| In memory of 14 year old Matthew Smith; 11 year old | | | | substitute for learning self-discipline. This problem is |
| Stephanie Hall; and 10 year old Shaina Dunkle and | | | | compounded when children are taken off medication |
| other children who have died from the use of | | | | and problem behavior initially rebounds to fantastic |
| psychotropic drugs for "ADHD". | | | | proportions. Second, longitudinal studies have confirmed |
| The Eli Lilly company has been marketing a new drug | | | | that children on drugs actually deteriorate in academic |
| for those who are labeled as ADHD known as | | | | performance over time. And we must consider the |
| Strattera. This drug is purported to be a non-stimulant | | | | sense of worthlessness most of these young people |
| medication, however the side effects are similar. | | | | experience. (McGuinness, 1985). Paul Wender, M.D. lists |
| Rather than effecting the dopamine system as do the | | | | criteria when beginning medication, he states that a |
| stimulants such as methylphenidate and | | | | child must first understand why he is receiving |
| dextroamphetamine, it works upon the norepinephrine | | | | medication, yet as Greenspan states above, this isn't |
| neurotransmitter. Strattera is considered a | | | | always happening. Wender states, "Most acknowledge |
| Norepinephrine reuptake inhibitor. Norepinephrine is the | | | | problems in his own behavior that he himself does not |
| brain's adrenalin. Norephinephrine is involved in the | | | | like, so that -he will not feel that medicine is being given |
| increased rate and force of the heart muscle, | | | | to him simply so that other people can tolerate him |
| constriction of heart muscles, pulmonary function | | | | more." Now, Wender is one who began the first tests |
| (Hedaya, 1999). | | | | on the use of methylphenidate and is in support of its |
| If these functions are increased, it would be evident | | | | use in treatment. |
| that Strattera could produce possible untoward | | | | I have had instances of being kicked, and even bitten |
| effects on the cardiovascular system. It is interesting | | | | by children going through behavioral difficulties, but at |
| to note that in the safety information that Eli Lilly | | | | the same time, I found methods to help a child be able |
| provides on its website, it refers to possible hazards to | | | | to deal with behaviors and to have progress while at |
| those who have heart disease or high blood pressure. | | | | the same time encouraging the child's own |
| Information provided by Eli Lilly accompanying | | | | responsibility and sovereignty, and working on the |
| prescriptions of this drug note the possibility of | | | | creative strengths of the child. Greenspan comments, |
| tachycardia, and increased blood pressure. Tourette's | | | | "working with the strengths of a child can create |
| disorder, though the etiology is not fully known is being | | | | motivation." A child needs to be able to recognize and |
| examined as difficulties arising in the metabolism of | | | | be motivated to change behaviors and work on |
| dopamine, serotonin, and norepinephrine. it is known | | | | strengths. Even Wender states that getting a child to |
| that stimulant drugs can produce Tourette's like | | | | 'label' behaviors is effective, that a child must recognize |
| behavior in some children (Breggin, 1998). | | | | what is appropriate and what is not, and that parents |
| If Strattera affects the norepinephrine system, then it | | | | should not encourage the idea that because the |
| would seem evident that the possibility of such | | | | medication was wearing off or so forth that such |
| Tourette's like behavior could also become manifest in | | | | excuses a level of knowledge and responsibility for |
| some children using Strattera. Therefore, though | | | | certain behaviors. In my experiences, I would argue |
| Strattera is being marketed in the fashion of being a | | | | that a child often has complete knowledge of some of |
| non-stimulant drug, its ill effects are quite similar to that | | | | his or her behaviors and may develop a manipulative |
| manifested by the stimulant medications. Eli Lilly's | | | | manner and 'test' the parent and find various triggers |
| website notes that growth suppression is a common | | | | and weaknesses where he the parent will give in to his |
| side effect and needs to be monitored in children | | | | immediate desire. My concern lies too in that whereas |
| making use of this drug. Loss of appetitite and weight | | | | some may feel medication to create some responsive |
| loss is also seen. The most common side effects as | | | | in level of focus and so forth, it comes with a cost in |
| listed by Lilly are upset stomach, decreased appetite, | | | | side effects. Some may take the view that the |
| nausea and vomiting, dizziness, tiredness, and mood | | | | potential for progress outweighs the potential side |
| swings. These are not unlike that associated with the | | | | effects. |
| stimulant medications. | | | | This is where I disagree, and feel it better to avoid that |
| Lilly states in its press release in regards to Strattera's | | | | which would cause any side effects, that |
| introduction: "It's not known precisely how Strattera | | | | psychotherapy alone can manage the difficulties. |
| reduces ADHD symptoms. Scientists believe it works | | | | These are some of the things that bring alarm to me. |
