year, Karen Gayhart busied herself piling up the green, plastic pill trays at the health clinic of Great Neck Middle School in Virginia Beach, Va...
...Educational improvement is not an expected outcome from Ritalin administration," he says...
...This comes as no surprise to psychiatrists such as Glen Pearson, a medical director for the Dallas Independent School District and former president of the American Society for Adolescent Psychiatry...
...Rates for minorities and girls were lower...
...Meanwhile, public-health researchers and doctors scattered across the country are shedding some skeptical light on the drugs' effectiveness...
...As such, they may well be more helpful to overworked teachers and other students than to the pill-taking student himself...
...LeFever's research has sounded alarm bells in the past...
...The advocates may not quite be claiming that drugs can help kids educationally, but they're hinting pretty darned hard...
...The NIH experts add that "further research is necessary to firmly establish ADHD as a brain disorder" and that there are "questions concerning the literal existence of the disorder, whether it can be reliably diagnosed, and, if treated, what interventions are the most effective...
...To be sure, there are tens of thousands of children whose hyperactivity and inability to concentrate lead their desperate parents to seek medical help...
...With the side effects of the drugs unknown, and their educational utility in doubt, the American dependency on Ritalin and other behavioral drugs for students seems far higher than it ought to be, yet it is still growing...
...If the state laws don't have an effect, what will...
...Stanley adds that the laws aren't necessary because "teachers can't prescribe the drug...
...All in a controversial effort to improve their ability to settle down and concentrate on learning...
...It's got to be very difficult to teach or attempt to teach a class when you've got children that are acting out or have behavioral problems," concedes Lenny Winkler, a nurse and Republican state representative in Connecticut who spearheaded the first state laws on Ritalin last summer...
Vol. 7 • March 2002 • No. 25
