Original airdate: April 10, 2001
Marcela Gaviria and Martin Smith
NARRATOR: How would you feel if you were told your child is failing pre-school?
YOLANDA DUPERRET: As a parent, you feel very horrible. You start blaming yourself. Then you start blaming your child.
NARRATOR: If you were told your child had a brain disorder?
NARRATOR: If your child had to be on psychiatric medications?
DIANE McCARTY: We thought maybe we would have to hospitalize Alex. He sat in the bathtub, he banged his head against the wall. You know, you don't want to think that this is real.
NARRATOR: If you tried every medication and none of them worked?
BARB DAY: We tried Ritalin, then Ritalin SR, then Cylert, then Wellbutrin, then Dexedrine. Then we added Zoloft to Dexedrine.
NARRATOR: Tonight on FRONTLINE, the story of four families trying to make sense of a mysterious and controversial mental diagnosis.
PROTESTERS: Leave our kids alone! Don't label our kids! Don't drug our kids! Just leave our kids alone!
NEWSCASTER: There was debate in Denver today over psychiatric drugs and how they can affect-
NEWSCASTER: -mind-altering drugs prescribed to control behavior. Drug watchdog groups told Colorado lawmakers-
NEWSCASTER: -between four and six million teenagers and children nationwide are on psychiatric drugs, some starting-
NEWSCASTER: Doctors tell us that only 1 to 2 percent of children actually have ADD, where they should-
NARRATOR: In the fall of 1999, Denver, Colorado was at the center of a highly charged debate over the prescription of powerful psychiatric medications to children.
INTERVIEWEE: These are toxic substances that drive some who take them to acts of violence or suicide.
INTERVIEWEE: The American public is getting very tired of fringe political groups using the courts for their own political-
NARRATOR: On average, two to three kids in every classroom across America are on some kind of behavior-modifying drugs, and the numbers are increasing. It is largely an American trend. School-age children in the United States consume at least four times more psychiatric medicine than children in the rest of the world combined.
We wanted to know why kids are being prescribed these drugs and whether or not they help.
NARRATOR: In December of 1999, Yolanda Duperret received a phone call from the principal at Nicolas's pre-school. Three-year-old Nicolas was "acting up," "disrupting class." They needed to come for a meeting.
YOLANDA DUPERRET: As a parent, when you first hear that your child is misbehaving and acting up, he's uncooperative, he's inattentive, he's unfocused, all these words, you know, you become very upset.
CYRILLE DUPERRET: The teacher he had was really having a problem with him. That's when we realized that, you know, there's more to him than we thought.
NARRATOR: Cyrille Duperret is from France, where a child is much less likely to be diagnosed with a mental disorder. It didn't occur to him that there was anything wrong with his son. To Nicolas's teacher it seemed obvious.
CYNDY OBERDIER, Pre-School Teacher: He really stuck out like a sore thumb. His approach was to bombard everyone with his presence. I just saw him as being immature, new to the classroom, new to the setting. And when the adjustment wasn't being made and, you know, he was continuing to be disruptive and impulsive, then we had to look further into what could be the reasons for that.
CYRILLE DUPERRET: At that point, I mean, we thought, you know, he's just a boy and he's very active and that's just- you know, we didn't think much of it.
YOLANDA DUPERRET: No.
NARRATOR: Nicolas's teacher suspected that he had Attention Deficit Hyperactivity Disorder, or ADHD.
YOLANDA DUPERRET: Nicolas, we're going in the car.
YOLANDA DUPERRET: Hey, watch your mouth!
NARRATOR: Around six million American school children have been diagnosed with this disorder.
CYNDY OBERDIER: Of course, as teachers, we've all been to workshops on ADD or ADHD. We've read material.
YOLANDA DUPERRET: Nicholas, sit down, please!
CYNDY OBERDIER: And I had this list of symptoms.
YOLANDA DUPERRET: Nicolas, sit down. Put your seatbelt on.
CYNDY OBERDIER: It was something like, if 5 out of 20 of these apply. Well, it was maybe 15 out of 20. And at that time, we discussed having them see somebody professionally.
NARRATOR: The Duperrets met with psychologist Ed Cable, an ADHD specialist. At first Dr. Cable thought Nicolas might be attending the wrong school.
EDWARD CABLE, Psy.D., Child Psychologist: They brought a videotape in of Nicholas in the classroom, and it was pretty apparent that he was below average in his ability to just stay in one place. He was always interested in what other children were doing in a very sociable way, not aggressive. But what would happen is, he would eventually distract the other child from what they were working on.
