To Everyone
I have taken some time to research the BBC's Webpage to read the following
text I am downloading a copy for others of the transcript from Panorama's:
'Kids on Pills', which was shown on Monday 10th April 2000, in the U.K.
This is for though of you who missed this programme; and especially
individuals in other countries.
I would like to hear your own views from this programme.
Do you think the programme was biased to the anti-Ritalin campaign ?
Does there need to be independent research in the USA, Canada,
Australia, U.K. and other countries where using stimulant drugs to control
children
and adults with A.D(H). D. ?
What are the ethical and moral questions ?
What do you think of Peter Breggin's comments, that Ritalin and other
similar
stimulants are being used as a social control mechanism in western culture ?
These are just some of the questions this programme has stimulated in my
mind to find answers.
Regards
Colin Revell
Adults with Dyspraxia Support Group
Research and Development
Hornsea
East Yorkshire
England
Kids on Pills
Monday April 10 2000
Reporter Shelley Jofre
Producer Dorothy Parker
This week's Panorama investigates the dramatic rise in the number of
children being diagnosed with Attention Deficit Hyperactivity Disorder
(ADHD) and its controversial treatment with drugs such as Ritalin.
Since 1995, there has been a staggering 9-fold increase in the number of
Ritalin prescriptions in the UK yet little is known about the long-term
effects of such drug-taking. The Government are so concerned at what they
call "the potential for inappropriate misuse" that they have asked the
National Institute for Clinical Excellence to appraise Ritalin and issue
guidelines to the NHS.
In Staffordshire, a consultant psychiatrist has been suspended while the
local health authority investigates the children who have been diagnosed
with ADHD and prescribed Ritalin at his clinic.
The programme then travels to the US where as many as 5% of children are now
prescribed Ritalin, and asks whether the UK is heading in the same direction
David Sanders is one of the children diagnosed at the Staffordshire clinic.
His anti-social and aggressive behaviour has long been a major worry to his
mother.
He'd kick and punch me in the streets, he was a very loud child. He's still
a very loud child. He couldn't play with other children, he had to muscle in
on the action, he had to be centre of attention. He was always on the go,
never sat still, always running about, and really difficult to control, I
couldn't control him at all."
He would actually get really violent. At one point actually put his fist
through his bedroom window and cut his wrists open be cause of a temper
tantrum. So he'd actually be unsafe, he wasn't safe to be left on his own
when he'd have a temper tantrum.
David was taken to the local child psychiatry clinic at Abbey Hulton and was
diagnosed as having ADHD. The consultant psychiatrist suggested David start
taking Ritalin.
"He takes two tablets a day at breakfast and at lunchtime, and it's like
having a little boy given back to me, it really is. Even though he still has
temper tantrums they're not as severe as what they were before he had
Ritalin. He can sit down and watch TV, he can sit down now and he'll play
quietly with the other children, whereas before he was, he was like a bull
in a china shop, he just run round and we couldn't do anything with him".
Prescriptions for Ritalin in the UK have rocketed from fewer than 16,000 in
1995 to nearly 140,000 in 1998 . Yet psychiatrists and psychologists do not
agree on the use of the drug.
Scientists cannot explain exactly how Ritalin helps children with ADHD but
it's effects on six year old Craig Buxton are remarkable.
His behaviour is wild and even now, before his medication kicks in, Craig's
mother and sister find him impossible to control. "He's dismantled the waste
under the sink unit slashed his mattress, strangled the cat, the list is
endless."
He takes two tablets a day at breakfast and at lunchtime, and it's like
having a little boy given back to me, it really is. Even though he still has
temper tantrums they're not as severe as what they were before he had
Ritalin. He can sit down and watch TV, he can sit down now and he'll play
quietly with the other children, whereas before he was, he was like a bull
in a china shop, he just run round and we couldn't do anything with him".
Teresa Sanders
Craig was prescribed Ritalin at Abbey Hulton at the age of four, even though
the drug's manufacturer, Novartis, does not recommended it's use in children
under 6. His case is one of 150 currently being investigated by the local
Health Care Trust. The Trust has admitted to Panorama that there have been
problems in almost half the cases so far reviewed. Craig's mother has been
told that he should not have been on Ritalin at all for the past two years.
His dose of the drug is to be cut in half.
Sharon Buxton said, "I feel angry because he's been taking such a powerful
drug for such a long time. It's going to take a lot to put right. They've
let us down, they've let Craig down."
