Strong evidence indicates that the epidemic of Attention Deficit Disorder affecting mostly white, middle class boys is to a large extent man-made, one result of a long-term, unpublicized financial relationship between the company that makes the most widely known A.D.D. medication and the nation's largest "A.D.D. Support Group." That case is made in our documentary, "A.D.D.-A Dubious Diagnosis?"

No question that A.D.D. is spreading, along with the use of powerful psychostimulants. The number of children being medicated-now an estimated 2,000,000-seems to be doubling every two years.

In preparing our documentary, we heard time and again that Ritalin is "all over the schools." Recovering drug addicts told us that Ritalin was becoming what's called a "gateway drug," the first drug a child tries. And addicts told us that some teenagers snort Ritalin for a quick, cheap (but dangerous) high.

Quick? Yes, because Ritalin is a stimulant.
Cheap? Yes, because parents pay the bill.

Dangerous? Yes, powerful enough to kill. The federal Drug Enforcement Administration reports that a Virginia teenager died from snorting Ritalin. We hope our documentary and this guide will help parents and educators find alternatives to unnecessary labels and powerful drugs-like smaller classes, more interesting curricula, and more personal attention at home and in school.

-John Merrow

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CHADD (Children and Adults with Attentin Deficit Disorder)

Thousands of parents turn to A.D.D. "support groups" for information and help. They expect that the information will be accurate, unbiased and complete. The largest of these support groups is CHADD, Children and Adults with Attention Deficit Disorder.

As we report in "Attention Deficit Disorder: A Dubious Diagnosis?", many parents do not know that CHADD has for years been receiving large sums of money from the maker of Ritalin, Ciba-Geigy.
Here is some of what CHADD's literature tells parents, along with information it doesn't present.

CHADD SAYS:

"Psychostimulant medications are not addictive."

WHAT'S NOT SAID:

Methylphenidate and Ritalin are nearly identical to amphetamine- otherwise known as "speed". The federal Drug Enforcement Administration puts methylphenidate in the same class of drugs as morphine and codeine- drugs with legitimate medical application, but a high potential for abuse. Withdrawal effects (agitation, marked anxiety, and tension) from psychostimulants are common, and many doctors recommend tapering the dosage before discontinuing medication.

CHADD SAYS:

"The most likely cause of A.D.D. is a chemical imbalance or deficiency in certain chemicals in the brain that are located in the area responsible for attention and activity."

WHAT'S NOT SAID:

CHADD bases this claim on a 1990 study by Dr. Alan Zametkin of the National Institutes of Health (NIH), which found slightly lower levels of glucose metabolism in the brains of adults diagnosed with hyperactivity. Not mentioned by CHADD are the succeeding attempts* to replicate those results in children. Dr. Zametkin's later studies found "no statistically significant differences" between the brains of normal children and children diagnosed with A.D.H.D. The root cause of the disorder remains unknown.

*Brain Metabolism in Teenagers With ADHD" ( Arch. Gen. Psychiatry, Vol. 50, May 1993) and "Reduced Brain Metabolism is Hyperactive Girls" ( J. Am. Acad. Child Adolesc. Psychiatry, 33: 6, July/August 1994)

CHADD SAYS:

"Emotional difficulties, including substance abuse, are more likely to occur when a child with A.D.D. is not treated."

WHAT'S NOT SAID:

There are no conclusive studies showing that treatment of A.D.D. reduces the risk of drug abuse. Even Ciba-Geigy's chief physician declined to support CHADD's assertion.

CHADD SAYS:

"Medication is not used to control behavior-medication is used to improve the symptoms of A.D.D."

WHAT'S NOT SAID:

The symptoms of A.D.D. outlined by the American Psychiatric Association (fidgets with hands or feet or squirms in seat, has difficulty remaining seated when required to do so, is easily distracted by extraneous stimuli, etc.) are all behavioral. Medication is used to help control these symptoms. Controlling behavior and improving the symptoms of A.D.D. are one and the same.

