Controversy over using drugs to control children's behavior
LaVARNE PARKER was unhappy about the effect of drugs on her son Melvin. Before he started taking them, she says, he was clean, neat, and well behaved. Afterward, he became hallucinatory, hostile, and suicidal. Melvin was not on drugs voluntarily. His teacher recommended he take the pharmaceutical drug Ritalin when he was 10 to control his hyperactivity. He took it for four years, at the school's insistence.
Not every child who takes Ritalin has Melvin's experience. For the past 25 years, doctors have prescribed it for children diagnosed as hyperactive. But recently Ritalin has been the center of controversy. Parents have been ordered by school officials to place their children on that medication - or see them expelled. And many of the parents are unhappy with the drug's effects.
Mrs. Parker, who has formed a parents advisory group - Children Having Ignored Learning Disabilities (CHILD) - says hundreds of other parents have called with similar stories.
She filed a $125 million class-action suit in November against the Gwinnett County School Board in suburban Atlanta. The suit charges that physicians have failed to warn parents of the drug's side effects.
Similar suits have been filed in Glendale, Calif.; Washington; and St. Paul, Minn. Parker and claimants in two other Ritalin cases are being represented by John P. Coale, a lawyer who is also representing victims of the Union Carbide Corporation plant in Bhopal, India.
Ritalin, or methylphenidate, is rated according to abuse potential by the Drug Enforcement Administration as a Class II controlled substance. So are opium and cocaine. In the last two years, the use of Ritalin has grown 97 percent, according to the DEA, which sets manufacturing quotas.
``We've gotten dozens of phone calls and hundreds of letters complaining about the overutilization and overprescribing of the drug all over the country,'' says Gene Haislip, deputy assistant administrator for the DEA.
Gloria Martini, manager of external communication for Ciba-Geigy Corporation, which manufactures the drug, says the rapid increase in its use is due to greater recognition of the condition of hyperactivity and to physicians' use of Ritalin as the ``drug of choice.'' She says it's also being used in the treatment of other conditions.
Jerry M. Wiener, president of the American Academy of Child and Adolescent Psychiatry and chairman of the department of psychiatry at George Washington University, says that while the drug is generally seen to be helpful in 70 to 80 percent of cases, ``I don't have any question that there's the possibility that the drug might be oversubscribed. Why? Better diagnosis, possible overdiagnosis, people using medication because it's easier to use than other interventions.''
The drug appears to enable fidgety children to concentrate. But, says William E. Pelham Jr., director of the Attention Deficit Disorders Program at the University of Pittsburgh, precisely how the stimulant works is not known. And it has been known to cause side effects, including suppression of growth and appetite.
Some parents challenge the criteria for diagnosing a child as hyperactive. According to a diagnostic manual of the American Psychiatric Association, the criteria include ``making comments out of turn, failing to wait one's turn in group activities, interrupting the teacher during a lesson, difficulty remaining seated when expected to do so, and excessive jumping about.'' They say the potential for misdiagnosis based on these criteria is great.
``It's a rather subjective area based on the evaluator,'' says Andrew Watry, executive director of the Georgia Board of Medical Examiners, which has been investigating the use of Ritalin in that state.
``This is a problem where people need to be informed consumers,'' he says, ``not to blindly put their children on medication because someone suggested it after a 15-minute interview.''
Child advocates, physicians, psychiatrists, and parents all say the drug is often used without exploring nonmedical, more long-term options, such as counseling.
``It's an easy out for teachers to contain behavior without solving the problem,'' says Carole Brill, director of Legal Services for Children, in San Francisco, a private advocacy group for children.
``If the child is having problems in school, sometimes changing learning techniques solves the problem. Some emotionally disturbed kids do very well when put in a class with six kids. I'm always suspicious when Ritalin is [claimed to be] the answer because it doesn't look at the whole child. Most importantly, parents shouldn't be told they have to do something; they must be equal participants in the plan.''
Instrumental in publicizing the issue has been the Citizens Commission on Human Rights, which is affiliated with the Church of Scientology. The commission publishes warning materials about Ritalin to parents and holds educational demonstrations against its use.