NARRATOR: In order to determine if Nicolas had ADHD, Dr. Cable proposed using a standard diagnostic tool, the Conners Scale, a checklist of 28 behaviors like "restless in the squirmy sense," "overly sensitive to criticism," "childish and immature," and "impulsive."
YOLANDA DUPERRET: You know, you're looking at these questions, going, "Wait a minute. You're going to test my child based on a list of multiple-choice questions?" You know, you start thinking this just doesn't make any sense! You could see where this was leading.
CYRILLE DUPERRET: And that's when the psychologist suggested he might be ADD or ADHD, which were kind of new acronyms for us. And it was- and then he suggested also the use of medication. And for us, it was like a cold shower. It was, like, "He's 3-and-a-half, and you want to give him medication?"
CYNDY OBERDIER: It doesn't bother me if a parent is in denial now because if it continues to be a problem, sooner or later they'll have to face it. And I want to know that I was the first one that may have said something about it.
CYNDY OBERDIER: And they'll realize, "Oh, she mentioned that three years ago. Now I get it."
YOLANDA DUPERRET: My child is who he- is who he is. I accept him and I love him for his personality. And I- you know, I love his personality. There is no way in the world I would ever want him to be different than who he is. He's a handful. He is more intense. He is more active. He's just more. I could never understand, then, how that would translate into my son having something wrong with his brain. It just doesn't make any sense.
NOELLE: Well, I take three tablets in the morning and sometimes at lunch, and after school for gymnastics. I'm taking it to help my attention span and help me concentrate, to help me do better in what I'm doing. If I don't take it, I just can't concentrate on what I'm doing. [sighs]
NARRATOR: Throughout grade school, Noelle Demo struggled. There were not only bad grades but fights and suspensions. For her parents, there was an endless string of tense parent-teacher conferences.
CAROL DEMO: It got to be so with each meeting I went to, the file would get thicker. And I cried through a lot of them because it was rough. I mean, she's a great kid and- and I don't know. I just- I just couldn't figure it out for a long time, what- what the deal was.
JOBETH MOSHER, Gymnastics Coach: Noelle was also having issues at the gym. She just seemed to have difficulty in tuning out what was going on around her. For example, on a balance beam, which is only four inches wide and five feet off the ground, and it takes a lot of concentration. But she would be busy looking around at what everyone else was doing and talking with people.
CAROL DEMO: We've tried a lot of different things before the medicine.
NOELLE: I already did math homework today.
CAROL DEMO: You sure you have no other homework?
CAROL DEMO: No catch-up or nothing?
CAROL DEMO: We've read more books and tried more strategies. And you know, you just- you don't want to give up.
Good. Wash your hands, and you can make the cookies. Oh, that does not sound good!
NOELLE: Ouch! And I didn't mean to do it.
JOE DEMO: It got to the point where, you know, we had tried enough things and enough people had said it- that it's, like, "OK. This is the next step."
CAROL DEMO: We were worried about it at first. You know, you hear bad things or you read bad things about the medications and the Ritalin. Then after talking to a couple doctors, they assured me that there have been more studies done on Ritalin than any other medication out there, that it's the safest medication out there. And it helps.
NARRATOR: At the end of 5th grade, as they were driving to gymnastics practice, Noelle asked her mother if she could try some Ritalin.
NOELLE: I said, "Mom, I don't think I'm doing real well in school, and maybe it'd help if I tried the medicine." I mean, she didn't really say much about it. She's, like, "Well, we can see what we can do." And so- [sighs] The next year she had me tested and put on the medicine.
CAROL DEMO: The Ritalin changed every aspect of Noelle's life. Her self-esteem improved. She went from C, Ds and Fs to As and Bs.
Looks like class average is 88, and you are 93 percent. Very nice. Very nice.
JOE DEMO: Doing better in school might have been, you know, part of the consideration, but it was affecting more than her school. It was affecting her whole life.
NARRATOR: Noelle was prescribed Ritalin by a psychiatrist, Dr. Jim Grubbs.
JAMES GRUBBS, M.D., Psychiatrist: So what's up? How are things? Life is good?
xxPrior to the medication, she was on a downward spiral of discouragement that therapy hadn't been able to address, that educational support had not been able to address, because it simply didn't work.
NARRATOR: Ritalin also appeared to make Noelle a better athlete. Although in international competition Ritalin is a banned substance, Noelle's gymnastic league allows it. On this day, Noelle was competing for a slot at the state championships.