I feel angry because he's been taking such a powerful drug for such a long
time. It's going to take a lot to put right. They've let us down, they've
let Craig down.
Sharon Buxton
In the US an estimated 3 million children now take Ritalin and other
stimulants. As the rates of ADHD diagnosis and drug prescription grows in
the UK, there are fears that Britain could soon be prescribing psychiatric
drugs at the same rate.
Some scientists are scared of the effects psychiatric drugs may have on the
development of young brains.
Psychiatrist Peter Breggin believes that these drugs are being used as a
form of social control.
There are no studies that show that Ritalin produces positive results if you
define positive results as a child learning to take responsibility for his
or her behaviour, or doing better in school, or having a long-term better
outcome in their life. The so-called positive results with Ritalin are very
clear cut. They have to do with the crushing of spontaneous behaviour".
Instead of responding to our children's signals that they're bored or
anxious or lonely or feeling hopeless, we crush the spontaneity with the
stimulants. Instead of giving them more interesting things to do in school
we enforce a rote obsessive compulsive behaviour with stimulant drugs. I
consider this a national tragedy. I consider it a kind of child abuse, a
technological child abuse".
"There are no studies that show that Ritalin produces positive results if
you define positive results as a child learning to take responsibility for
his or her behaviour, or doing better in school, or having a long-term
better outcome in their life. The so-called positive results with Ritalin
are very clear cut. They have to do with the crushing of spontaneous
behaviour".
Peter Breggin, Psychiatrist
The case of twelve year old Andrew Fraser shows how excessive the use of
medication has become in America. Andrew was first prescribed Ritalin five
years ago, and was also given Clondidine to help him sleep. His doctor
started prescribing even more drugs until by the time Andrew was 11, he was
taking five different pills.
Andrew's father noticed his son's personality becoming evermore s distorted
and sought help. Andrew met Peter Breggin who helped wean him off the
powerful cocktail of medication he was taking.
TRANSCRIPT – PANORAMA "KIDS ON PILLS"
NB: THIS TRANSCRIPT WAS TYPED FROM A TRANSCRIPTION UNIT
RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT: BECAUSE OF
THE POSSIBILITY OF MIS-HEARING AND THE DIFFICULTY, IN SOME
CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH
FOR ITS ACCURACY.
...............................................................
RECORDED FROM TRANSMISSION: BBC-1 DATE: 10:04:00
...............................................................
SHELLEY JOFRE
Tens of thousands of British children are being given psychiatric drugs to
control their bad behaviour.
SHARON BUXTON
I thought long and hard before saying yes, medication has got to be the only
thing, and it was the only thing.
JOFRE
But are these drugs being used as a quick fix.
PROF. STEVE BALDWIN
What children need is our understanding. What they don't need is to be
drugged.
JOFRE
Tonight on Panorama, the growing number of kids on pills.
Seven-thirty in Stoke-on-Trent and Theresa Senders is getting her children
ready for school.
It's a daily struggle, especially with her 9 year old son David. His
behaviour
has been a constant source of worry to her.
TERESA SENDERS
He used to soil himself and wipe it round his bedroom. He'd take plaster
off his bedroom walls. He'd kick and punch me in the street. He was a
very loud child, he still is very loud.
He couldn't play with other children, he had to muscle in on the action, you
know, he had to be the centre of attention. He was always on the go, never
sat still, always running about, and really difficult to control.
I couldn't control him at all.
JOFRE
David's parents split up when he was a baby. Theresa now brings up four
children on her own with no help from their fathers. It hasn't been easy
coping with David.
SENDERS
He would actually get really violent. At one point he actually put his fist
through his bedroom window and cut his wrists open because of a temper
tantrum. So he would actually be unsafe. He wasn't safe to be left on his
own when he'd have a temper tantrum.
JOFRE
The situation got so bad that David was eventually referred to the local
child psychiatry clinic at Abbey Hulton. The consultant diagnosed a
condition called 'attention deficit hyperactivity disorder' or ADHD.
SENDERS
He explained to me that he was hyperactive and he was impulsive, he
had impulsive behaviour which are classic signs of attention deficit
hyperactivity disorder. He suggested David was put on Ritalin.
