Peter R. Breggin M.D. Testimony
September 29, 2000
Before the Subcommittee on Oversight and
Investigations
Committee on Education and the Workforce
U.S. House of
Representatives
I appear today as Director of the
International Center for the Study of Psychiatry and Psychology (ICSPP),
and also on my own behalf as a practicing psychiatrist and a
parent.
Parents throughout the country are being
pressured and coerced by schools to give psychiatric drugs to their
children. Teachers, school psychologists, and administrators
commonly make dire threats about their inability to teach children without
medicating them. They sometimes suggest that only medication can
stave off a bleak future of delinquency and occupational failure.
They even call child protective services to investigate parents for child
neglect and they sometimes testify against parents in court. Often
the schools recommend particular physicians who favor the use of stimulant
drugs to control behavior. These stimulant drugs include
methylphenidate (Ritalin, Concerta, and Metadate) or forms of amphetamine
(Dexedrine and Adderall).
My purpose today is to provide to this committee,
parents, teachers, counselors and other concerned adults a scientific
basis for rejecting the use of stimulants for the treatment of attention
deficit hyperactivity disorder or for the control of behavior in the
classroom or home.
I. Escalating Rates of Stimulant
Prescription
Stimulant drugs, including methylphenidate and
amphetamine, were first approved for the control of behavior in children
during the mid-1950s. Since then, there have been periodic attempts
to promote their usage, and periodic public reactions against the
practice. In fact, the first Congressional hearings critical of
stimulant medication were held in the early 1970s when an estimated
100,000-200,000 children were receiving these drugs.
Since the early 1990s, North America has turned
to psychoactive drugs in unprecedented numbers for the control of
children. In November 1999, the U.S. Drug Enforcement Administration (DEA)
warned about a record six-fold increase in Ritalin production between 1990
and 1995. In 1995, the International Narcotics Control Board (INCB),
a agency of the World Health Organization, deplored that �10 to 12 percent
of all boys between the ages 6 and 14 in the United States have been
diagnosed as having ADD and are being treated with methylphenidate
[Ritalin].� In March 1997, the board declared, "The therapeutic use of
methylphenidate is now under scrutiny by the American medical community;
the INCB welcomes this." The United States uses approximately 90% of
the world's Ritalin.
The number of children on these drugs has
continued to escalate. A recent study in Virginia indicated that up to 20%
of white boys in the fifth grade were receiving stimulant drugs during the
day from school officials. Another study from North Carolina showed
that 10% of children were receiving stimulant drugs at home or in
school. The rates for boys were not disclosed but probably exceeded
15%. With 53 million children enrolled in school, probably more than
5 million are taking stimulant drugs.
A recent report in the Journal of the American
Medical Association by Zito and her colleagues has demonstrated a
three-fold increase in the prescription of stimulants to 2-4 year old
toddlers.
II. Legal
Actions
Most recently, four major civil suits have been
brought against Novartis, the manufacturer of Ritalin, for fraud in the
over-promotion of ADHD and Ritalin. The suits also charge Novartis
with conspiring with the American Psychiatric Association and with CHADD,
a parents' group that receives money from the pharmaceutical industry and
lobbies on their behalf. Two of the suits are national class action
suits, one is a California class action and one is a California business
fraud action. The attorneys involved, including Richard Scruggs,
Donald Hildre, and C. Andrew Waters have experience and resources
generated in suits involving tobacco and asbestos. That they have joined
forces to take on Novartis, the American Psychiatric Association, and
CHADD indicates a growing wave of dissatisfaction with drugging millions
of children.
The suits and the contents of
the complaints are based on information first published in my book,
Talking Back to Ritalin (1998), and I am a medical expert in these
cases.
III. The Dangers of
Stimulant Medication
Stimulant medications are far more dangerous than
most practitioners and published experts seem to realize. I
summarized many of these effects in my scientific presentation on the
mechanism of action and adverse effects of stimulant drugs to the November
1998 NIH Consensus Development Conference on the Diagnosis and Treatment
of Attention Deficit Hyperactivity Disorder, and then published more
detailed analyses in several scientific sources (see
bibliography).
Table I summarizes many of the most salient
adverse effects of all the commonly used stimulant drugs. It is
important to note that the Drug Enforcement Administration, and all other
drug enforcement agencies worldwide, classify methylphenidate (Ritalin)
and amphetamine (Dexedrine and Adderall) in the same Schedule II category
as methamphetamine, cocaine, and the most potent opiates and
barbiturates. Schedule II includes only those drugs with the very
highest potential for addiction and abuse.
Animals and humans cross-addict to
methylphenidate, amphetamine and cocaine. These drugs affect the
same three neurotransmitter systems and the same parts of the brain.