JOBETH MOSHER: Having known Noelle for four years, I can tell you when she's not on medication. I can walk in that gym and watch Noelle's performance and be able to say, "She didn't take her medication, did she." I think she could compete without medication. Would she do as well? No. . Her focus would not be there. I'm not saying the medication makes her score well. It makes Noelle concentrate and want to perform well.
[www.pbs.org: Ritalin - what science knows]
NARRATOR: Noelle took Ritalin throughout the 6th grade, but a few weeks into the 7th grade, she began to have doubts.
NOELLE: I didn't think it was making a difference, but everybody could tell that it was.
JOE DEMO: Let's go, Noelle. Elise is going to be here in a few minutes.
NOELLE: My parents all started, like, saying, "You should really take it." And I told them, "You said I don't have to if I don't want to, so I'm trying not to." And that's why I didn't take it.
NARRATOR: Noelle's decision to stop taking Ritalin coincided with her new car-pooling arrangement. Every day, just as her Ritalin pills were taking effect, Noelle would be picked up by an herbalist who was promoting a so-called "natural alternative" to Ritalin.
CAROL DEMO: That all started when a friend of her's mom, I believe, implied that she shouldn't take Ritalin, that it was bad for her. She has a bumper sticker on her car that says, "Say no to Ritalin," I think, or something to that effect. And that's when Noelle stopped taking it. When she stopped taking the Ritalin, it went right back to the way it used to be.
NARRATOR: Patty Johnson is one of Denver's most vocal opponents of Ritalin. In the fall of 1999, she was one of seven members of Colorado's state school board and was determined to use her elected office to reverse what she believed was a dangerous trend.
PATTI JOHNSON, Colorado Board of Education 1996-2000: Too many children are being diagnosed and labeled, and too many children on are on these drugs. And I look back at when I was in school, and they weren't on these drugs. What-what's changed? Why do we have six million children on drugs now, and we didn't have it in the '50s and '60s?
NARRATOR: On October 13th, 1999, Patti Johnson summoned her colleagues to examine if kids in Denver were being over-diagnosed and over-treated.
GULLY STANFORD, Colorado Board of Education 1996-2000: She believed that it was important for us to discuss the issue of medication and diagnosis. We have a mission, and that is to serve the 700,000 students in Colorado. If there are concerns of over-diagnosis and over-medication, they need to be addressed.
BRUCE WISEMAN, Citizens Commission on Human Rights: Ladies and gentlemen, we stand at the dawn of the 21st century, with technology hurtling us into a space-age future while an estimated five million American children have been labeled with a so-called mental disorder that has no basis in medical fact.
NARRATOR: The school board hearings were not filmed, but three weeks later the same witnesses addressed the Colorado state legislature.
BRUCE WISEMAN: -Attention Deficit Disorder, with or without hyper-activity. This is simply a label given to what is essentially normal childhood behavior.
NARRATOR: The hearings were controversial. Four of the five witnesses were anti-medication, and three of them were sponsored by the Citizens Commission on Human Rights, an anti-psychiatry group founded by the Church of Scientology.
FRED BAUGHMAN Jr., M.D., Neurologist: It is not a matter of misdiagnosis or overdiagnosis. ADHD is a total, 100-percent fraud.
NARRATOR: After a few weeks of deliberation, the school board voted.
PATTI JOHNSON: By a six-to-one vote, we passed a resolution that basically told the districts that they can not pressure parents to put their child on a drug and that their responsibility is to stick to academic and discipline solutions within the classroom, to leave the medicating decision up to the parents and the doctors.
NARRATOR: In its final form, the resolution simply urged the districts to review their practices. But the one member of the school board who dissented believes his colleagues were fooled by outsiders with an ulterior agenda.
GULLY STANFORD: I don't believe this community can be convinced that there is no such thing as Attention Deficit Disorder. We know there is. These people have Scientology connections and essentially were part of a national, if not international, effort here to undermine the diagnosis and treatment of mental health. I believe that there is a right to medical treatment, and I would hope that school districts, in light of the implicit threat that's underlying this effort, this agenda, will be working with parents to let them know what their rights are.
[www.pbs.org: More on schools and ADHD]
NARRATOR: From what we observed, the resolution has had little effect inside Denver's schools.
When Noelle Demo stopped taking her Ritalin, her new 7th-grade teachers were quick to get involved. At the time, they were not aware that Noelle had previously been diagnosed with ADHD or had taken medication, but her behavior made them immediately suspicious.
MICHELLE MINISH, Teacher: Our teacher's consensus was that we believed Noelle might have Attention Deficit Disorder or something of that nature because she was so very fidgety. And that's when we found out that she did have ADD and that she had chose not to take medications for that and that was her own personal choice.