He takes two tablets a day at breakfast and at lunchtime, and it's
like having a little boy given back to you, it really is. Even though he
still has temper tantrums, they're not as severe as what they were
before he had Ritalin. He can sit down now and he'll play quietly
with the other children, whereas before he was like a bull in a china
shop, he'd just run round and we couldn't do anything with him.
JOFRE
Ritalin is a psychiatric drug that seems to help children like David control
their behaviour.
David's in no doubt that it works for him.
Q: So does it feel different when you take the pill?
DAVID
Yes.
Q: How does it feel?
DAVID SENDERS
Um... good, good.
Q: Can you describe? Does it feel different in your head?
DAVID
Um... yes.
Q: It does. Does it feel better when you take the tablets?
DAVID
Yep. Yep.
Q: And what happens when you haven't taken one? How do you feel then?
DAVID
I get a bit mad.
Q: You're mad when you don't take the tablets?
DAVID
Yep. (laughs) You see, ?? ?? ??
JOFRE
David is just one of a growing number of British children who have been
prescribed Ritalin.
There's been a 9 fold increase in prescriptions in just four years, from
fewer than 16,000 in 1995 to nearly 140,000 in 1998. Ritalin has rapidly
become an accepted treatment for ADHD but some have grave concerns
about its use.
PROFESSOR STEVE BALDWIN
UNIVERSITY OF TEESSIDE
What children need is our understanding. Occasionally they need
psychotherapy, they need counselling, 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.
SHELLEY JOFRE
Worries over spiralling prescription rates are being brought into sharp
focus in Stoke. The number of children here who are on Ritalin has
sparked a local row that mirrors concerns at a national level.
The clinic where children were diagnosed with ADHD has come under
unprecedented scrutiny in recent months. The local health care trust is
currently investigating the cases of 150 children aged between 5 and 11
who may have been misdiagnosed or wrongly prescribed Ritalin.
The child psychiatrist at the centre of the controversy has been suspended
from duty. Doctor David Foreman arrived at Abbey Hulton 12 years
ago. He set up and ran a specialist ADHD clinic.
This brought him to the attention of the local media.
DR DAVID FOREMAN
There are some special teaching techniques required, these involve, in part,
being able to constantly bring the child back to the topic in hand when
they're
drifting off. Recognising that the child will behave and concentrate less
well
in a group setting than in one to one and that isn't simply being naughty or
being lazy.
JOFRE
But it was his use of the drug Ritalin at the clinic that proved
controversial.
Ritalin is a brand name for methylphenidate, a stimulant so powerful it's
kept under lock and key by pharmacists. It's a controlled drug in the
same class as cocaine and speed, but psychiatrists and psychologists
are deeply divided over use of the drug. They also hotly dispute whether
the bad behaviour displayed by children who've been diagnosed with ADHD
is caused by their environment or by a brain disorder.
PROFESSOR ERIC TAYLOR
INSTITUTE OF PSYCHIATRY
Well ADHD is a sort of problem with disorganisation in children. It's a
behavioural pattern.
It's a pattern that goes on over time in which children tend to be, very
much more than others,
inattentive, restless, impulsive, they find it hard to wait, they find it
hard to hold themselves back from doing things, they find it hard to
restrain themselves. It's an impulsive overactive inattentive pattern.
JOFRE
Is it a brain disorder?
TAYLOR
It is probably a brain disorder. It's not only a brain disorder, because
like other things that affect children's brains, the psychological
environment that you're living in affects it a lot.
JOFRE
It's not only hard to define, it's also difficult to diagnose. There's no
test for ADHD, just an accepted list of symptoms which doctors
observe in children with the disorder. These symptoms range from
lack of concentration, shyness and disobedience to nose picking and
whining. Doctor Foreman sent a checklist to parents to fill in which he
used to screen cases of ADHD from the very long list of children
waiting to be assessed. He used the results to try to work out
which of the children may be suffering from ADHD. Those children
were invited back to the clinic to be assessed. Until then, doctors here
had seen very few cases of ADHD.
After the checklist was introduced though, there was a dramatic 15 fold
increase in the number of children diagnosed. Professor Steve Baldwin
is a clinical psychologist. He thinks many doctors are too quick to
prescribe when other non-drug treatments have not been tried.
The 15-fold increase in ADHD cases in Stoke is, he says, a reflection
of the national trend.