It should have been no surprise when Nadine Lambert presented data at the
Consensus Development Conference (attached) indicating that prescribed
stimulant use in childhood predisposes the individual to cocaine abuse in
young adulthood.
Furthermore, their addiction and abuse potential
is based on the capacity of these drugs to drastically and permanently
change brain chemistry. Studies of amphetamine show that short-term
clinical doses produce brain cell death. Similar studies of
methylphenidate show long-lasting and sometimes permanent changes in the
biochemistry of the brain.
All stimulants impair growth not only by
suppressing appetite but also by disrupting growth hormone
production. This poses a threat to every organ of the body,
including the brain, during the child's growth. The disruption of
neurotransmitter systems adds to this threat.
These drugs also endanger the cardiovascular
system and commonly produce many adverse mental effects, including
depression.
Too often stimulants become gateway drugs to
illicit drugs. As noted, the use of prescription stimulants
predisposes children to cocaine and nicotine abuse in young
adulthood.
Stimulants even more often become gateway drugs
to additional psychiatric medications. Stimulant-induced
over-stimulation, for example, is often treated with addictive or
dangerous sedatives, while stimulant-induced depression is often treated
with dangerous, unapproved antidepressants. As the child's emotional
control breaks down due to medication effects, mood stabilizers may be
added. Eventually, these children end up on four or five psychiatric
drugs at once and a diagnosis of bipolar disorder by the age of eight or
ten.
In my private practice, children can usually be
taken off all psychiatric drugs with great improvement in their
psychological life and behavior, provided that the parents or other
interested adults are willing to learn new approaches to disciplining and
caring for the children. Consultations with the school, a change of
teachers or schools, and home schooling can also help to meet the needs of
children without resort to medication.
IV. The Educational Effect of
Diagnosing Children with ADHD
It is important for the Education Committee to
understand that the ADD/ADHD diagnosis was developed specifically for the
purpose of justifying the use of drugs to subdue the behaviors of children
in the classroom. The content of the diagnosis in the 1994
Diagnostic and Statistical Manual of Mental Disorders of the American
Psychiatric Association shows that it is specifically aimed at suppressing
unwanted behaviors in the classroom.
The diagnosis is divided
into three types: hyperactivity, impulsivity, and inattention.
Under hyperactivity, the first two (and most
powerful) criteria are "often fidgets with hands or feet or squirms in
seat" and "often leaves seat in classroom or in other situations in which
remaining seated is expected." Clearly, these two "symptoms" are
nothing more nor less than the behaviors most likely to cause disruptions
in a large, structured classroom.
Under impulsivity, the first criteria is "often
blurts out answers before questions have been completed" and under
inattention, the first criteria is "often fails to give close attention to
details or makes careless mistakes in schoolwork, work, or other
activities." Once again, the diagnosis itself, formulated over several
decades, leaves no question concerning its purpose: to redefine disruptive
classroom behavior into a disease. The ultimate aim is to
justify the use of medication to suppress or control the
behaviors.
Advocates of ADHD and stimulant drugs have
claimed that ADHD is associated with changes in the brain. In fact,
both the NIH Consensus Development Conference (1998) and the American
Academy of Pediatrics (2000) report on ADHD have confirmed that there is
no known biological basis for ADHD. Any brain abnormalities in these
children are almost certainly caused by prior exposure to psychiatric
medication.
V. How the medications
work
Hundreds of animal studies and human clinical
trials leave no doubt about how the medication works.
First, the
drugs suppress all spontaneous behavior. In healthy chimpanzees and
other animals, this can be measured with precision as a reduction in all
spontaneous or self-generated activities. In animals and in humans,
this is manifested in a reduction in the following behaviors: (1)
exploration and curiosity; (2) socializing, and (3) playing.
Second, the drugs increase obsessive-compulsive
behaviors, including very limited, overly focused
activities.
Table II provides a list of adverse stimulant
effects which are commonly mistaken as improvement by clinicians,
teachers, and parents.
VI. What is Really
Happening
Children become diagnosed with ADHD when they are
in conflict with the expectations or demands of parents and/or
teachers. The ADHD diagnosis is simply a list of the behaviors that
most commonly cause conflict or disturbance in classrooms, especially
those that require a high degree of conformity.
By diagnosing the child with ADHD, blame for the
conflict is placed on the child. Instead of examining the
context of the child's life�why the child is restless or disobedient in
the classroom or home�the problem is attributed to the child's faulty
brain. Both the classroom and the family are exempt from criticism
or from the need to improve, and instead the child is made the source of
the problem.