NARRATOR: The school psychologist sent Noelle home with pamphlets on the benefits of medication. Her other teachers weighed in, as well.
MICHELLE MINISH: Myself and some of the other teachers I talked to talked to her about the importance of taking medications so that you can really focus on school and how important school is, and that even if she feels that she isn't as social and- and I don't know, vibrant, during medication, that during school time that it's just so important for her to really be able to focus on school work, if she wants to, you know, advance through school well.
NARRATOR: After only a month off Ritalin, Noelle started taking her pills once again. Her teacher was pleased.
MICHELLE MINISH: I like the idea of the new or the medicated Noelle being able to focus on her schoolwork and get done what's necessary for her to get done. Our goal, as teachers, is to get them there, is to, you know, give them all the tools that they can have in order to be successful, and if it's, you know, recommending some things that we are aware of as far as how they can do certain work, what can make them more successful, ultimately, it's a parent's choice. But I think that if any parents want their children to be successful, I mean, they're going to do what needs to be done.
NARRATOR: Halfway through the 7th grade, Noelle's psychiatrist recommended she switch to a different stimulant.
Dr. JAMES GRUBBS: Since we started with the Ritalin, there's another medication that's available which is now on your insurance plan - it wasn't originally on it - called Adderall, which seems actually to work at least as well, if not better, than the Ritalin. And you take it once in the morning, and it lasts all the way through the school day for most kids.
NARRATOR: He says it's all part of an effort to help Noelle become a happy, well-adjusted child.
Dr. JAMES GRUBBS: I actually have some people who are taking Adderall in the morning and Ritalin in the afternoon.
NOELLE: Well, we could do that for gymnastics.
Dr. JAMES GRUBBS: The medication has helped her nervous system function in the normal range. She is a normal, healthy, growing, intelligent, bright, energetic kid, and in part that's as a result of the medicine.
CAROL DEMO: I know that probably sounds strange, but I mean, it just kept going and going until- until something finally worked. And it was the medicine that finally worked.
NOELLE: Having ADHD isn't really that bad. It's not really something you can prevent or, like, get rid of with surgery or something. You can't really prevent it. And it's not that bad.
BILL DODSON, M.D., Psychiatrist: [answering the telephone] Hello. ADHD Experts on Call. This is Doctor Bill Dodson. What question do you have today?
NARRATOR: Dr. Bill Dodson is a Denver-area psychiatrist who specializes in ADHD.
Dr. WILLIAM DODSON: We're at a cusp in history in which people are beginning to recognize, "Wow, this has been around forever." And we have a great treatment for it.
NARRATOR: Dr. Dodson is one of several doctors who receive payments from Shire Richwood, the makers of Adderall, to promote ADHD awareness.
Dr. WILLIAM DODSON: ADHD is a lifelong condition. It's a neurologic condition, highly heritable, and-
NARRATOR: In the summer of 2000, Dr. Dodson was in New Jersey. Shire Richwood had invited a handful of local physicians to listen to Dr. Dodson give an ADHD lecture. The lure: a hot air balloon ride over the Garden State.
Dr. WILLIAM DODSON: ADHD is a neurologic disorder that has a primarily behavioral presentation. ADHD persists into adulthood.
NARRATOR: Talks like these are very important for boosting sales. Stimulants are classified by the DEA as a potential drug of abuse, and federal law prohibits stimulant makers like Shire Richwood from advertising their drug directly to consumers.
Dr. WILLIAM DODSON: In that 120 people, 50 percent of them really liked Adderall best.
NARRATOR: A recent poll published in the Journal of American Medical Association found that doctors are 19 percent more likely to prescribe a drug after hearing such presentations.
INTERVIEWER: There's studies that show that free samples, trips, does have an influence on doctors' opinions, that it biases, it changes your prescription habits.
Dr. WILLIAM DODSON: Otherwise, if it did not change prescription habits, most drug companies wouldn't do it.
INTERVIEWER: When your patient comes in here, do they necessarily know up front that you are representing, making speeches on behalf of Shire Richwood?
Dr. WILLIAM DODSON: A few do. Most do not.
INTERVIEWER: Is it a problem? You don't see it as a problem?
Dr. WILLIAM DODSON: No, I don't.
NARRATOR: Shire Richwood's marketing strategy seems to be working. Their time-release Adderall recently surpassed Ritalin as the number-one stimulant medication on the market. It's a market worth a billion dollars a year. And there are now five major drug makers banking that there will be many more patients, not just children but adults, diagnosed with ADHD in the coming years.