CHADD SAYS:

"Between 70-80% of children respond positively to these (psycho-stimulant) medications."

WHAT'S NOT SAID:

Research suggests that medication may not be so effective a treatment. Dr. James Swanson, Director of the Child Development Center at the University of California, has written: "...the short term effects of stimulants on academic performance are minimal compared to the effects on behavior, and there is no evidence of beneficial effects on learning or academic achievement."*

*"Treatment of A.D.D.: Beyond Medication" (Beyond Behavior, Fall 1992/Vol. 4 No,1)

CHADD SAYS:

"Hundreds of studies on thousands of children have been conducted regarding the effects of psycho-stimulant medications. Relatively few long term side effects have been identified."

WHAT'S NOT SAID:

Hundreds of studies on stimulant medications have been conducted, but few have looked at long term side effects. Measuring the long term effects of pediatric medications is prohibitive because of legal and ethical dilemmas surrounding the use of children as test subjects. The federal Food and Drug Administration labeling for Ritalin includes the specific warning "Sufficient data on the safety and efficacy of long term use of Ritalin in children are not yet available."

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The Experts

An interview with: Stanley Greenspan, M.D.

In the process of putting together "Attention Deficit Disorder: A Dubious Diagnosis?," we spoke with Dr. Stanley Greenspan, the child psychiatrist and author of The Challenging Child. Greenspan writes that many attention problems result from the way children process visual, auditory, motor, and spatial information, but these are often misdiagnosed as A.D.D.

DR. GREENSPAN: Many children who come in with attention problems in a general sense are actually having attention difficulties in one area but not another area. One little boy came in with mommy and daddy saying he never pays attention in school, but it turned out it was mostly during writing assignments. Talking to him one on one, he was very attentive. When he was examining things visually he was very attentive. It was only when he had to write things that he became inattentive. There were a lot of writing assignments in school, so he looked inattentive during a good deal of the day. Once we found out the primary challenge, we worked on his being able to write more effectively...and that helped him out

Q- Is medication the only approach to treatment?

DR. GREENSPAN: There are many ways to help a child with attention problems. One is to shore up the area that's vulnerable; like writing skills or looking skills or listening skills, or the way the child reacts to sensations by getting overloaded. Another approach is using medication along with therapy to help the child cope better and deal with the challenges they face, but if you don't diagnose the particular problem you're not going to know which approach is the most effective for the child.

Q- How can parents tell if they're getting a proper diagnosis?

DR. GREENSPAN: Ideally, the parents come in first and talk to the clinician about what their concerns are, what they worry about, what's going on at school, what's going on at home, and what their main worries about the child are. Then the clinician should do a careful review of the child's functioning in all areas. There should be a careful developmental history, tracing that child's development from infancy, including the pregnancy and delivery up through the current age.

Q-Is that what usually happens?

DR. GREENSPAN: Sometimes children aren't seen for long enough periods of time on their own. Instead of being seen for a whole 45 minute session they are seen for 10 or 15 minutes. Instead of being observed interacting with their parents, sometimes young children are just provided with a standardized battery of tests. Sometimes family function isn't gone into in as much depth as it should. So it doesn't always occur the way it ought to occur.

Q- What's the cost of misdiagnosis and mistreatment?

DR. GREENSPAN: If you don't formulate the proper intervention, then the child's psychological coping capacity won't develop as optimally as it could. As the child gets along in life, he won't function- either as a parent rearing children, as a worker out on the job, or as a citizen. We are robbing our country of the kind of wisdom it's going to need in the future.

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"Ritalin Ain't the Answer"

by Matt Scherbel

Matt Scherbel was 14 and in the eighth grade at Thomas Pyle Middle School in Bethesda, MD, when he wrote this for his school newspaper, "The Pyle Print."

