Parents, Schools Face Off Over Ritalin

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Aug. 15, 2000 -- When Patricia Weathers took her 9-year-old son off an antidepressant and medication similar to Ritalin, she thought it was the best thing she could do for him. After taking the drugs, he constantly gnawed his shirt collar and began to hear "voices."

But soon, Weathers, of Millbrook, N.Y., found herself in a situation that is becoming more common around the U.S. as the debate over the use of psychiatric drugs for children continues: Her son's elementary school accused her of medical neglect and called child-abuse investigators.

Eventually, Weathers was cleared of any charges. She says her son, Michael Mozer, is now doing well without medications. But the years of battle with his public school over medication, and the horrible side effects he suffered from the drugs, convinced her to place him in a private school. She tells WebMD that she hopes her story will encourage parents to resist pressure from schools that might want children to be medicated because of their behavior problems.

School officials, of course, cannot write prescriptions themselves. But can they force a parent to seek out a professional, such as a psychiatrist, who will? And can they expel a child who doesn't take medication or intimidate parents by threatening to phone social services or child-abuse investigators? Weathers says that's what happened to her, and there are reports of other similar cases around the country.

These parents' experiences are occurring against the backdrop of an ongoing controversy not only over the use of psychiatric medications for children, but about attention deficit hyperactivity disorder (ADHD) itself. Researchers believe some 3% to 5% of school-aged children have ADHD; symptoms include constant motion, impulsivity, and an inability to concentrate. Children are commonly prescribed Ritalin or other stimulants that seem to help some children settle down and focus better.

While some studies suggest these medications are being overprescribed, some physicians believe just the opposite. They say that far more children need care and aren't getting it because their problems are going unrecognized. The issue also raises a question that some believe needs an answer: Should parents be allowed to refuse psychiatric medications for their children?

As early as kindergarten, Michael's teachers were frequently calling his mother to complain that he was "anxious, hyperactive, impulsive, distracting the other kids." Weathers recalls. A school psychologist recommended Ritalin, and Michael's pediatrician put him on it; he took the medication for all of second grade and had an "uneventful year."

But by third grade, Michael was "socially withdrawing and gnawing on things, pencils, his shirt" and being shunned and ridiculed by the other children, Weathers says. His pediatrician switched him to Dexedrine, and, on the advice of the school psychologist, Weathers also took Michael to see a psychiatrist. The psychiatrist diagnosed social anxiety disorder and put him on Paxil, a medication similar to Prozac, and urged Weathers not to stop the Dexedrine.

But instead of getting better, Michael worsened. He was up all night, he paced the floors; he said he heard voices in his head. When he mentioned this at school, he was sent home, Weathers says, and the school arranged for a tutor to bring his classwork home. The psychiatrist told her to stop all the medications, but the hallucinations continued for five weeks. When Michael did not return to school after a few weeks, the school called Child Protective Services.

The principal of Michael's elementary school declined to speak to WebMD.

Now enrolled in a private school program that involves two days of classroom attendance and three days of home-schooling, Michael no longer has hallucinations, and while he is still "hyper," his symptoms are manageable without medications, his mother says. Moreover, he has grown three shirt sizes; while he was on the drugs, his height and weight never increased. Weathers blames the school for her ordeal and says she relied, mistakenly, on the advice of people she considered experts.

"It was wrong what they did," she says. "They push drugs, and they have side effects and they made him worse. I thought they were helping me. [Now] he is in private school and they are telling me that he is gifted." Had she been aware that the Paxil was not approved for use in children, Weathers would not have given it to her son, she says.

And that would have been the correct response, say some experts. "Parents should retain an absolute right to reject psychiatric medications for their children. Drugs are not the answer," says Peter Breggin, MD, who evaluated Michael after he was taken off all medications and says they were not helping him. Breggin, a psychiatrist in Bethesda, Md., is an outspoken critic of some psychiatric medications, particularly when used for children.

Breggin says a parent's first task should be to determine if a child with ADHD or similar disorders has problems only in school. "If they are not doing well in school, evaluate the school," he says. "[Some children] are in boring, overly structured classrooms. They are not getting enough attention. They are not getting enough playtime. They are reacting as any child would. I have seen many a child be uncontrollable with one teacher and not with another. What disease acts like that?

"Many parents might want to go to the extreme of private school or home schooling," he says. "I would take any steps necessary to keep my child off psychiatric medications.

"If the problem is at home, you need to consider what you need to do to handle your child," Breggin says, adding that he believes many symptoms ascribed to ADHD result from conflicts between parents and children.

Breggin's opinion, however, is not universally shared. To Peter Jensen, MD, director of the Center for the Advancement of Children's Mental Health at Columbia University in New York, refusing to give medication to children with ADHD is comparable to withholding asthma drugs from a child who needs them.

Jensen, the former top government expert on ADHD research and treatment while at the National Institute of Mental Health, says science has made a clear case that Ritalin is an appropriate medication for a child with ADHD. "If the parent doesn't want to put a child on medication, we say, 'OK, let's try behavior modification,'" he says. But if that doesn't work, he says, the parents should turn to medication.

He says any school -- and any physician -- has a duty to report a child who is thought to not be getting appropriate medical care. To do otherwise, he argues, is to risk being sued for failing to protect the child.

"These medications are safer than asthma medications, and they, by and large, have fewer side effects," Jensen says. Untreated ADHD "has life-long consequences."

Ross Greene, PhD, a psychologist, author of The Explosive Child, and an assistant professor of psychology at Harvard University School of Medicine, says medication alone is not the solution for children with ADHD. Medications may help a child concentrate, but they won't teach problem-solving or social skills, which these children usually need.

"I don't think you can ever eliminate all the symptoms," he tells WebMD. "The goal is progress, and to help the child achieve at the highest potential, to reduce negative adverse effects to the greatest extent possible." He stresses that making the child 'normal' should not be the goal; instead, it should be to reduce negative behavior so the child can function better in his environment.

Greene, whose treatment strategies involve both parents and children, says he isn't sure whether Ritalin and other stimulants are overprescribed for children, but he notes that Americans fill more prescriptions for these drugs than do people in other countries. "Perhaps we have a great emphasis on 'sit still and listen,'" he says.

"Medication can be very helpful if parents are comfortable with it," Greene says. "I certainly respect people who are not jumping for joy at medicating their children. If this is not something that is for them, then we probably place a greater emphasis on classroom modifications and adaptations. There are ways to run a classroom so that a child with ADHD doesn't have to stick out like a sore thumb."

For more information from WebMD, see our Diseases and Conditions page on ADD/ADHD.

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