[www.pbs.org: Explore the business of ADHD]
STEFAN ANTONSSON, Senior VP, Marketing, Shire Richwood: Shire has three additional medications in development for the treatment of ADHD. Clearly, we're taking a very, very long-term view in trying to identify medications that will help treat patients with ADHD that have many different symptoms. We consider ourselves an ADHD support company.
NARRATOR: Much of that support is funneled through an advocacy group called CHADD, Children and Adults with Attention Deficit Disorder. Other drug makers support CHADD, as well.
HARVEY PARKER, M.D., Founder, CHADD: I don't think CHADD has ever done anything wrong with respect to taking funds and getting grants from pharmaceutical companies. We're not unlike any other nonprofit organization that advocates for an illness. We submit grants, we get- we take money from- to fulfill those grants in support of our mission. And I don't think that there's any problem associated with that.
NARRATOR: In 1990, CHADD mounted a major lobbying campaign in Washington. At stake was whether Attention Deficit would be recognized under the Individuals with Disabilities Education Act, IDEA. If recognized, children with Attention Deficit would be granted special accommodations.
Dr. HARVEY PARKER: We were surprised, actually, to find that there were a lot of organizations who opposed another group of children seeking eligibility under IDEA. We thought for sure that most people would embrace us without any reluctance whatsoever and say, "Certainly, these kids are suffering. They need help." They needed to be convinced that ADHD was a real disorder and kids were suffering from real problems.
NARRATOR: After a massive-letter writing campaign by CHADD, Attention Deficit was officially recognized. Children would now be entitled to extra time on tests, less homework and extra tutoring, all at the schools' expense. Ever since, the diagnosis of Attention Deficit has skyrocketed, and along with it the number of stimulant prescriptions for children.
LAWRENCE DILLER, M.D., Pediatrician: Ritalin production remained stable all through the 1980s. And so 1991, it takes off. The question is, what was the spark? And we look at the history, we look at the data, the only thing that changed was the administrative change in the educational laws guiding our country's accommodations to children.
And in 1991, it began to include children with the diagnosis ADD or ADHD. And I think once parents who were genuinely trying to get help for their children, found out that they could get special services and accommodations by getting the diagnosis, they flocked to their doctors. Word spread, and you know, along the way you also got Ritalin.
NARRATOR: The rise was so rapid and steep that some people wanted to cry foul.
NEWSCASTER: But two class action lawsuits charged that Novartis, the company that makes Ritalin conspired with the American Psychiatric Association and a support group called CHADD to boost sales of the drug
NARRATOR: Recently three class action suits were brought against the historic market leader, Novartis, CHADD, and the American Psychiatric Association for allegedly conspiring to encourage the over-diagnosis of ADHD in order to increase Ritalin sales.
To families like the McCartys, a lawsuit like this is incomprehensible. They believe stimulant medications might have saved their son's life.
NEWSCASTER: APA officials called it ludicrous and totally false and CHADD leaders said the lawsuit is, quote again, "gravely irresponsible."
NARRATOR: In many cases, the diagnosis of ADHD is complicated because doctors often believe it coexists with other psychiatric ailments. Twelve-year-old Alex McCarty may be one of those cases.
TIM McCARTY: Very early on in 1st or 2nd grade, he started to talk about things like, you know, "Well, why aren't I the best in anything? I never finish first in a race. I never get the best grade in the class." And I would tell him, "Well, Alex, everybody's got their specialty. You're going to find it sooner or later. You're a smart kid." I always used to tell him that. He didn't believe it.
Alex, you awake? Wake up. You got to go to school.
ALEX: What time is it?
TIM McCARTY: It's time to wake up and go to school. It's, like, 7:00 o'clock.
ALEX: I have to go at 8:00 o'clock.
TIM McCARTY: I know, but you've got to get up now. You have to get dressed.
He's always had somewhat of social problems, but he generally gets along well with other kids and generally has a lot of friends. It's just when- he's real sensitive.
DIANE McCARTY: Sometimes he'd be real negative to me, and I'd say, "Oh, he's just a boy. He's going through a phase." He's just an only child. Tim would say I, you know, dote on him too much, or this or that, never knowing how he was hurting inside- never, ever knowing.
School was a ring of fire to him. And then on the playground, he was getting it, too. So he was having a tough time in the classroom, and he wasn't feeling like he could do anything. And it was so hard and he was so lost.
STEVEN HERZOG, School Principal: I remember him precisely because he had such a flat affect at the time. He was kind of a very depressed-acting child most of the time. He did make a couple of friends, but he was in a particular social group that had a number of kids who weren't particularly kind to one another.