BALDWIN
It fits with what's happening in Britain generally which is the same kind of
increase over the last ten years in this country of more and more
children being viewed as having this so-called biological brain disorder,
ADD or ADHD, and what we know is that some children have arousal,
hyper arousal, hyper activity problems, but certainly not.. nothing
explains that kind of increase other than paediatricians and psychiatrists
over-diagnosing and over-prescribing.
JOFRE
In Stoke the Kent family and many others are now anxiously waiting to find
out if that's what happened at Abbey Hulton Clinic. Nine year old Jason
Kent has had behavioural problems since he was a toddler.
ADRIANA & PETER KENT
When he started nursery school he used to be disruptive and he wouldn't
mix with all the other kids. The teachers had problems with him. He'd
throw
chairs, have tantrums, kick and bite other pupils in the class, be very
disruptive. When he was about 4 he was expelled for fighting.
JOFRE
Jason was first diagnosed with ADHD aged 5. He was prescribed Ritalin
by Dr Foreman but his mum didn't let him take it at that time. Over the
next
three years Jason's behaviour got worse and he was referred back
to the clinic. His mum and step-dad saw Dr Foreman again.
ADRIANA KENT
He didn't even see Jason.
JOFRE
He didn't actually physically see him on that visit?
ADRIANA KENT
He saw him sitting in the waiting room but he didn't go in the room with us.
PETER KENT
He made Jason sit in the waiting area while we were interviewed in a
separate room away from him. And he made no intention of talking to
Jason. And at the next visit we were told that Jason was to go back on
Ritalin, so we weren't very happy with that decision.
JOFRE
Jason's parents have been through a stormy divorce, yet his mum and
step-dad say no effort was made to explore if this might be at the root of
his behavioural problems. In fact, more than three quarters of the
children
diagnosed with ADHD at the clinic have been through a parental divorce
or the death of a loved one. So could this better explain why these
children
are badly behaved?
BALDWIN
There may be a bereavement or there may be some grief. They may have
lost a relative, a grandparent. They may have problems at school. They
maybe being bullied, they me falling out with their brothers and sisters,
being cramped in small room in a small house with a single parent, with
unemployed parents. A whole range of social and interpersonal
conditions explain children's problems, but none of them are explained by
a so-called biological brain disorder, and none of these problems is
fixed with methylphenidate or other drugs.
JOFRE
Jason's mother is not convinced that he has ADHD or that he needed Ritalin
at all.
ADRIANA KENT
It could just be things that have happened in his past. He needs
counselling,
he needs to talk to somebody. I really don't think he needs any kind of
medication.
JOFRE
Jason was prescribed two half tablets of Ritalin a day. But after just
three doses his mum stopped it because he became withdrawn
and tearful.
ADRIANA KENT
At the end of the day I think Ritalin should have been given as a last
resort, but it wasn't, it was given first. Nothing else was tried first.
JOFRE
Scientists can't explain exactly how Ritalin helps children with ADHD, but
they think it stimulates part of the brain which is under-active.
This stops their impulsive behaviour and helps them concentrate.
PROFESSOR ERIC TAYLOR
INSTITUTE OF PSYCHIATRY
Medication is a control of the symptoms, but that can be a very important
thing to achieve, because if a child's whole progress, whole social
relationships, whole family relationships and school learning, if they're
disrupted by the ADHD problem, then to control those symptoms
for long enough for their normal development to proceed can be of
very great benefit to them.
JOFRE
With a child as hard to control as six year old Craig, Ritalin seems to make
all the difference.
His mother has lost count of how many times he's been suspended from
school.
His behaviour is by all accounts wild. Before his medication kicks in,
Craig's mum and sister find him impossible to deal with.
SHARON BUXTON
He's dismantled the waste under the sink unit, slashed the three piece,
taken the door socket off in the middle of the night, unscrewed it and
pulled it away from the wall. I've found him with knives in his bed.
He cut his hair. He swung from the light shade, he's pulled his
curtains down, slashed his mattress, he set the bin afire, he set the paper
in the cat litter tray alight, strangled the cat. The list is endless.
JOFRE
Craig was prescribed Ritalin at Abbey Hulton at the age of 4 even though the
drugs manufacturer, Novartis, does not recommend its use in children
under 6. He also takes a very high dose, three tablets a day.
As the medication takes effect on the way to school, the change in Craig's
behaviour is striking. But while the drug clearly calms him down, it also
has
some worrying side effects.
