-Caveat Lector- ----- Original Message ----- Sent: Saturday, March 10, 2001 9:36 PM Subject: OBRL - Medicate Or Else - Schools Pressure Parents > > Please copy and distribute > to other interested individuals and groups > > ********** > > Medicate Or Else - Schools Pressure Parents To Force Ritalin Use > By Lawrence H. Diller, M.D. > Special To MSNBC 3-4-1 > http://www.msnbc.com/news/534034.asp?bt=msn&btu=http://go.msn.com/zz > > Public school administrators, long the enthusiastic adherents of a "Just > Say No!"policy on drug use, appear to have a new motto for the parents of > certain tiny soldiers in the war on drugs: "Medicate or Else!" > > It is a new and troubling twist in the psychiatric drugs saga, in which > public schools have begun to issue ultimatums to parents of hard-to-handle > kids, saying they will not allow students to attend conventional classes > unless they are medicated. > > With a 700 percent increase in the use of Ritalin since 1990, parents have > been repeatedly told that their kids probably have ADHD and that Ritalin is > the treatment of choice. > > In the most extreme cases, parents unwilling to give their kids drugs are > being reported by their schools to local offices of Child Protective > Services, the implication being that by withholding drugs, the parents are > guilty of neglect. > > At least two families with children in schools near Albany, N.Y., were > reported by school officials to local CPS offices when the parents decided, > independently, to stop giving their children medication for > attention-deficit hyperactivity disorder. (The parents of one student > pulled him from school; the others decided to put their boy back on > medication so that he could continue at his school.) > > Meanwhile, class-action lawsuits were filed in federal courts in California > and New Jersey, alleging that Novartis Pharmaceuticals Corp., the > manufacturer of Ritalin, and the American Psychiatric Association had > conspired to create and expand the market for the drug, the best known of > the stimulant medications that include the amphetamines Adderall and > Dexedrine. The suit appears to be much like another lawsuit brought > against Novartis in Texas earlier this year. > > As a doctor with a practice in behavioral pediatrics -- and one who > prescribes Ritalin for children -- I am alarmed by the widespread and > knee-jerk reliance on pharmaceuticals by educators, who do not always > explore fully the other options available to deal with learning and > behavioral problems in their classrooms. Issues of medicine aside, these > cases represent a direct challenge to the rights of parents to make > choices for their children and still enjoy access to the public education > they want for them -- without medication. These policies also demonstrate > a disquieting belief on the part of educated adults that bad behavior and > underperformance in school should be interpreted as medical disorders that > must be treated with drugs. > > Unfortunately, I know from the experience of evaluating and treating more > than 2,500 children for problems of behavior and school performance that > these cases represent only a handful of the millions of Americans who have > received pressure from school personnel to seek a "medical evaluation" for > a child -- teacher-speak for "Get your kid on Ritalin." > > Most often, evaluations are driven by genuine concerns first raised by a > teacher or school psychologist. But too frequently the children are sent to > me without even a cursory educational screening for learning problems. With > a 700 percent increase in the use of Ritalin since 1990, parents have been > repeatedly told that their kids probably have ADHD and that Ritalin is the > treatment of choice. More and more often, the parents who buck this trend > are being told they must put their children in special restricted > classrooms or teach them at home. > > Patrick and Sarah McCormack (not their real names) came to my office in a > panic last year because a school wanted them to medicate their 7-year-old > son. Sarah tearfully explained that the principal and psychologist at > Sammy's school in an upscale Bay Area town were absolutely clear that the > first-grader should be on Ritalin. An outside private psychologist who had > previously tested Sammy did not find any learning problems but concluded > that he had ADHD and was defiant of authority. She suggested medication. > The school psychologist, in his report on Sammy, was straightforward in > recommending "psychopharmacological therapy" for the child. > > The McCormacks were told, in no uncertain terms, that unless Sammy's > behavior changed, he would be transferred to a special class for > behavior-problem children at another school or the McCormacks would have > to consider alternatives to public education like home schooling. > > Pro: Effective treatment of ADHD > > Patrick and Sarah had few problems with their son at home, though they > conceded he was a "handful" and sometimes had problems getting along with > other children. They deeply valued his outgoing personality and feared that > Ritalin would