STEVEN HERZOG: You know, he was put under some stress by those kids.
ALEX: Everyone in that period of time was making fun of me and- they would make fun of me about my weight and really hit me hard and that, like, you couldn't believe how much insults you could get in one day.
My grades were doing really bad, so I figured, like, I'm not going to get anywhere in life. I was just afraid of, if I did continue my life, where would it go? Would it- would I have a decent job, make good money, pay taxes, or would I live in the back of a dumpster, barely making a cent?
NARRATOR: Diane began to worry that this was more than just a case of pre-adolescent moodiness, so she took Alex to her church. There he met therapist John Emmons.
JOHN EMMONS, Counselor: Alex did present as very depressed. And he did have some suicidal ideations going. There was more than once, a number of times, I put him on what we call a no-suicide contract. I had him call me from time to time throughout the week. I'd call him. I'd have his parents call me just to make sure that he was holding together emotionally because there were times that I was concerned about him hurting himself. He did have some plans in place, and for a therapist, that is a very alarming reality.
It was very hard to get through to Alex. And I though it was a good idea to get him checked out by a physician, which is when, oh, six or eight sessions into seeing me, we made an appointment to see Asa Yancey.
ASA YANCEY, M.D., Psychiatrist: What's going on? How's it going?
Dr. ASA YANCEY: Alex came in in January of 2000 and was referred to me specifically for medications. I thought, through examining him and getting some global assessment scales and doing a depression scale inventory and talking to he and his mother, that he was depressed.
DIANE McCARTY: He glanced over all the forms, he evaluated anything and he says, "Well, I don't need to tell you the severity of Alex's depression."
NARRATOR: Alex was given a low dose of Effexor, an antidepressant. Displaying no side effects after seven days, Dr. Yancey doubled the dose to 75 milligrams. Three months later, while on Effexor, Alex attempted suicide.
ALEX: I was in class and I was feeling really bad, like, "I want to end my life now, just get it over with."
DIANE McCARTY: I get a phone call. It's the school principal, that I must come pick up Alex right away. He's in the bathroom. He won't come out, and he's cutting himself. He's cutting himself. They were very scared at school, having him there. We thought maybe we'd have to hospitalize Alex.
Dr. ASA YANCEY: He couldn't see the good in anything, really just wanted to get his life over.
NARRATOR: Dr. Yancey upped Alex's dose of Effexor yet again. The suicidal thoughts and depression finally went away, but Alex's problems at school continued.
LYNN SIS, Teacher: It's hard to tell what is really going on inside him that causes him to not do his work. I know that he can do work, but his attention span [unintelligible] is short. He does not work long periods, either.
Dr. ASA YANCEY: Toward February or March, it became clear that some people really thought he had an attention problem. Those people included one of his teachers. They also included one of his parents. I think he thought he had an attention problem, and also his therapist did.
NARRATOR: Following standard procedure, Dr. Yancey had three of Alex's teachers and both his parents fill out a variety of child behavior checklists. But the results were inconclusive.
In an effort to clarify the situation, Dr. Yancey tried a computer program called the Conner's Continuous Performance test. For fifteen minutes, Alex was asked to stare at a screen. He was instructed to click the mouse each and every time a letter flashes before him, unless the letter was an X. An inattentive child, like Alex, will flunk because he is unable to control his impulses and not click when he sees an X.
ALEX: He said there is a chemical imbalance in my brain which doesn't allow me to concentrate correctly, only on things that I really, really like, like video games. So he gave me some medication for that and told me a lot of times attention deficit disorder can be linked to depression. So if I get rid of the ADD, I get rid of the depression.
Dr. ASA YANCEY: Eighteen percent of these kids with ADHD also have depression, and I think, you know, Alex is a good example of that.
NARRATOR: Alex was then given Adderall for his attention deficit. Dr. Yancey says he chose Adderall because one of the side effects is weight loss.
Dr. ASA YANCEY: Very nice. You've lost a pound.
ALEX: From the last time?
Dr. ASA YANCEY: Yes. Down to 166.
NARRATOR: Alex took his first dose of Adderall on his 12th birthday and spent the day at Waterworld.
ALEX: Well, the first day I was skeptical of it. I said it would probably not help me. But then it did.
I liked to do school, and I wrote stories and concentrated more in math. So I felt better about myself. And when I really look back on my day, I'm, like, "Wow, I actually completed some work that I could never do before."
LYN SIS: What did you need, McCarty? You're doing really good work, by the way. You're really sticking to it.
I think so far, Alex has improved a lot over the time of this school year. When he came, he was not doing too much work at all, but over the course of the year, he is doing most things on a modified scale. But he needs guidance and a lot of monitoring and help to do that.
