What got you interested in the story?
Martin Smith: It came from my own personal experience. I have two children who are in
grade school, and I knew of friends of theirs who were being medicated, and I
knew friends of theirs who had been diagnosed and not medicated, and then I
realized how common it was. And then it hit us personally. We were told by
the teachers that we should have our own children looked at. But I was just
aware of it because you cannot avoid being aware of it, as a parent of a grade-school child.
Marcela Gaviria: From my perspective, it was kind of bizarre because I actually studied
psychopharmacology at the university. So I was very much, at least in my
younger years, in tune with these medications, and very much a believer in
them, I suppose. So I guess we were coming from very different backgrounds.
MS: Let's say I was very leery--I would say that--of the whole phenomenon,
because it was so new. Just as with Cyrille DuPerret, it hit us like a
Did either of you "switch sides" during the course of your research on how
you felt about psychopharmaceutical medication for children?
MS: I think when we began the project, Marcela and I had many discussions in
which she was more positive about medication and I was more dubious. And I
think as we did the project, we both came to a middle ground where we realized
that it applies in some cases and not in others.
MS: I think I came to the point of view that you have to take this issue case
by case, and that there are cases where these drugs appear to be helping, and
there are cases where this seems like clearly an over-diagnosis.
MG: Yes, definitely. You just start wondering when it's helpful and when
it isn't. When you think it's going to be helpful, the kid actually might
not have been helped, and vice versa. But I also was born and raised in a
culture that doesn't medicate their kids, and where all of these diagnoses just
don't exist. So it was an eye-opening experience to see so many kids in these
classrooms that are medicated.
Were there things that surprised you in your research, that you didn't
expect to find?
MG: When I used to interview all these parents, I was sort of amazed at how
easily they accepted medications in their lives, for the most part. I think I
must have interviewed around 50 families, and for the most part everybody was
pretty gung-ho on these things, and hadn't really thought about the long-term
implications too much. So that was kind of weird.
So you found there were many more families that were open to medication than
were leery of it?
MG: Yes. It was hard to find, actually, Cyrille DuPerret.
MS: But it wasn't hard to find families that had initially gone down the
medication route, who then had second thoughts about it. So it's not to say that everybody just goes down this road and is happy forever
after. I think one of the things that surprised me is how many kids seem not
to enjoy the medicine at all. ... Getting the dosage right
is a very difficult thing for the psychiatrists and for the families.
What didn't they like about it? How did it make them feel?
MS: We hear different comments from different kids, of course. But jittery is
one of them.
MG: And most of them will say things like, "I don't feel like myself." That's
the most common comment.
MS: And the parents worry about the side effects, such as loss of sleep or
Isn't it true, too, that although Ritalin in particular and all these drugs
have been studied a lot, [researchers] haven't done a lot of longitudinal studies? They don't really know what the long-term effects on these kids will be?
MG: They haven't done a lot of longitudinal studies, but these drugs have been
used since the 1960s. So far, you've got a lot of patients that have been
on it for a long time. So I think there haven't been serious studies of that
sort, but on the other hand they've been in the market for a while, and usually
drugs that are dangerous get taken off the market.
MS: The one thing that I've heard said about these drugs is that they leave
your system quickly. The amphetamine class (such as Dexedrine and Adderall), they go in your system and then they leave your system;
whereas drugs that are in the antidepressant class, like Prozac and Zoloft,
they know less about what those drugs' long-term effects will be. For one,
they haven't been around that long. And two, they don't leave the system so
How did you pick Denver as a community to look at? I know that there's a lot
of disparity among different communities in terms of the rate of ADHD diagnosis
and stimulant prescriptions. Where's Denver on that continuum?
MG: I think that we didn't necessarily want to go to a place that had a lot of
over-medication. We wanted to go to just a typical place. We were looking
at some of the statistics about where the incidence of ADHD was, and it's
generally in suburban white middle-class communities. So you can narrow
down a certain amount of places based on that. Something very
interesting was occurring in Denver, October 1999, about four months before we
started research, which was the school board issue. So we felt like it was
interesting politically. Something had happened there and issues were being
MS: The school board had held hearings on whether or not the schools were
pressuring parents to put their kids on Ritalin, so it had become a
political issue in the communities.
MG: That was the first time that it had ever happened, nationwide, where
some kind of a resolution like that had been put into effect. Even if it was
non-binding, it was at least getting a lot of coverage in Denver. We
thought it would be interesting to see how families reacted to this very
personal, intimate decision when all these headlines were saying extreme
things, like "kiddie cocaine" or, vice versa, "This is the best thing that ever
Was it hard to get them to open up? The stories in the film are very
personal. I imagine that it was difficult for the families to talk about some
MS: Marcela was responsible for approaching the families and talking them
through what it would be like to participate. She spent a lot of time with them, and
I think that was key. We also made the decision to work with a [digital video] camera, and
put a crew into the homes of these families for many more days than we
regularly would spend. Because of the lower cost of shooting with DV, we were
able to spend a lot of hours and get them acclimated to being filmed.