change him. They also worried about the immediate and > long-term side effects of the drug. They acknowledged that Sammy struggled > at school but felt school personnel had not done enough and were using the > wrong approaches with their kid. They hoped he could continue at the > neighborhood school where he had made friends despite his problems. They > wanted my opinion and support for their point of view at the school. > > When I met Sammy in my office, he was full of life and reasonably focused, > chatting at length about activities at home and at school. Though he was in > first grade, he could read at a fourth-grade level. I got a better picture > of his problems when I met him with his parents. When they were there he > acted impulsively, getting up and down from his seat and moving about the > room when we tried to have a family conversation. Sammy regularly > interrupted his parents and bossed them around, especially Sarah. > > His lack of respect troubled me, but I felt optimistic that Sammy could be > successful without medication, especially after I spoke with his teacher. > She was more positive about him than others who had reported on his > conduct at school. She felt he had made progress in her classroom but > still wondered how she could help him better stay on task. She was open to > ideas. > > I suggested that Sammy be immediately rewarded for good behavior and given > chips for finished work that could be exchanged for prizes at the end of > the day. She was comfortable with giving him tangible consequences for not > meeting her expectations. > > I suspected that medication would probably help with Sammy's self-control, > but, as I told the McCormacks, it was not absolutely necessary. I told them > that children of Sammy's age never become addicted and that the drug's > effects on his behavior would last only four hours per dose. But it was > more important that they work on their parenting, and I referred them to a > counselor. I couldn't say for sure whether changes at home and school would > make the difference for Sammy, but I certainly felt it was up to the > parents to decide on the medication. I said I would support their decision > either way. > > A year later the McCormacks returned, frustrated and embittered. Sammy had > a very good end to first grade, but second grade with an unsympathetic, > unyielding teacher had been disastrous. The principal and school district > were now insisting that Sammy be on medication if he was to stay in a > regular third-grade classroom. The school said it "could not meet the > child's needs within the regular classroom setting without medication." He > was disrupting the classroom. Other parents had complained about his > behavior. A one-on-one aide assigned to Sammy had not worked. Sarah > thought the aide was nothing more than a snitch who regularly recorded > Sammy's misdeeds for the principal. > > If the family refused to give Sammy medication, the boy would be > transferred to a different school, a bus ride from their home, to be in a > special class with four other "disturbed" children. They could also > home-school him or challenge the school's decision in a hearing. > Ultimately they could go to court, but a final decision could take years > -- by then Sammy might be in middle school. The parents were loath to move > Sammy to a new school. However, they still were against using medication > with their son. > > Families like the McCormacks, who reject medication and face a loss of > access to conventional public school classrooms, are increasing in > numbers. In May, I testified before a congressional subcommittee hearing > on ADHD and Ritalin organized by several congressmen who had received > letters from distressed parents pressured by their local schools to > medicate their children. The pressure has become so intense in some areas > that resolutions urging teachers to restrain from recommending medical > evaluations and Ritalin for students are under consideration in several > states. One passed recently in Colorado. > > Yet even as the issue of parents' rights is being considered in some areas, > the stakes have dramatically increased in others, where schools are seeking > the intervention of CPS to get parents to medicate their kids. It is no > longer simply an issue of which school or which class a child will attend. > Instead, some parents are being threatened with the possibility of losing > custody of their children if they refuse to comply with suggested treatment > for an alleged medical condition. > > Many doctors and educators would agree that withholding medication can be > viewed as a form of child abuse or neglect. Dr. Harold Koplewicz, vice > chairman of the New York University Child Study Center, said on "Good > Morning America" last month that he felt a CPS referral was justified when > a family refused to medicate a child for whom a diagnosis of ADHD had been > made by an experienced evaluator. "Ritalin is simply the best treatment > for this disorder," he said. > > I can't agree. It is true that the courts have ordered medical intervention > when a child's life is threatened. Judges