BUXTON
He can be quite tearful sometimes. Recently I've noticed he can become
tearful. Sometimes he can be moody, but I don't know whether that's an
effect of taking the drug. Loss of appetite is the worst one.
JOFRE
Does he find it quite difficult to eat when he's taking Ritalin?
BUXTON
Yes, he does. I have to watch him. I have to watch everything he eats,
make sure he eats.
Sometimes literally stand over him or feed him yourself to make sure he has
eaten.
JOFRE
Loss of appetite and mood swings are two of a long list of side effects that
children may suffer when taking Ritalin.
PROFESSOR STEVE BALDWIN
UNIVERSITY OF TEESSIDE
Parents clearly notice differences in their children at home, and teachers
at school report the same kinds of differences. Apparently the child's
concentrating is subdued, this maybe attending to their work in school, or
their playmates at home, but what's really happening is the drug is
narrowing the child's focus of attention and this is the classic
effect of methylphenidate, of amphetamines on not just children and
teenagers but, as it turns out, adults and animals too. All of these
studies
point to the same things, that the drug apparently works because the
behaviour is blunted. What is really happening is that the child's
behaviour
or the teenager's behaviour is being narrowed down on one or two activities.
Apparently the child is improving but what's really happening is there is
less
behaviour and 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
Craig Buxton's case is among the 150 currently under investigation by the
local Health Care Trust. It's an anxious wait for his mother to find out
the results.
Q: How will you feel if they tell you that he's been over-prescribed, or
even misdiagnosed with ADHD?
BUXTON
Devastated, because I've been pumping drugs into my son's body that is known
to give him the side effects that come with taking the drug that are
terrible.
I thought long and hard before saying yes, medication has got to be the only
thing, and it was the only thing. But with a drug this powerful, you can't
mess
about with it.
JOFRE
It's not just some parents and doctors in Stoke who are concerned about the
rapid rise in the use of Ritalin. Across the UK more and more children are
taking the drug.
At this London school 2% of the pupils are on it. Many doctors, though,
believe the real problem is not over prescription but that ADHD all too
often
goes untreated.
DR GEOFFREY KEWLEY
ADHD LEARNING ASSESSMENT CENTRE
I'm much more concerned about the current under-awareness and under-
diagnosis of conditions such as ADHD. I do think it needs to be put in
context
of a condition which is a very severe public health issue that untreated can
be
life-threatening. Some children with ADHD act impulsively. They are more
prone to depression and suicide and the like.
It certainly is a relentless condition that significantly interferes with
everyday
functions that the rest of us take for granted.
JOFRE
But as diagnosis of ADHD grows in this country, so too do drug prescription
rates. The worry is that we could end up like America where it's estimated
that 3 million children now take Ritalin and other stimulants. In the
United States
cases of attention deficit disorder have now become so common place that as
many as a third of students in some schools are being prescribed stimulants
like Ritalin. In fact America consumes more than 80% of the world's supply
of
these drugs. And cases of childhood depression are on the increase here
too.
Growing numbers of even very young children are being prescribed
antidepressants like Prozac. This private school in Massachusetts caters
for
children with ADHD.
Like most schools in America, Hillside takes a firm line against illegal
drugs.
Yet a third of the boys here takes psychiatric drugs every day. At lunch
time
the school nurse measures out the correct dose of medication for each child.
She dispenses a vast array of stimulants and antidepressants.
BARBARA JOHNSTON
SCHOOL NURSE
Some of our boys are on Dexedrine, some are Adderall, a couple on Prozac.
Ritalin and Adderall are neck and neck for the most prescribed for our kids
anyway.
JOFRE
When the stimulants like Adderall and Ritalin cause insomnia the boys are
often given another drug, Clonidine, to help them sleep. Their drug regime
is
carefully planned around the academic schedule.
JOHNSTON
You don't want a medication to start working and kicking in at 3 o'clock
when their academics are done. So it's really important that we're finding
the
right balance. So from 7 to 3 during their academic times, that's when the
medication is working its best, so the feedback from the teachers is crucial
so we can make sure the child is getting what they need.
CHILD
I have to take Adderall, Wellbutrin and Respiratol.
Q: And do you know what all those are fore?
CHILD
Just to calm me down because I'm very hyper at times.
2nd CHILD
I take Ritalin normally around breakfast time, and sometimes when I'm at
home on vacation I'll take it more than once a day, but I also take not for
ADHD but I take Clonidine at night just to help me get to sleep, but Ritalin
is supposed to help me focus on my work more, and I take that in the morning
near breakfast.
