A graph from the World Health Organization quantifies America’s bizarre prescribing pattern: “The figures are mind-boggling. Nearly 4 million Americans, most of them children and young adults, are being prescribed amphetamine-like stimulants to treat attention deficit hyperactivity disorder (ADHD). Up to a million more may be taking the drugs illegally.”
Specialists in addiction, including the head of the National Institute of Drug Abuse (NIDA) worry about these drugs leading to drug dependency: Dr.
Nora Volkow argues “There has to be a re-evaluation and reassessment of the extent to which there is proper prescription.”
Scientists have known that as with chronic use of Cocaine, ADHD drugs cause profound long-term changes in cognitive and other mental functions. Indeed, in 1996, Dr. Steve Hyman, the former director of the National Institute of Mental Health (now Harvard Provost) wrote: These drugs cause “molecular and cellular changes in neural function that are produced as adaptations to chronic administration of addictive drugs such as psychostimulants.” Chronic exposure to psychotropic drugs, he wrote, “creates perturbations in neurotransmitter function that likely exceed the strength or time course of almost any natural stimulus.”
In other words, the drugs induce a disease process by interfering with normal brain function. They produce profound neural damage and drug
addiction–a disease. See: Hyman, SE. and Nestler, EJ. 1996. Initiation and adaptation: a paradigm for understanding psychoactive drug action. American
Journal of Psychiatry, 153:151-162.
And in 2001, Dr. Nora Volkow and a team of researchers at Brookhaven Laboratories, found evidence using photo imaging techniques that contradicted the claims made by those who advocate the use of psychostimulants: “A typical dose [of Ritalin] given to children, 0.5 mg/kg, blocked 70% of dopamine transporters” –more than cocaine. “The data clearly show that the notion that Ritalin is a weak stimulant is completely incorrect.” [See, JAMA http://jama.ama-assn.org/issues/v286n8/ffull/jmn0822-1.html ]
William Carlezon of Harvard Medical School, has studied the drugs’ effects in animals and believes that they do have some lasting effect on the brain,
even if its exact nature is not yet known. “Stimulant drugs leave molecular signatures on the brain, and we have to be very careful.”
The New Scientist reviews some of the documented drug hazards for children reported at an FDA advisory committee (March 22): the adverse psychiatric side effects include disturbing hallucinations often involving worms, snakes or insects, experienced by up to 5 per cent of children taking the drugs.
Stimulants are not the only drugs prescribed for children without reliable or credible diagnostic criteria: antipsychotics, the most toxic of all psychotropic drugs which are linked to life-threatening hazards are prescribed for children with ADHD: A Vanderbilt report last month revealed that in 2002 two and a half million children were prescribed antipsychotic drugs. These toxic drugs have not been approved for children; for adults they are approved for schizophrenia and short-term treatment of bipolar disorder. The atypical antipsychotics are linked to cardiac arrest, hyperthermia, acute weight gain-over 100 lbs in children-dangerous levels of cholesterol, and the most severe form of diabetes.
MSNBC reports what is surely reckless irresponsible professional hucksterism: psychiatry’s latest expansion is an intrusion into the neurodevelopmental life of infants: “a hot topic at major universities, and last year the American Academy of Pediatrics launched a task force with at least part of its purpose to push more infant/toddler mental health intervention.” Some are already calling themselves expert “infant psychiatrists.”
We challenge these newly proclaimed “experts” to show empirical evidence demonstrating that their intrusion into the life of an infant will be beneficial to that infant. Given the uncertainty at best-this constitutes an uncontrolled (hence scientifically useless) human experiment. The record demonstrates that tinkering with children’s neurodevelopment is fraught with unintended harmful consequences. It is, therefore, not acceptable for those who want to intervene in infants and toddlers’ lives, to be given license on the basis of an unbinding statement: “With the right therapy and care, many of these conditions can be helped significantly and often swiftly.” Standards and rules of evidence must be established and met before anyone should be
given carte blanche to alter infants’ behavior patterns.