have overruled the wishes of > Christian Scientist parents not to give antibiotics to children who face > life-threatening infection. Similarly, blood products have been given to > children in surgery over the objections of Jehovah's Witnesses. But those > situations are quite different from ones in which ADHD is diagnosed and > Ritalin is prescribed, according to Dolores Sargent, a former special > education teacher now practicing family law in Danville, Calif. > > "ADHD children and families do not face immediate life-threatening > situations," she says, "and ADHD continues to be a "disease" with multiple > causes and no definitive markers. It's unlikely any decision that insists > on the use of Ritalin for ADHD could withstand a court challenge." > > The existence of effective alternative treatments makes any forced decision > to medicate children against parents' wishes both legally and ethically > shaky. Yet, the willingness of some CPS workers to pursue families > unwilling to dose their children shows how strongly entrenched medication > for behavior problems in children has become in our country. > > A local CPS office cannot demand that a child be medicated -- yet -- but it > can ascertain whether a child is safe in his or her parents home. > Legally, CPS can alert parents that their child's uncontrollable behavior, > which puts the child at significant risk of abuse at home, must change. If > they feel this advice is not being taken, the agency can remove children > from their homes. > > What seems to be overlooked in this simplistic, and seemingly convenient, > way of dealing with hard-to-handle kids is that alternative strategies to > medication exist, from family counseling to short-term respite care. The > perceived superiority, rapid onset and inexpensive nature of Ritalin make > it a very attractive choice for school administrators, who may pressure > parents of students who threaten to drain their beleaguered schools of > time or money. As more and more families opt for the Ritalin fix, it > becomes easier to insist that other families in similar situations try the > drug, even though these families may not want their kids to take > stimulants. > > I still prescribe Ritalin, but only after assessing a childs school > learning environment and family dynamics, especially the parents' style of > discipline. But I continue to ask questions about Ritalin in a country > where we use 80 percent of the world's stimulants. I have no doubt that > Ritalin "works" to improve short-term behavior and school performance in > children with ADHD; however, it is not an equivalent to or substitute for > better parenting and schools for our children. > > I was surprised to see Surgeon General David Satcher quoted recently as > saying that he believes Ritalin is under-prescribed in our country. I > participated in last week's Conference on Childrens Mental Health > sponsored by his office and found that Ritalin is thought to be both > under-prescribed and over-prescribed, depending upon the community being > assessed and its specific threshold for ADHD diagnosis and Ritalin > treatment. > > Data shows, for example, that African-American families use Ritalin at > rates one-half to one-quarter of their white, socioeconomic peers. > Asian-American youth are virtually absent in statistics for Ritalin use. I > happen to believe that Satcher's comments were intended for these > communities and, ironically, will not have any impact on them. Instead, I > think, his statement will have perverse impact on white middle- and > upper-middle-class families. In some communities, Ritalin use among boys > in this group is as high as one in five. > > After much agonizing, Sammy's parents decided to put him in a special > education class rather than give him Ritalin and, for the moment, things > are going well for him. But they plan to move from the Bay Area, largely > because of Sammy's school experience. > > With 4 million children taking Ritalin in America today, there are > undoubtedly millions of other parents struggling with the decision of > whether to medicate their children. The McCormacks' story demonstrates the > dilemmas and pressures many of these families face. Proponents of drug > treatment for childrens behavior problems applaud those parents who > choose Ritalin to improve their childrens learning experience. But civil > libertarians -- and doctors like me -- worry about the specter of more > families being forced against their will to put their children on > psychiatric medication. These families, and their right to make choices > for their children, deserve our support and protection. > > "Just say yes to Ritalin!" by Lawrence H. Diller, M.D. first appeared in > Salon.Com on September 25, 2000 > > The number one link for the truth of the horrors of ritalin use: > www.breggin.com > > > > ********** <A HREF="http://www.ctrl.org/">www.ctrl.org</A> DECLARATION & DISCLAIMER ========== CTRL is a discussion & informational exchange list. Proselytizing propagandic screeds are unwelcomed. Substance—not soap-boxing—please! 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