DIANE McCARTY: Of course, I'd not want him to take medication if he didn't have to. But for Alex it's working. And I don't know, for some other children, it may not be working. I mean, I think there are so many factors that go into this. I know in my heart that I've gone the distance, and I'm helping my son. You know, I love him.
TIM McCARTY: The bottom line is that after we went on medication that we saw the results. I don't think those results were achievable by other means.
NARRATOR: Scientists are still trying to determine what is going on in the brains of kids like Alex, but it is elusive. Dr. Xavier Castellanos, the head of ADHD research at the National Institute of Mental Health, is perhaps the most trusted ADHD scientist in the world.
XAVIER CASTELLANOS, M.D., National Institute of Mental Health: I have a simple job description, which is to understand what ADHD is, because we don't. The problem is, we're searching in the dark, and we don't know where that clue is going to be. It's a treasure hunt, or a puzzle, except we don't know what the puzzle's supposed to look like. That's what we're trying to figure out.
And we're not sure the pieces fit in this puzzle or not. It's also difficult because the brain is the most complex thing we know, changing, re-wiring itself. And so what we measure are very crude, preliminary things. But we've only been at it for about 10 or 12 years. We don't yet have our Einstein.
[www.pbs.org: Read the experts' interviews]
NARRATOR: While neuroscience waits for their Einstein, Dr. Castellanos uses magnetic resonance imaging to peer into the brain. The scans allow him to measure differences in brain structure among ADHD children, but they don't tell him what causes ADHD or why stimulants are effective in the treatment of this disorder.
Dr. XAVIER CASTELLANOS: We still don't really know much about how Ritalin on Dexadrine or Adderall work.
NARRATOR: But based on a sample of 187 kids, Dr. Castellanos has found that children diagnosed with ADHD may have a subtle difference in their brain.
Dr. XAVIER CASTELLANOS: The posterior inferior vermis of the cerebellum is smaller in ADHD. It's taken about five years to convince myself that that's the case. Here is, in fact, that piece of the cerebella vermis. This is the cerebellum, which is Latin for "little brain." Even though it's only about 10 percent of the size of the total brain, there are more neurons here than in the entire rest of the brain combined, which is fascinating.
But the cerebellum has never been thought to be that important because you can remove it and not much terrible happens. One person says the cerebellum is a little bit like a co-processor. It's useful, but not necessary. And that makes some sense to me, that maybe that's what's not working so well in ADHD because people with ADHD can do anything, they just don't do it quite so well. It's a disorder of efficiency, or inefficiency, as much as anything, I believe.
[Little Rock, Arkansas, hearing]
BRUCE WISEMAN, Citizens Commission on Human Rights: Today psychiatric drugs have replaced common sense in our schools, and it is time to change.
NARRATOR: While scientists continue experimenting, American politicians are left listening to lobbyists.
BRUCE WISEMAN: We cannot, as a nation, as legislators, as teachers, as parents, continue to play the game of Russian Roulette with our children's lives.
NARRATOR: Over the last four years, hearings have been held in four state legislatures around the country.
BRUCE WISEMAN: And questionable psychological curricula that could be wreaking havoc on the values and minds of our youth.
NARRATOR: By the summer of 2000, ADHD was being debated on Capitol Hill in Washington.
[Washington, D.C., hearing]
COMMITTEE CHAIRMAN: The Sub-Committee is meeting today to hear testimony on the use of behavioral drugs in schools.
PATTI JOHNSON, Colorado Board of Education 1996-2000: Many of the learning disorders are an effort to medicalize what are actually failures in proper instruction and discipline-
NARRATOR: The Citizens Commission on Human Rights, CCHR, the group founded by the Church of Scientology, was continuing to lobby for anti-medication statutes.
PATRICIA WEATHERS: I, as a parent, felt extremely pressured by the school staff to-
NARRATOR: In many of the state and federal hearings, they have sponsored key witnesses.
FRED BAUGHMAN Jr., M.D., Neurologist: None of these children have diseases of the brain. They are all entirely physically normal children until the moment they are given brain-altering medication.
PROTESTERS: Don't label our kids~! Don't drug our kids! Leave our kids alone!
NARRATOR: The group has also demonstrated outside the annual meeting of the American Psychiatric Association.
PROTESTERS: Don't label our kids! Don't drug our kids! Psychs leave our kids alone!
NARRATOR: CCHR's position is radical. They believe that psychiatry is not a science and that mental diagnoses such as ADHD, as well as schizophrenia and autism, are fraudulent. CCHR's president is Bruce Wiseman.