Who has the authority to intervene with a child’s birthright to be? Or to be allowed to develop naturally and idiosyncratically at his/ her own individual pace? Who has the moral authority to say that some children should be delivered for experimental human engineering?
“the signs and symptoms of mental disorders are often also the characteristics of normal development.” [See:Surgeon General Report, 1999]
As acknowledged by the chief NIMH child psychiatrist, Dr. Benedetto Vitiello: “diagnostic uncertainty surround[s] most manifestations of
psychopathology in early childhood” [See: Psychopharmacology for Young Children, Pediatrics, 2001, 108:983-989]
What evidence do these self-anointed “experts” provide to substantiate their claim of diagnosing infants?
What evidence is there to support the claim that a therapy is “right” for a young child or infant?
What empirical evidence do “infant psychiatrists” provide for the claim “these conditions can be helped significantly?”
At the very least, shouldn’t we as a society require of every professional seeking to render mental health services to children, to show empirical evidence that all but guarantees that no harm will result to the child who is exposed to the services being offered?
Dr. Joan Luby who is “diagnosing” toddlers with manic-depression (bipolar)–one of the most severe mental disorders that hitherto has never been unheard of in children-is quoted stating: “Treatment for mood disorders really depends on the disorder but, in general, behavioral and psychotherapeutic modalities are still the first line.” But she is quick to add: “The more severe the impairment, the more likely the child will eventually need psychotherapy and medication.”
What evil Pied Piper has mesmerized American adults into suspending their own judgment and common sense to the detriment of their children?
Why are intelligent parents blindly following medically unsound directives whereas parents in other parts of the world do not succumb to the lure of “quick fixes?”
How can the “experts” who have knowingly recommended harm-producing drugs for children be trusted?
Contact: Vera Hassner Sharav
<strong>Prescribing of hyperactivity drugs is out of control
. 31 March 2006
. NewScientist.com news service
. Peter Aldhous
Rise in ADHD?
THE figures are mind-boggling. Nearly 4 million Americans, most of them
children and young adults, are being prescribed amphetamine-like stimulants
to treat attention deficit hyperactivity disorder (ADHD). Up to a million
more may be taking the drugs illegally.
Now, amid reports of rare but serious side effects, leading researchers and
doctors are calling for a review of the way ADHD is dealt with. Many
prescriptions are being written by family doctors with little expertise in
diagnosing ADHD, raising doubts about how many people on these stimulants
really need them. Just as worrying, large numbers of children who do have
ADHD are going undiagnosed.
Both trends could lead to problems with drug dependency, argue specialists
in addiction. "There has to be a re-evaluation and reassessment of the
extent to which there is proper prescription," says Nora Volkow, director of
the National Institute on Drug Abuse in Bethesda, Maryland.
Last week, the debate intensified, following two meetings of advisers to the
US Food and Drug Administration (FDA). First, the agency's Pediatric
Advisory Committee suggested that parents and doctors should be warned about
the risk of ADHD drugs triggering hallucinations. This followed a review of
evidence of the drugs' psychiatric side effects, including disturbing
hallucinations often involving worms, snakes or insects, experienced by up
to 5 per cent of children taking the drugs. In February, a separate FDA
panel recommended that they should carry the most prominent type of safety
warning, following 25 reports of sudden deaths from heart problems (New
Scientist, 18 February, p 7).
Another FDA committee last week voted to delay an application for a drug
previously used to treat sleep disorders to be marketed for ADHD. The drug,
modafinil, has less potential for abuse and addiction, but the FDA's
Psychopharmacologic Drugs Advisory Committee wants to see more evidence
proving its safety before backing the application (see "Alternative
treatments for ADHD").
Stimulants such as methylphenidate, marketed by Novartis as Ritalin, have
been used to treat ADHD for decades. As well as increasing arousal and heart
rate, the drugs allow people who have difficulty concentrating to focus on
tasks more effectively. Their use has exploded in recent years, especially
in the US, where prescription rates are several times higher than across
most of the developed world – in part because US doctors tend to use a
broader definition of the condition.