The system wasn't and still isn't made for the extremists. The perfect student isn't a genius; he only takes extra care and concern. A stupid kid obviously doesn't fit; he needs more time to learn to learn and special attention that the system doesn't like. No, the perfect student is a schmo. He only hands in what is asked of him, therefore no special praise. He's quiet and speaks not a word of his own mind.

Schools don't like extremists who like to think and question. They are the dreamers. That doesn't mean that they are wrong. They just don't fit the norm, so they are labeled and damned, labeled as A.D.D. (Attention Deficit Disorder).

So the doctors dope us up with Ritalin and control our minds with low doses of speed. The teachers pay us no mind until our minds are under control. It screws up our train of thought and makes us one-dimensional. We get headaches and almost depressed getting on and off it. It takes away extra imagination and flow of the mind, hence destroying the true, purest ideas of my mind. I can't think right, and for six hours of the day, I'm not me. I'm what the system would like me to be.

The schools should shape our education around our idiosyncratic minds, our quaint minds, our quirky minds, our crackpot minds, our curious minds. Where would we be without eccentric people? We need them. The system should not shape our minds with dope and low doses of speed; the system should be shaped around us.

Ritalin does not help me learn; it simply lowers my mind down between the selected lines in which we are taught. Who's going to get further in life, the schmo with the same textbook answers and ideas, or the "A.D.D. kid" who can offer ideas that have never been thought of or a new perspective on something?

I truly look forward to the day when Ritalin isn't an answer. To the day when every student is labeled "learner."

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BOOKS:

The U.S. Department of Education publishes a list of books about A.D.D. Copies of "Where do I turn?: A resource directory of materials about Attention Deficit Disorder" can be ordered through Eric Document Reproduction service (1.800.443.ERIC) Document #ED-370333.

In The Challenging Child, (New York, Addison Wesley, 1995) Psychiatrist Stanley Greenspan outlines numerous kinds of attention problems that stem from the way children process information. Greenspan believes a proper diagnosis is the first step to finding the correct treatment.

The War Against Children (New York, St. Martin's Press, 1994) by Dr. Peter Breggin and Ginger Ross Breggin takes a critical look at Ritalin and A.D.D. Other books by Dr. Breggin include Toxic Psychiatry and Talking Back to Prozac., also published by St. Martin's Press.

In The Myth of the ADD Child, (New York, Dutton Press, 1995) Dr. Thomas Armstrong outlines 50 ways to improve a child's attention span without drugs or labels.

The Physician's Desk Reference, published by Medical Economic Data in Montevale, NJ. contains FDA- approved labeling information for Ritalin and other prescription drugs. The PDR can be found in most public libraries.

Dr. James Swanson Ph.D has published many scientific studies on stimulant medication for children. To learn what to expect from medication, read "Effect of Stimulant Medication on Children with Attention Deficit Disorder: A Review of Reviews", Exceptional Children, Vol. 60, no. 2, pp 154-162.

ORGANIZATIONS:

Children and Adults with Attention Deficit Disorder (CHADD)
CHADD
499 Northwest 70th Avenue, Suite 109
Plantation, FL. 33317

The nation's largest A.D.D. support group, CHADD publishes newsletters, fact sheets and educators' manuals. CHADD presents itself as an impartial source of information for parents; only after we began our investigation did CHADD tell its members-in very general terms-about its financial support from Ciba-Geigy, Abbott Labs and Burroughs Wellcome, the makers of Ritalin, Cylert, and Dexedrine respectively.

The Center for The Study of Psychiatry
4628 Chestnut Street
Bethesda, MD 20814

Founded by Dr. Peter Breggin, the center describes itself as a research and educational network devoted to reform in psychiatry and to offering independent analyses of current psychiatric theories and practice. The center publishes newsletters and holds annual meetings for members.

The Feingold Association of the United States
PO Box 6550
Alexandria, VA 22306

Founded by Dr. Benjamin Feingold, this organization is committed to the belief that ADHD symptoms arise from artificial food additives and preservatives. It endorses a diet designed to lessen reactions that may create ADHD symptoms.