BRUCE WISEMAN: I'm trying to make people aware that we've got abuse going on in this country, that children are being drugged. There's no science to psychiatry. It's witchcraft!
INTERVIEWER: But you don't recognize psychiatric illness. Is that a fair statement?
BRUCE WISEMAN: Well, I don't know what you mean by "psychiatric illness." Do some people go crazy? Yes, they do. Of course. Is ADHD a disease? It is not. There's no such thing.
NARRATOR: The mystery of ADHD and its treatment endures, in part, because there are some kids where nothing seems to work.
NARRATOR: Robin Day spent his early childhood in what was apparently a loving and nurturing home. His mother says it was the happiest time of her life. The happiness didn't last.
BARB DAY: I think there was this natural creativity, impulsiveness, aliveness that didn't quite cut it, you know, in the classroom. At the end of 2nd grade, the teacher asked him, "What did you learn the most?" He said, "To learn to shut up." And he misspelled "shut up," but that's what he put. That is the biggest thing that he learned in 2nd grade.
NARRATOR: Robin was diagnosed with ADHD in the 4th grade and put on Ritalin. His teacher and his parents noticed improvements.
NARRATOR: But Robin said the drug made him feel jittery, a common Ritalin side effect. His doctors prescribed new drugs.
BARB DAY: By the time my son was in 6th grade, we'd tried Ritalin, then Ritalin-SR, then Cylert, then Wellbutrin, then Dexedrine. Then we added Zoloft to Dexedrine.
NARRATOR: One of the psychologists that saw Robin was Dr. Larry Allen.
LAWRENCE ALLEN, Ph.D., Psychologist: I certainly remember Robin. He was a youngster when he came to see me. He was not thrilled about coming in. He struck me as kind of a moody child. I didn't really find what I thought were very significant learning disabilities, per se. I thought some of the data that I got was colored by the fact that he was really unhappy to be there and pretty unmotivated.
NARRATOR: The Days kept searching for answers. In the 6th grade, Robin even spent two days on the psychiatric ward at Denver Children's Hospital.
Robin's 7th grade teacher was Sherri Morrison.
SHERRI MORRISON, Teacher: I've known Robin since he was in 6th, 7th grade. He was in a charter classroom that I taught at. He was given so many different dosages and medications, and they tried so many different approaches with him. And he was so up and down.
When they tried all those different medications and techniques, I didn't know from week to week which Robin was coming to my classroom. But when he wasn't on anything, I knew what I saw is what I got.
BARB DAY: We began to treat Robin like a disorder, a pathology. I started to look at everything as a crisis.
LAWRENCE ALLEN: Robin is one of the more difficult cases. It's hard to say how much good we've done. I would suspect, though, that we've probably helped prevent Robin from being in a worse situation. Again, none of us are going to know that, but we do know that children like this, if they're not treated properly, can end up becoming anti-social.
NARRATOR: When we met up with Robin, he had stopped taking stimulants. Like many teenagers, he was experimenting with his own drugs now, trying marijuana and staying out late. His mother insisted on him taking medication. At one point, she went as far as getting a court order to force Robin back on Adderall.
Eventually, the continuing struggle took a toll on the family. We were there the day Robin's mother moved out of the house.
BARB DAY: I would never want to say that our marriage fell apart because of my son. On the other hand, I feel that if he didn't have whatever this is, whether this is Attention Deficit Disorder or whatever this is- that it has come into play in our everyday life, so I think there are two things that can happen. You either draw together and get as much information as possible, or it becomes a wedge and it separates everything you're about. And it gets wider, and it gets wider, and there's no going back. And I think the more important question is, what has this done to my children?
ROBIN: I'm mad. It kind of pisses me off that she made me take all the medicine, even when I didn't want to, even when I told her that I didn't want to and that I don't think it helps.
NARRATOR: Robin Day has been off medications now for six months. He says he is much happier, but he still struggles with attention problems in school. And what happened to the other children we met in Denver?
Noelle Demo seems to be benefiting from Adderall. Last semester she received straight A's, and in December of 2000, Noelle's team won Colorado's state gymnastics championship.
Alex McCarty is also still taking his medications. He plans to stop taking Effexor in the summer, but his doctor says he will likely be taking stimulants for the foreseeable future.
And finally, what happened to the first family, the Duperets? Cyrille and Yolanda decided they need to spend more time with Nicolas, that both of them should not work full-time. For now, Cyrille is staying home and taking care of Nicolas and his baby brother. But they have stood firm in their decision not to medicate him.
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