Psychiatrists stress that side effects are rare, and say that the drugs have
helped millions of people who would otherwise have had huge problems
focusing at school and work. "These are some of the most effective
treatments that we have in psychiatry," says Chris Kratochvil of the
University of Nebraska Medical Center in Omaha.
To diagnose ADHD reliably, a psychiatrist would ideally observe a child for
several hours, checking their behaviour against a list of symptoms relating
to activity and ability to concentrate. But in many cases, family doctors
are prescribing the drugs after just a few minutes of consultation, based
largely on evidence of boisterousness.
Doctors are under growing pressure from children and their parents to
prescribe the drugs, as many believe that stimulants will help them get
better school grades. "I have a colleague whose son was mobbed by friends
wanting prescriptions," says Scott Kollins, a child psychologist at Duke
University in Durham, North Carolina.
This demand is also fuelling an illegal trade. Findings published last month
indicate that in 2002 more than 750,000 Americans aged 12 and over were
taking the stimulants without medical supervision (Drug and Alcohol
Dependence, DOI: 10.1016/j.drugalcdep.2005.12.011). Some may have been using
the drugs for a traditional "high", or to keep going during all-night
parties. But Larry Kroutil of RTI International in Research Triangle Park,
North Carolina, who led the study, suspects that much of the illegal use is
by children and young adults taking the drugs as study aids. In some cases,
they are being bought by parents from illicit websites that do not ask for
evidence of a prescription. "We need to look more at how people are getting
these drugs, and why," Kroutil says.
Members of the FDA's Drug Safety and Risk Management Advisory Committee,
which recommended the prominent safety warning on heart risks, say that they
were motivated in part by concerns that many people who do not have ADHD are
taking the stimulants. "It has been clear that the drugs are overused," says
Peter Gross of Hackensack University Medical Center in New Jersey, who
chairs the committee.
The American Psychiatric Association argues that the picture is more
complex. "Yes, there is overprescribing," says Jason Young, the
association's communications manager. "But there is also underprescribing."
Among poorer sections of the US population, and particularly in minority
groups such as African Americans and Hispanics, ADHD is believed to be
Volkow is worried that underprescription of stimulants could lead to
problems with drug abuse. Children with ADHD who are not given stimulant
drugs are more likely to develop problems with drug abuse and dependency
than those who are, perhaps because they have to turn to illegal stimulants
on which they can become hooked to get relief from their symptoms. So
improving diagnosis and treatment among people with poor access to mental
health services is important, Volkow argues.
Meanwhile, the long-term effects of giving prescription stimulants to
healthy people remain largely unknown. Kroutil's team asked illicit users
whether the drugs were interfering with various aspects of their lives. On
this basis, the researchers estimated that about 10 per cent were having
problems with dependency.
Volkow fears that problems with dependency may be more widespread. There are
also hints that taking stimulants may lead to abuse of other drugs. Some
studies suggest that exposing juvenile animals to stimulants makes them less
likely to self-administer drugs such as cocaine when they are offered the
drugs as adults, but other studies indicate the opposite. What is needed,
says Volkow, are long-term follow-up studies on people who do not have ADHD
and who have taken stimulants such as methylphenidate. In the meantime, she
wants medical associations to take a stronger lead in educating doctors
about the proper diagnosis and treatment of ADHD.
William Carlezon of Harvard Medical School agrees. He has studied the drugs'
effects in animals and believes that they do have some lasting effect on the
brain, even if its exact nature is not yet known. "Stimulant drugs leave
molecular signatures on the brain, and we have to be very careful," he says.
"Diagnosis needs to be taken less lightly."
