Using drugs to rein in boys

When he was 11 years old, Michael Gurian was diagnosed as hyperactive, and for six months he was given regular doses of a drug called Ritalin to control his behavior.

"It helped me and my parents," recalls Mr. Gurian, now a family therapist in Spokane, Wash. But what he really needed, he sees now, "was a different kind of school and family environment - a better structured, more attentive one."

The Littleton, Colo., school-shooting tragedy has highlighted the widespread use of powerful prescription drugs to treat what are diagnosed as emotional and behavioral problems in adolescents - the great majority of them boys.

Several of those involved in recent school shootings were being treated with drugs, and the number of young Americans regularly taking prescription drugs for such things as depression and "attention deficit disorder" has shot way up in the past few years. It's now in the millions - many times higher than in any other country.

Advocates say such drugs can help certain kids through the already-tough teen years, preventing antisocial and even criminal behavior later in life.

Russell Barkley, director of psychology at the University of Massachusetts Medical Center in Worcester, Mass., calls Ritalin "the most effective treatment we have available for the management of this disorder."

Critics charge that some of these substances have not been adequately tested on young people, and federal agencies warn of possible adverse side effects.

Some experts say such heavy reliance on drugs is an easy and relatively cheap cop-out favored by disengaged parents and insurance companies who'd rather have kids pop a pill than deal with root causes through counseling and the family. There's also evidence that widely used prescription drugs such as Ritalin (a stimulant used to treat those diagnosed with attention deficit disorder) are being abused by teens and college students, much like amphetamines and cocaine.

"Our society has institutionalized drug abuse among our children," says Peter Breggin, director of the Center for the Study of Psychiatry and Psychology in Bethesda, Md., and one of the most outspoken critics. "Worse yet, we abuse our children with drugs rather than making the effort to find better ways to meet their needs."

"In the long run, we are giving our children a very bad lesson - that drugs are the answer to emotional problems," says Dr. Breggin, whose recent book is titled "Talking Back to Ritalin."

"We are encouraging a generation of youngsters to grow up relying on psychiatric drugs rather than on themselves and other human resources," says Breggin, suggesting that creativity - perhaps even brilliance - is being stifled in such young people.

Nonsense, says Dr. Barkley, who recommends the use of drugs as part of a treatment regime. "Characterizing this group of children as our best, most creative, and brightest does a severe injustice to the facts of the matter and is woefully misleading to the public in general and to parents of these children in particular," says Barkley, who accuses Breggin of violating the physician's oath to "do no harm."

Characteristics of ADD

Simply put, attention deficit disorder (ADD), also known as attention deficit/hyperactive disorder (ADHD), means the inability to sit still, pay attention, and concentrate on an assigned task - such as classroom schoolwork.

From time to time, any exasperated parent or teacher may think they spot these ants-in-their-pants characteristics in offspring or pupils. But the scientific symptoms attached to such behavior can be fuzzy and therefore controversial.

In their book "Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood through Adulthood," physicians Edward Hallowell and John Ratey suggest 100 questions to ask a patient to determine the presence of ADD (the more "yes" answers, the greater the likelihood of a problem). Among them: "Do you change the radio station in your car frequently?" "Are you particularly intuitive?" "Are you a gung-ho, go-for-it sort of person?" "As a kid, were you a bit of a klutz at sports?" "Are you a maverick?"

Many of these characteristics, critics say, amount to nothing more than rambunctious, boy-like behavior. Harvard psychologist William Pollack estimates that 90 percent of those so diagnosed are boys. While some adolescent males may need such drugs, says family therapist Michael Gurian, many others are misdiagnosed and do not.

"Most boys are Huck Finn and Tom Sawyer," says Mr. Gurian, author of "A Fine Young Man" and several other books on adolescent boys, "and if Huck and Tom were alive today and going to school, they'd be drugged."

Rise in prescriptions

Ritalin (known generically as methylphenidate or MPH) is a stimulant that - paradoxically - is said to calm agitated children. Estimates of the number of children in the United States taking Ritalin range from 1.5 million to upwards of 4 million - most of them white, middle-class boys who live in the suburbs. (In addition, more than 800,000 American children are taking antidepressant drugs such as Prozac or Luvox. Eric Harris, one of the alleged assailants in Littleton, had been taking Luvox.)

The number of prescriptions for MPH products reportedly has increased by 50 percent over the past five years, to more than 9 million prescriptions in 1998. According to the federal Drug Enforcement Administration (DEA), the United States "manufactures and consumes five times more MPH than the rest of the world combined," noting also that MPH "is now the most commonly prescribed psychotropic medicine for children in the US."

"Treatment rates for ADHD in some American schools are as high as 30 percent to 40 percent of a class and children as young as one year old are treated with methylphenidate," the International Narcotics Control Board, a United Nations agency, reported in March.

In addition, the report noted, "American culture and its drug-taking behavior have a strong influence on other regions. Methylphenidate use for children has rapidly increased in Australia, Canada, and several European countries."

The DEA describes MPH as "a central nervous system stimulant [that] shares many of the pharmacological effects of amphetamine, methamphetamine, and cocaine." The DEA warns that a "significant number" of children and adolescents are misusing Ritalin.

"Students are giving and selling their medication to classmates who are crushing and snorting the powder like cocaine," reports the DEA, which urges "greater caution and more restrictive use of MPH."

Such caution appears to have been confirmed in a recent survey of family physicians and pediatricians.

At a meeting of the Pediatric Academic Societies in San Francisco May 1, clinical scholar Jerry Rushton of the University of North Carolina School of Medicine at Chapel Hill reported that 72 percent of 600 family physicians and pediatricians surveyed had prescribed antidepressant drugs for patients under age 8. But just 8 percent of those surveyed said they had adequate training in the management of child depression.

"Our survey data suggest that despite a lack of research support, adequate training, and comfort with the management of depression, [antidepressant drugs] are gaining physician acceptance and becoming incorporated into primary care practice," says Dr. Rushton.

While such drugs "show promise," he adds, "they should be used with caution and monitored closely, not used haphazardly for transient problems - not for school problems or nebulous behavioral problems."

Some medical professionals have begun to see that there are broader issues involved here.

"Demands on children have grown, while the strength of their social supports - school and family - has decreased," says Lawrence Diller, a pediatrician in Walnut Creek, Calif., and author of "Running on Ritalin: A Physician Reflects on Children, Society, and Performance in a Pill."

"Children are expected to learn earlier and learn more, yet we have higher student-teacher ratios in the classroom," Dr. Diller wrote recently in the San Francisco Chronicle. "Parents are working harder and longer. That means less time for their children and more structured day care and latchkey kids."

In the wake of the school shootings in Springfield, Ore., and Littleton, Colo., (where the attackers had been taking prescribed drugs), some lawmakers are urging greater government oversight.

In a letter to Food and Drug Administration commissioner Jane Henney earlier this month, Rep. Dennis Kucinich (D) of Ohio expressed concern that the FDA (which must approve prescription drugs) "has failed to provide adequate oversight of the health consequences of prescribing certain drugs to children."

Representative Kucinich called for "comprehensive clinical trials by the pharmaceutical companies prior to FDA approval."

He wrote: "It should be apparent that this matter carries considerable urgency."