3rd CHILD
I take Wellbutrin and that's like Ritalin, it's a stimulant, and lots of my
friends
also take pills, so I'm not like the only one out of like five kids and my
friends, so...
JOFRE
Even pre-school children in America are being prescribed psychiatric drugs.
A recent study found there's been a dramatic rise in the number of children
aged between 2 and 4 who are taking stimulants and antidepressants, and
that's
in spite of the fact that there's very little evidence that these drugs work
in small children, or that they're safe. In the study scientists analysed
prescriptions rates
to pre-school children over a five year period.
They were alarmed to find that use of antidepressants like Prozac had more
than doubled, and use of stimulants like Ritalin had trebled. There was
nearly
a 30 fold increase in the prescription of Clonidine.
Some experts fear the effect all this may have on the development of young
brains.
DR JOSEPH COYLE
CHAIR, DEPT OF PSYCHIATRY
HARVARD MEDICAL SCHOOL
We have very little experience on the outcomes for children treated early
pre-school stage.
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. We cannot be cavalier about this.
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.
JOFRE
That sounds quite worrying. Could that be the case in children too?
COYLE
Well we don't know and it's the type of experiment you don't really want to
do. So that's why I want to emphasise that the use of these drugs in
children
in the 0 to 4 age group should be highly restricted and only after ruling
out other psychological and family directed treatments.
JOFRE
Cameron was just 4 years old when he was prescribed Ritalin and Chlornodene.
Even as a toddler he was aggressive and uncontrollable. At one point his
parents
feared he would be thrown out of nursery school. The medication transforms
his behaviour.
Cameron takes a Ritalin tablet twice a day and then a Clonidine at night to
help
him sleep. A lot of powerful medication for a young child.
JENNIFER & TOB SEVEN
It was a big, big decision. I really did not want to do drugs with him at
all and it took
a lot to convince me.
TOB SEVEN
Then finally we said to the psychologist, "You don't seem to understand
doctor, it's
not for him, it's for us, because we need something. It was just becoming
too
difficult at home.
JENNIFER SEVEN
It was for him, not just because he was driving us crazy, so he could he
successful
in his life and in his day and at home. That's what really convinced me.
JOFRE
And has the Ritalin made much difference to your own experience of living
with Cameron?
JENNIFER SEVEN
Well let's just say it's the first thing we do in the morning. (laughs)
Can't get it in fast
enough.
TOB SEVEN
Before the cornflakes and milk.
JENNIFER
Every once in a while, because I still have this guilt about him taking it,
I'll skip
his lunch dose and I will pay for it all afternoon.
JOFRE
But while drugs clearly offer welcome relief for parents of children like
Cameron,
there are fears that they also absolve mums and dads of their
responsibilities.
Some people say that by putting your child on Ritalin you're putting the
blame on
him rather than looking to yourselves as parents and what might be wrong
there.
JENNIFER
We spent four years before we were able to make the decision that maybe it
was beyond us and to go to a professional and say "Is it me?" and what a
relief
to hear a very clearly "This is not you, this is your child. You are not a
bad parent." What a weight to have lifted.
JOFRE
But are parents doing the right thing? They can take comfort from the work
of scientists like Peter Jensen. He recently completed the largest ever
study into
the treatment of ADHD. He compared drug treatment with behavioural therapy
on
600 children, and concluded that the drugs really do work.
DR PETER JENSEN
NEW YORK STATE PSYCHIATRIC INSTITUTE
In the particular study we did, we spent hours and hours and hours of time
with parents. We did the best study that's ever been done on planet earth
helping
parents and teachers with these children, and what did it show? It showed
that
the medicine was still a great deal more effect for these children. Many
children suffered despite the very best we could do with the behaviour
therapy. So the appropriate use of medicine, well diagnosed, carefully done
and carefully
monitored with a well trained doctor and careful parents, could have an
enormous
boon for many, many children who are not being treated properly right now.
JOFRE
But others believe psychiatric drugs are doing more harm than good to
children. Psychiatrist Peter Breggin has written extensively about his
belief that these
drugs are being used as a form of social control.
Dr PETER BREGGIN , Psychiatrist
There are no studies that show that Ritalin produces positive results if you
define positive results as a child learning to take responsibility for his
or her
behaviour or doing better in school, or having a long-term better outcome in
their life. The so-called positive results with Ritalin are very clear cut.