Alternative treatments for ADHD
Despite concerns about the possible side effects of stimulant drugs such as
methylphenidate, the alternative treatment options are limited. A
non-stimulant called atomoxetine was approved in the US for ADHD in November
2002. Although it belongs to a different class of drugs from the more widely
used stimulants, atomoxetine was implicated in some of the cases of
hallucinations considered by the FDA's Pediatric Advisory Committee last
ADHD specialists had hoped that atomoxetine would be joined by modafinil
later this year. This drug is currently used to treat excessive sleepiness,
and seems to improve focus and alertness (New Scientist, 18 February, p 34).
But an application to approve modafinil for treating ADHD suffered a setback
on 23 March when the FDA's Psychopharmacologic Drugs Advisory Committee
recommended that the drug's manufacturer, Cephalon, conduct a further study
in 3000 children. Committee members were worried about a single case of a
potentially fatal skin condition among the 933 patients in Cephalon's trials
Though slightly less effective than methylphenidate in treating ADHD, both
modafinil and atomoxetine are less likely to lead to addiction problems.
That may make them particularly useful in treating patients whose social
environment makes them vulnerable to drug abuse.
Apr 03 13:30:42 BST 2006
When babies see shrinks
Sometimes very young minds need special care, experts say
By Victoria Clayton
Traditionally, young children have rarely crossed paths with psychiatrists
or psychologists. Not anymore. With a growing amount of research focusing on
early brain development, more youngsters – even infants – are being targeted
to receive the services of mental-health professionals.
There are no hard numbers available for just how many pre-kindergarten
children are being seen, but experts say infant/toddler mental health is
moving into the mainstream. Psychological research on this age group is a
hot topic at major universities, and last year the American Academy of
Pediatrics launched a task force with at least part of its purpose to push
more infant/toddler mental health intervention.
This may cause some readers to roll their eyes – especially those who
believe Americans have a tendency to pathologize and treat the slightest
blip of a bad mood.
Before you pass judgment, however, it’s important to understand what
infant/toddler mental health is all about, says Ngozi Onunaku, a policy
analyst with Zero to Three, a Washington, D.C.-based nonprofit organization
dedicated to furthering mental wellness for preschool-age children.
“When you put the words ‘infant’ and ‘mental-health treatment’ next to each
other, that’s really scary to some people,” says Onunaku. “People think of
medication and, from a more comical standpoint, they think of a baby on the
Onunaku says that, in fact, a more accurate way to talk about this issue is
to call it infant/toddler mental wellness. “It’s more helpful to see mental
health as a continuum. There are kids who need intense interventions, there
are kids in the middle who are at risk for a problem and then at the other
end you have your everyday, typical children who also need their caregivers
to promote mental health and wellness.”
While all humans can benefit from what researchers and doctors are learning
about infant mental development – namely, that infants are sentient,
perceptive beings whose brain development can be strongly influenced in the
first weeks, months and years of life – there are certain issues that drive
most parents to get help for their children.
Eating and sleep issues are primarily why mental-health professionals see
infants, says Dr. Thomas Anders, an infant psychiatrist at the University of
California, Davis M.I.N.D. Institute and president of the American Academy
of Child and Adolescent Psychiatry. Toddlers are more often seen because of
developmental delays or behavioral problems such as temper tantrums. Other
reasons infants and toddlers are evaluated include abuse, adoption or other
separation from a birth parent, maternal depression, premature birth and
trauma such as a natural disaster or illness.
With the right therapy and care, many of these conditions can be helped
significantly and often swiftly. “Sometimes one session or two sessions and
a couple of phone consultations are all you need to take care of a problem,”
Oftentimes, it’s just a matter of educating parents or teaching them some
very specific parenting skills. For example, Anders, who studies infant
sleep, says he may get a call because an infant appears to have a sleep
disorder but sometimes it’s a matter of working with parents to establish a
more productive bedtime ritual.
“Most of the treatment for children under 3 or 4 is what we call
parent-infant therapy,” says Anders. “Medications are very rarely used in
this age group.” In fact, when a young child is having any sort of problem
it’s always a matter of determining how the family can solve the problem.
