Kids on Pills investigated the alarming rise in the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) amongst children. The BBC's flagship documentary programme Panorama, broadcast April 10, showed how this was accompanied by an increased use of psychotropic drugs to control the behaviour of children diagnosed with ADHD in Britain and the US.
Panorama revealed that such drugs are habitually used to deal with "problem" children in America, and that same tendency can now be witnessed in Britain. A recent report by the International Narcotics Control Board for the United Nations has called on both countries to carefully review their prescription practices.
Since 1995 there has been a nine-fold increase in the UK in the number of prescriptions for Ritalin—a brand name for methylphenidate, a stimulant whose effects are similar to those of amphetamine, methamphetamine and cocaine.
ADHD is defined as “developmentally inappropriate inattention and impassivity, with or without hyperactivity”. Symptoms include distraction, impatience and difficulty concentrating. It occurs in children of both sexes, but is diagnosed four times more frequently in boys. All the children filmed in the documentary were boys aged between four and twelve years.
Kids on Pills explored the conflicting opinions of psychiatrists and psychologists regarding Ritalin's use and whether the behaviour displayed by children diagnosed with ADHD is caused by their environment or by a brain disorder.
Professor Steve Baldwin, a clinical psychologist from the University of Teeside, expressed grave concerns about the use of Ritalin, which has increased from less than 16,000 prescriptions in 1995 to nearly 140,000 in 1998 in Britain. He stressed, “What children need is our understanding ... they need us to provide them with our best services and our best efforts to meet their needs, their health needs, their social needs, their educational needs, and their interpersonal needs. What they don't need is to be drugged.” Baldwin believes there is a rush to prescribe such drugs before other treatments have been tried. He stressed that there is no conclusive clinical evidence that ADHD is caused by a brain disorder.
Professor Eric Taylor from the Institute of Psychiatry described ADHD as an impulsive overactive inattentive pattern, and said it was probably a brain disorder that was greatly affected by the psychological environment.
Professor Baldwin stated that it was impossible to explain a whole range of social and interpersonal conditions by a biological brain disorder. Nor can they be treated successfully, he argued, using Ritalin or other drugs. But his views are those of a minority. In most cases, medical professionals like Professor Taylor believe that controlling the symptoms of behaviour is the most important aspect—even if this is done through medication.
Kids on Pills criticised the rush to diagnose ADHD in children who display quite common childhood behaviour patterns. Reporter Shelley Jofre explained that there is also no clinical test for ADHD. Diagnosis is usually based on an accepted list of symptoms that doctors observe in children. These range from lack of concentration, shyness and disobedience to nose picking and whining.
The programme went to Stoke-on-Trent, where the local health care trust is currently investigating the cases of 150 children aged between five and eleven who may have been misdiagnosed with ADHD or were wrongly prescribed Ritalin. The child psychiatrist at the centre of the controversy, Doctor David Foreman of the Abbey Hulton clinic, used a checklist system to diagnose ADHD, which parents were required to fill in. After the introduction of the checklist, there had been a 15-fold increase in the number of children diagnosed with ADHD. Dr. Foreman has since been suspended from duty.
The Kent family is typical of those waiting to hear the outcome of the investigation. Their son Jason was diagnosed with ADHD at the age of five. His mother said all that was on offer to help Jason was Ritalin, but she refused to allow him to take it. Jason's parents went through a stormy divorce. When his behaviour deteriorated over the next three years, he was referred back to the Abbey Hulton clinic and he was again prescribed Ritalin.
Reporter Shelley Jofre pointed out that three-quarters of the children diagnosed with ADHD at the clinic had experienced divorce of their parents or suffered the death of a loved one.
Craig Buxton is a very lively six-year-old who has been suspended from school innumerable times and whose case is also under investigation. His mother said that she needed Craig to be on Ritalin in order to control him. He was prescribed Ritalin at the age of four and takes a high dose of three tablets a day. The programme showed footage of Craig's behaviour, both before and after taking the drug. The transformation was frightening. Shown travelling to school, Craig had changed from a live wire into a tearful little boy. He now has to be spoon-fed to ensure that he eats.