They have to do with the crushing of spontaneous behaviour.
Instead of responding to our children's signals that they're bored or
anxious
or lonely or feeling hopeless, we crush the spontaneity with the stimulants.
Instead of giving them more interesting things to do in school, we enforce a
rote obsessive compulsive behaviour with stimulant drugs.
I consider this a national tragedy. I consider it a kind of child abuse, a
technological child abuse.
JOFRE
Twelve year old Andrew Fraser's story shows just how extreme the use of
medication has become in America. He was first prescribed Ritalin 5 years
ago. He started on half a tablet but soon progressed to 7 tablets a day.
He was also given Clonidine to help him sleep.
Then his doctor prescribed even more drugs.
BRUCE FRASER
Approximately two years into his programme he was given Prozac.
Prozac is an antidepressant. And then later on there was another
antidepressant that was added, so by the time that he was 11 he was taking
4 of these different medications, a very high dose of Ritalin, the
Clonidine, the
Prozac, and this other medication. And then a fifth medication had been
suggested at that time.
JOFRE
How did you feel about your son taking all this very powerful medication?
FRASER
As time went on, we became more and more sceptical. It was a therapy that
was going nowhere. We weren't solving any problems. The fact that the
dosages were continually being increased to try and counter effect the
things
that we saw, started to make us sceptical whether this whole programme was
worthwhile or not, and by the time we reached the point where this fifth
medication - it was a mild anti- psychotic - by the time that was suggested,
we
had pretty much hit the wall. I think his personality was completely
distorted, and
we didn't know who the real Andrew was. Andrew didn't know who the real
Andrew was because he had grown up, during his very critical times of
growing
up, being modified by these medications, and at that time we pretty much
said
no, we have to try something different, and that's when we found and sought
alternative therapies.
JOFRE
Andrew met Dr Breggin who helped wean him off the powerful cocktail of
medication he was taking.
ANDREW
I think it was important the way that you talked to me and the way that you
talked
to me helped.
BREGGIN
What way was that Andrew?
ANDREW
Like with a calm tone of voice and understanding.
BREGGIN
I've always liked you a lot. Did that come through?
ANDREW
Yes.
BREGGIN
You're very easy to like you know, and I think that your psychiatrist should
have liked you more and drugged you less until you got to me, and you
wouldn't have needed me.
BREGGIN
When I first met Andrew Fraser I wanted to cry. He was skinny and small for
his age. He was very sad. He was very tired. He was kind of tipping over
on the couching part because he was taking Clonidine, a drug that sedates
you because
he was being over-stimulated by the drugs. He was involved in a lot of
fighting
and other aggressive behaviour at home, and everybody was just having a
terrible time, including Andrew. There is no way on the face of the earth
that
taking 3, 4 or 5 psychiatric drugs at once is having a good effect on a
child.
It's disrupting multiple neurotransmitter systems which are then disrupting
each
other in a chain reaction that's beyond our imagination or understanding at
the
present time.
JOFRE
Dr Breggin's intervention changed their lives. The whole family is much
happier
now that Andrew is off drugs completely.
Q: So when you came off all the medications, what did you do?
ANDREW FRASER
I took them all and went to the bathroom and poured them all in the toilet
and
flushed them down the toilet and it was fun.
JOFRE
Have you had to take a hard look at yourselves, you and your wife, and your
parenting skills.
BRUCE FRASER
Absolutely and I think this is one of the things that I feel is where we
have really
let down is in our parenting skills, and that parenting skills are probably
as
important as any medication that can be given. You are the one in control.
You are the one that has the final decisions, and you are the one that needs
to
be there emotionally and connect with that child, not the medications.
JOFRE
On both sides of this debate opinions are becoming more and more entrenched,
but it seems psychiatric drugs have become the American way of dealing with
problem children.
DR PETER JENSEN
NEW YORK STATE PSYCHIATRIC INSTITUTE
We know that not treating is a very bad thing. The consequences of ADHD
untreated, many of these children go on to substance use and abuse,
delinquency, a substantial subset go into lives of crime, they're double or
triple the risk for that. Auto accidents, substantial marital problems, job
failure etc. So not doing anything is a bad thing for many kids.
The question is, what's the relative advantage of doing something versus the
disadvantages of doing something, and as best as we can tell now, the
advantages are all pretty much on the side of treating.
