Colorado Board of Education Resolution Lead to a National Furor

"Behavior Drugs for the Young Debated Anew," Michael Janofsky, New York Times, page 1+, November 25, 1999. The controversy over ADHD and stimulant use just will not end despite the hopes of the proponents of the neurobiological approach to the diagnosis and treatment of ADHD.

Here on the front page of America's national newspaper, the Colorado Board of Education is reported to have passed a resolution urging teachers to rely on discipline and instruction to handle behavior problems in the classroom and discouraging teachers from making recommendations for medical evaluations for ADHD and treatment with Ritalin.

The pro and anti ADHD/Ritalin forces were in attendance at the hearing. Matthew Cohen, president of CHADD made a plea for "common sense" in allowing teachers to offer parents a range of possibilities for helping their children. Peter Breggin, M.D., a psychiatrist, well-known for his anti-medication position stated in the article "We're drugging them (the children) into submission rather than identifying and meting the genuine needs of the family, school and community. It's wrong in principle." I find it incredible but I am not surprised that a school board would feel the need to pass such a resolution but then again we are "the Ritalin Nation."

While I agree in part with Dr. Breggin's statement, unfortunately he generally tends to overstate the case against Ritalin in the individual child. He sets the "questioning Ritalin" camp up for easy counter-attack by more responsible researchers and clinicians. I continue to be troubled by our country's use of a performance enhancer to address a wide range of both serious and minor childhood behavioral and performance issues. However, I maintain that once issues of family and school have been addressed as best as possible and the child continues to struggle it is not unreasonable to try medication. The "debate" (if one can call it that) continues...

Secretin for Autism Fails the Test

"Lack of Benefit of a Single Dose of Synthetic Human Secretin in the Treatment of Autism and Pervasive Developmental Disorder," A.D. Sandler, et al, New England Journal of Medicine, vol. 341, pp. 1801-6 (editorial pp. 1842-1844) December 9, 1999.

I include a review of this article even though the disorder is autism, not ADHD because it highlights the pitfalls of rushing to a new unproven treatment after the media grabs hold of a single anecdotal experience.

Read more ...

Ritalin Protects User Against Drug Abuse?

Pharmacotherapy of Attention-deficit/Hyperactivity Disorder Reduces Risk for Substance Use Disorder, Joseph Biederman, Timothy Wilens, et al. Pediatrics vol. 104, no. 2, August 1999.

The doctors at the Harvard pediatric psychopharmacology clinic make the claim in this article which has received some press notice that treatment with stimulants actually protects teens from abusing alcohol and drugs. The doctors, in their discussion, suggest that teen drug abuse may simply be self-medication for ADHD.

Unfortunately, the researchers do not make the case that treatment with medication prevents drug abuse. Rather the only conclusion that can be made based on their data is that treatment with medication is associated with lower rates of drug abuse in adolescents. However, it is not clear that the medication is the cause for the lower rates for the following reason. Young adolescents (and their families) who are willing to work with a doctor and cooperate in a treatment are different from those who will have nothing to do with either. Those kids willing to work with a doctor may be inherently less likely to abuse drugs just based on who they are and what their families are like. Indeed, at the beginning of the four-year treatment period 7 of 19 teens who did not take medication from the doctor were already abusing drugs while none of the 54 teens who did agree to take medication abused drugs. Seven more of the first group four years later abused while 14 of the second group wound up abusing. The parents of the teen group not involved with the doctors also seemed to have more problems with substance abuse themselves.

I continue to question any link between the medical use of stimulants in children and later abuse as adolescents, but I do not believe this study confirms my own clinical experience.

Reviewed 8/15/99