“What we’re really doing primarily with infant and toddler mental health is
saying, ‘What guidance can we provide to help a parent cope better?'” says
Penny Glass, a developmental psychologist with Children’s National Medical
Center in Washington, D.C. “Sometimes it’s amazing when you just counsel
parents on how to establish structure.”
Glass notes that having organized mealtimes and bedtimes often help families
feel as if they have more control and helps eliminate toddler behavioral
problems. “Even if you just help a child get a decent amount of sleep many
of the problems don’t seem so big,” says Glass.
In some cases, parents may mistake one issue for another. Glass recently saw
a boy, age 3 and a half, who was referred to her for behavior problems. But
when Glass did the full evaluation she found out that the child was actually
developmentally delayed and operating more at a 2-year-old level. He didn’t
understand some of the words or thoughts and ideas that people were trying
to convey to him because they were speaking to him at the level of a 3- or
4-year-old. Once this was understood Glass could recommend therapy to help
get him up to speed but she could also counsel the parents, teachers and
caregivers in how to speak and treat him appropriately.
Just knowing the problem and what they were dealing with, Glass says, helped
the parents feel better, understand the child better and treat him in a more
Some conditions are being detected at much earlier ages than ever. Dr. Joan
Luby, a child psychiatrist at Washington University in St. Louis, says
thanks to the attention being focused on infant mental health, professionals
are now more likely to diagnose certain problems such as autism spectrum
disorders as early as 18 months.
Research in the past several years by Luby and colleagues, published in the
Journal of the American Academy of Child and Adolescent Psychiatry and
elsewhere, has helped scientifically validate that children as young as
preschool age can suffer from depression, anxiety and other mood disorders.
Even with these disorders, though, doctors tend to be wary about medicating
the pre-kindergarten set because most of the drugs used to treat the
disorders haven’t been properly studied in children.
“Treatment for mood disorders really depends on the disorder but, in
general, behavioral and psychotherapeutic modalities are still the first
line,” says Luby. The more severe the impairment, she adds, the more likely
the child will eventually need psychotherapy and medication.
“It sometimes helps to think about [mental illness] in terms of diabetes,”
says Anders. “If a child was diabetic you wouldn’t like it but you’d get
treatment. If it’s true that your child has a problem, you need to treat
Teen problems can have early roots
Experts say that while many of us haven’t realized it, our children have
often paid steep prices for not having their mental health taken into
consideration. Dropout rates, drug abuse, suicide and eating disorders are
all adolescent problems that could have roots in treatable early childhood
mental health issues.
Zero to Three’s Onunaku points out that we don’t even have to wait until
adolescence to see the impact of ignoring early childhood mental wellness.
A Yale study last year looked at the problem of pre-kindergarten children
being expelled. Led by Yale Child Study Center researcher Walter S. Gilliam,
the study found that in classrooms where the teacher had no access to a
psychologist or psychiatrist, preschool students were expelled about twice
“We know for certain that kids this young can have significant problems. By
catching the problems early and working with them we have a chance to
positively influence how their lives progress,” says Onunaku.
Researchers point out that more than just influencing whether a child gets
kicked out of a school or not, by identifying and treating certain mental
and emotional problems extremely early there is a chance that the brain
could even be altered positively.
“If we intervene early there is the issue of plasticity of the brain,” says
Glass. The ability of the brain to change with learning is called
neuroplasticity, or plasticity. “There are no absolutes and we know we can’t
just fix everything that isn’t right.”
But, she says, there is reason to believe that if we help early on we may be
able to help more and perhaps in a more permanent way.
There’s even hope, says Glass, that with early intervention we’ll have fewer
teens and adults “on the couch” in the future.
Victoria Clayton is a freelance writer based in California and co-author of
“Fearless Pregnancy: Wisdom and Reassurance from a Doctor, a Midwife and a
Mom,” published by Fair Winds Press.
C 2006 MSNBC Interactive
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