Ritalin's side effects include mood swings and loss of appetite. Professor Baldwin described how the drug alters behaviour. It narrows the child's focus of attention—the classic effect of methylphenidate, not just on children but also on teenagers, adults and animals. He continued, "Apparently the child is improving but what's really happening is there is less behaviour. The emotion is cut off and the feeling is cut off, and what we're left with is children that behave like robots and zombies."
Jofre explained that many doctors believe the problem is not over-prescription of Ritalin but that ADHD all too often goes untreated. Dr. Geoffrey Kewley of the ADHD Learning Assessment Centre described ADHD as a very severe public health issue, which left untreated could be life threatening.
The programme then shifted its attention to the US, where an estimated 3 million children now take Ritalin and similar drugs. As many as a third of students in some American schools are using medically prescribed stimulants. The US presently consumes more than 80 percent of the world's supply of these drugs. In parallel with the increase use of stimulants given to children has been a growth of childhood depression and the prescription of antidepressants such as Prozac.
A recent study in the Journal of the American Medical Association (JAMA) showed a dramatic rise in the number of pre-schoolers taking stimulants and antidepressants in the US. Scientists had analysed prescriptions rates to pre-school children over a five-year period and were alarmed to find that use of drugs like Prozac had more than doubled, and the use of stimulants like Ritalin had trebled.
The programme showed a private school in the US in Massachusetts that caters to children with ADHD. The school nurse was filmed preparing the various cocktails of drugs she would dispense. The children's drug regime, which is planned around the academic schedule, is reliant on feedback from teachers, she explained. Some of the young children were interviewed. The names of the drugs they had to take slipped off the tongue like their favourite sweets.
In the programme, concerns were voiced about the effect such drug use may have on the development of young brains. Dr. Joseph Coyle of the Harvard Medical School's Department of Psychiatry warned that little work had been done on the outcome of these drugs for pre-schoolers: “This is a time of tremendous change and maturation of the nervous system, and the very chemical messengers that these drugs manipulate in their therapeutic effects are the same chemical messengers that regulate brain development, and so I think we do have to be concerned. There have been studies done in experimental animals that show that manipulation of these chemical messengers that are affected by these drugs can alter normal brain development.”
Coyle believes that drug prescriptions should be highly restricted and only used after ruling out other psychological treatments involving the family.
The programme presented the views of those for and against drug use for treating ADHD. Psychiatrists like Dr. Peter Jensen of the New York State Psychiatric Institute presented a number of case scenarios arguing that if children were not treated with Ritalin, then they would go into substance abuse, delinquency and crime.
However, Dr. Peter Breggin believes that drugs like Ritalin are being used as a form of social control. The apparently "positive results" their use seems to bring are due to their crushing of spontaneous behaviour, he argues, and likens this to technological child abuse. A generation is being brought up to conform—if they do not sit down, shut up and do what they are told, they are diagnosed and drugged, he said.
Kids on Pills concluded by returning to Stoke-on-Trent, where Craig's mother had received the results of the investigation into her son: Craig should never have started on Ritalin at such a young age, she was told. She now faces the prospect of having to wean her young boy off a powerful drug, not knowing how he will react.
The Department of Health in the UK is to evaluate the appropriate use of Ritalin, but current trends suggest a continuing rise in the number of prescriptions to both children and adults. Interviewed on the programme, Dr. Roger Bloor, said that of the 100 Abbey Hulton clinic cases reviewed so far, 50 percent had been found to have been wrongly diagnosed. As for the remainder, if the parents were happy with the use of Ritalin then that was fine, he said. Jofre questioned this, saying, “Surely it's entirely wrong to prescribe a child a drug like Ritalin if they don't have ADHD.” Bloor replied,” If it produces an improvement in their condition, then it doesn't really matter what the diagnosis is. It was clearly the right thing to prescribe."