The medicating of the child then becomes a
coercive response to conflict in which the weakest member of the conflict,
the child, is drugged into a more compliant or submissive state. The
production of drug-induced obsessive-compulsive disorder in the child
especially fits the needs for compliance in regard to otherwise boring or
distressing schoolwork.
VII. Conclusions and
Observations
Many observers have concluded that our schools
and our families are failing to meet the needs of our children in a
variety of ways. Focusing on schools, many teachers feel stressed by
classroom conditions and ill-prepared to deal with emotional problems in
the children. The classroom themselves are often too large, there
are too few teaching assistants and volunteers to help out, and the
instructional materials are often outdated and boring in comparison to the
modern technologies that appeal to children.
By diagnosing and drugging our children, we shift
blame for the problem from our social institutions and ourselves as adults
to the relatively powerless children in our care. We harm our
children by failing to identify and to meet their real educational needs
for better prepared teachers, more teacher- and child-friendly classrooms,
more inspiring curriculum, and more engaging classroom
technologies.
At the same time, when we diagnosis and drug our
children, we avoid facing critical issues about educational reform.
In effect, we drug the children who are signaling the need for reform, and
force all children into conformity with our bureaucratic systems.
Finally, when we diagnose and drug our children,
we disempower ourselves as adults. While we may gain momentary
relief from guilt by imagining that the fault lies in the brains of our
children, ultimately we undermine our ability to make the necessary adult
interventions that our children need. We literally become bystanders
in the lives of our children.
It is time to reclaim our children from this
false and suppressive medical approach. I applaud those parents who
have the courage to refuse to give stimulants to their children and who,
instead, attempt to identify and to meet their genuine needs in the
school, home, and community.
Appendices:
Table I:
Harmful Effects Caused by Ritalin, Dexedrine, Adderall and Similar
Stimulants
Table II:
Harmful Stimulant Effects Commonly Misidentified as �Therapeutic� or
�Beneficial� for Children Diagnosed with ADHD.
Description
of ICSPP
Scientific
Sources
This report draws on hundreds of published
scientific studies. I have provided the committee with two sources
for the specific citations: My scientific presentation to the NIH
Consensus Development Conference and my peer-reviewed scientific paper
that expands on it. My book, Talking Backing to Ritalin
(1998), also elaborates on many of these issues and provides many
scientific citations. A more recent book, Reclaiming Our
Children: A Healing Solution to a Nation in Crisis (2000), further
describes the harm done by drugs and proposes solutions for teachers,
parents, and other adults who want to retake responsibility for our
children.
Abbreviated
Bibliography
American Academy of Pediatrics. (2000a). Practice
guideline: Diagnosis and evaluation of a child with
attention-deficit/hyperactivity disorder. Pediatrics, 105,
1158-70. Also available at
http://www.aap.org/policy/ac0002.html
American Psychiatric Association. (1994). Diagnostic and
statistical manual of mental disorders, Fourth Edition (DSM-IV).
Washington, D.C.: author.
Breggin, P. (1998). Talking back to Ritalin: What doctors
aren't telling you about stimulants for children. Monroe, Maine:
Common Courage Press.
Breggin, P. (1999a). Psychostimulants in the treatment of
children diagnosed with ADHD: Part I: Acute risks and psychological
effects. Ethical Human Sciences and Services, 1 13-33.
Breggin, P. (1999b). Psychostimulants in the treatment of children
diagnosed with ADHD: Part II: Adverse effects on brain and behavior.
Ethical Human Sciences and Services, 1, 213-241.
Breggin, P. (1999c). Psychostimulants in the treatment of
children diagnosed with ADHD: Risks and mechanism of action.
International Journal of Risk and Safety in Medicine, 12,
3-35. By special arrangement, this report was originally published
in two parts by Springer Publishing Company in Ethical Human Sciences
and Services (Breggin 1999a&b).
Breggin, P. (2000). Reclaiming our children: A healing
solution for a nation in crisis. Cambridge, Massachusetts:
Perseus Books.
Lambert, N. (1998). Stimulant treatment as a risk factor for
nicotine use and substance abuse. Program and Abstracts, pp.
191-8. NIH Consensus Development Conference Diagnosis and Treatment
of Attention Deficit Hyperactivity Disorder. November 16-18,
1998. William H. Natcher Conference Center. National
Institutes of Health. Bethesda, Maryland.
Lambert, N., & Hartsough, C.S. (in press).
Prospective study of tobacco smoking and substance dependence among
samples of ADHD and non-ADHD subjects. Journal of Learning
Disabilities.
Zito, J.M., Safer, D .J., dosReis, S., Gardner, J.F., Boles, J., and
Lynch, F. (2000). Trends in the prescribing of psychotropic
medications to preschoolers. Journal of the American Medical
Association , 283, 1025-1030.
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