BREGGIN
We are bathing the brains of so many of our children with these toxic
substances.
The kids who get drugged are often our best, our brightest, our most
exciting, our
most energetic. So we're now bringing up a generation in this country in
which
you either sit down, shut up and do what you're told, or you get diagnosed
and drugged.
JOFRE
The amount of psychiatric drugs being prescribed to children is now coming
under close scrutiny both here in America and worldwide.
The International Narcotics Control Board,which monitors drug use and
production across the world, has been concerned for several years now that
America is
using too much Ritalin. In their most recent report for the United Nations
here
in New York, they called on America, Britain and other countries to
carefully
review their prescription practices.
Back in Stoke on Trent the local health care trust has been forced to review
its prescription practices too. Dozens of parents are waiting to find out
if their
children have received the correct treatment at Abbey Hulton Clinic.
Sharon Buxton has just heard the result of her son's case review.
SHARON BUXTON
I was told he was on too much medication. It's got to be reduced by half.
He shouldn't have been taking Ritalin until he was 6.
JOFRE
So he shouldn't have been on Ritalin at all?
BUXTON
No, no. He should have been assessed and he should be.. you know, starting
to take Ritalin now at this age, 6.
JOFRE
So he's been taking Ritalin for two years unnecessarily. How do you feel
about that?
BUXTON
Angry, very angry, because the tablets stunt your growth and do other things
to the body and it's in later life that the children are affected by this,
and he's
been taking such a large amount for such a long time that he shouldn't have
been, it's going to be hard to reduce his dose.
We'll have to wean him off it slowly and how he's going to react to that I
just don't know.
JOFRE
And Sharon's son is not the only child to have been given the wrong
treatment
at Abbey Hulton. The Trust has now reviewed more than 100 of the 150 cases
that were causing concern.
DR ROGER BLOOR
NORTH STAFFS COMBINED HEALTH CARE TRUST
Over 50% of those children were actually happy that their diagnosis
treatment
and management is what they would get anywhere else.
JOFRE
What about the other 50%?
BLOOR
With the other 50% we have a range of concerns, and some of those are ones
where we feel that perhaps the child behavioural check list has included
people
who wouldn't normally be included within that range, and we have other
children
where families haven't responded to the check list and therefore have not
been
taken into the system, and therefore haven't had the chance of a diagnosis,
and so with them it's not a question of misdiagnose, it's just the fact that
the
families felt unable to, for whatever reason, return the check list and
therefore
didn't get into the system.
JOFRE
But some of these children who have been misdiagnosed at Abbey Hulton
must have been prescribed Ritalin which they didn't actually need.
BLOOR
Again it depends what you mean by misdiagnosis. We have children who are
on Ritalin, who their parents are perfectly happy with.
JOFRE
But it's not up to their parents. This is a very powerful stimulant. It's
similar to
amphetamine. If children are being given this when they don't really need
it, surely that's a cause for great concern?
BLOOR
But I think I'd dispute your view that it's not up to the parents that..
JOFRE
Surely it's entirely wrong to prescribe a child a drug like Ritalin if they
don't
have ADHD.
BLOOR
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.
JOFRE
However, the Royal College of Psychiatrists says a clear diagnosis of ADHD
is required before stimulants are prescribed to children. Dr Foreman
refused to
be interviewed for this programme. In a statement to Panorama he maintains
he used internationally recognised procedures at the clinic. He said he
was
surprised by the marked increase in diagnosis, that he told the Trust about
the
rise and was given a salary increase in recognition of his work. He says
"I've
been heartened by the extent of support expressed for me locally." But some
parents have been left with grave concerns about the treatment their
children
received.
BUXTON
I feel angry because he's been taking such a powerful drug for such a long
time that it's going to take a lot to put right. None of it's our fault.
It's the system's
fault, the health authority's fault. They've let us down, they've let Craig
down.
That's how I feel.
JOFRE
To drug or not to drug. That's the question parents face across the UK.
The Department of Health is so concerned it's commissioned independent
experts to evaluate the appropriate use of Ritalin.
Guidance will be issued later this year which doctors will be expected to
follow.
But current trends suggest we will continue to see a rising number of kids
on pills.
You can comment on the issues raised in this programme by contacting
www.bbc.co.uk/panorama. Next week They Dying Game, the sexual crisis that's
killing South Africa.
ENDS
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