Why do you think they agreed to do it?
MG: I was definitely looking for families that wanted to participate because
they felt that their experience would help other people. Sometimes people want
to participate for the wrong reasons, but I was confident that these families
had been through certain things, and that they wanted to participate because of
their desire to help other families understand what this is like.
MS: I think also, parents that go through this feel that there's a lot of
misunderstanding, and that other parents misunderstand their decision to
medicate or their decision not to medicate. This was an opportunity to go
public and to show and discuss what it was that they went through. So I think
that they felt that they might reach more understanding even within their own
communities, as well as help families beyond their communities.
What about the controversy over definitions? I know there's a lot of debate
both about the etiology of ADHD and about how you actually diagnose ADHD.
Where did you end up coming down on that? Do you think it's a brain disease?
And do you think it's a definable condition?
MS: That's the million dollar question!
Well, if you can't answer definitively, did your feelings shift towards one
end of the spectrum or the other?
MS: I think there's a portrait of the scientist in the story. Dr.
Castellanos at the National Institute of Mental Health gives the most
compelling evidence that I have ever seen that there is some kind of brain
difference. However, the diagnosis that is used to determine whether a child
has ADHD is a subjective set of questions. There's a big difference
between the kind of work he's doing in the laboratory with the MRI, and what
happens when a child goes to see a psychologist. Of course, depending on
[psychologists'] training and sensitivity and prejudice, the diagnosis can vary quite a bit.
MG: In general, I feel like there's been a huge tendency to
simplify this as a brain disorder. I think a lot of doctors would do the
community a lot of service to say, "The brain is the most complex thing that we
know, and definitely something is up there. But we can't pinpoint it, and we
can't pretend that we know these answers." I think there are a lot of gurus
out there who are convincing parents that this is the most understood disorder
in the history of psychiatrics, and I don't think that's quite the case.
What is it about the ADHD issue that makes it, of all the psychiatric
diagnoses, so politicized and so polarized?
MG: It's politicized because kids are the most innocent, impressionable beings
out there, and we have a hard time believing that there could be something
wrong with their brains, and that they have a mental illness. On the other
hand, mental illness is hard to pinpoint because they don't have a litmus test
to figure out what this is, who has it and who will get it. So therefore it
becomes a very difficult and subjective diagnosis.
MS: Yes. I'd add that schools also are battlegrounds, for a whole set of
reasons. We have gone through a revolution in our educational institutions. We
have larger classrooms. We have open classrooms, which make a child who has
maybe some relative difficulty concentrating a more challenging experience.
Together with a larger classroom, it's of course going to be harder for
teachers to handle children that in the bell curve are outliers in terms of
attention or impulsivity. So a lot of people who are told that their children
are at fault, turn around and say, "No, it's the school that's at fault. They
aren't teaching our children correctly."
Another reason it's highly politicized is because there's a tremendous
amount of stigma when a public institution tells you that something is wrong
with your child and wants to label him. And so I think that's another reason
that it's not just a private family matter. It's between the family and a
Is it your sense that the rate of diagnosis has peaked? Or will it keep
MS: I believe it's still going up. I think that the rate of prescribing
medications to children is rising, and I think that you're seeing more and more
of the antidepressants, too, and not just the stimulant class.
MG: I definitely think it's going to keep on going up. And the proof of that
is how the pharmaceutical companies are practically each one developing three
new products for ADHD that will be out on the market by the year 2002. So they
clearly see a growing market.
What about the kids in the film? Is there an update on how they're
MG: Noelle is still in the seventh grade. She got straight As last
semester. She went on to the state gymnastics championship and won it. She's
doing beautifully, and has switched from Ritalin to Adderall. Initially she
didn't like it, but seems to be on the right dose of Adderall at the moment,
and doing quite well.
Alex is still struggling in school. He was getting Cs in class, and a
few Ds. The plan is to take him off the antidepressant Effexor this coming
summer. He is going to be on Adderall probably throughout school,
according to his psychiatrist. Actually, I think the filming did a lot for
him as well. I think he's the one that blossomed with the attention, and it
was a very positive experience for him.
Then there's Robin. My latest update is that he's no longer taking
medication. Apparently the teachers in his new school say that he's a
completely different kid than he used to be last year. Apparently he's doing
really, really well without the medications, according to his mom. He's very
popular and adjusting very well.
Nicolas is not taking medication. He is in kindergarten. They did switch his teachers once during this period, because he didn't adapt that well
to the first one, but he's doing beautifully with the next teacher he has.
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