| by blocking or slowing reabsorption of norepinephrine, a | | | | Wender states, "Most common side effects of the |
| brain chemical considered important in regulating | | | | stimulant medications are appetite loss...difficulty in falling |
| attention, impulsivity and activity levels. This keeps | | | | asleep." He suggests the use of a small dose of |
| more norepinephrine at work in the tiny spaces | | | | sedative 'major tranquilizer' an hour before bedtime to |
| between neurons in the brain." If we examine this | | | | solve this in some cases. So, here a see a cycle of |
| statement carefully, we see it states 'it is not precisely | | | | drugs needing to be used and that's worrisome. |
| known', therefore once again a drug is being | | | | Wender states, "Research is being conducted to |
| prescribed whose effects are not fully known for | | | | determine the -exact- effects of stimulant medication |
| a'disorder' whose psychopathology is not yet | | | | on growth." This tells me they are prescribing |
| delineated. Clinical trials for Strattera have been limited | | | | something, which they really do not know yet what the |
| and any information on long term effects has only | | | | effects are on growth. He states as well that stimulant |
| been studied by Lilly itself. It is interesting to note that | | | | medication IS addictive in adults, but says, "The results |
| before Strattera was actually placed on the market | | | | suggest that there is no increased risk for drug abuse |
| and had just received FDA approval that the stocks | | | | associated with treatment, although -more research is |
| for Eli Lilly rose 6% at the announcement (CBS | | | | needed to rule this out conclusively.-" Here again, if it is |
| Marketwatch, November 27, 2002). Lilly is aware that it | | | | addictive to adults, I ask, why not children too, and he |
| will profit highly by being able to market a drug as a | | | | says that research is yet conclusive. With effects on |
| non-stimulant (though its ill effects are similar), that is | | | | the cardiovascular system, Barkley states, "studies |
| not a Schedule II drug thus less subject to scrutiny and | | | | have -not- specifically addressed this important issue." |
| regulation. Hemant K. Shah, an independent analyst | | | | So, they are prescribing something for which they are |
| qouted in an AP Health News Report (August 15, | | | | unsure of the effects on growth as well as the |
| 2002) states that Strattera's market potential is large | | | | cardiovascular system. |
| at a time when Eli Lilly is seeking to offset recent | | | | Barkley states as well, "The side effect that should |
| setbacks. , "Parents who have refused stimulant | | | | receive serious attention from clinicians is the possible |
| dangers because of their knowledge of the hazards | | | | increase in motor or vocal tics produced by stimulant |
| involved will now be coerced to utilize Strattera being | | | | medication." He continues- "It still seems prudent to |
| led to believe it is somehow safer because it does not | | | | screen children with ADHD adequately for a personal |
| fall into the category of a stimulant/ Schedule II drug. | | | | or family history of tics or Tourette's Syndrome." I |
| There is no test for ADHD and neurological testing | | | | recall having a session with a child with the mother first |
| shows these children to be perfectly normal. Dr. William | | | | and being informed that he was being treated with |
| Carey of Children's Hospital in Philadelphia states, | | | | Ritalin, I later had subsequent time with the father, and |
| "common assumptions about ADHD include that it is | | | | he had visible tics, this really alarmed me in reading |
| clearly distinguishable from normal behavior, constitutes | | | | about the issue of tics and Tourette's and I had to |
| a neurodevelopmental (brain) disability, is relatively | | | | question not to the family but within myself if this was |
| uninfluenced by the environment (home, school)...all of | | | | really the best option for the child faced with this risk. |
| these assumptions...must be challenged because of the | | | | Barkley also states, "Isolated cases may arise in which |
| lack of empirical support and the strength of contrary | | | | parents note that a child is no longer 'spontaneous' or |
| evidence...what is now described in the US as ADHD is | | | | childlike in his or her behavior and appears -controlled- |
| a set of normal behavioral variations. This discrepancy | | | | or -socially aloof-. This is concerning, and it appears |
| leaves the validity (of ADHD) in doubt." The U.S. | | | | that stimulants do have an affect in gaining control and |
| National Institutes of Health Consensus Development | | | | conformity. Many of the stated results of the stimulant |
| Conference on ADHD in 1998 reported, " we have do | | | | medication are too subjective, and Barkley states |
| not have an independent, valid test for ADHD, and | | | | clearly that, "an improved ability to master increasingly |
| there are no data to indicate that ADHD is due to a | | | | difficult or higher-level academic material, such as that |
| brain malfunction...and finally, after years of clinical | | | | assessed in achievement tests, has -not- been |
| research and experience with ADHD, our knowledge | | | | demonstrated. |
| about the cause or causes of ADHD remains | | | | Here we have an example that it would not have |
| speculative." Further, Dr. Edward C. Hamlyn, a founding | | | | been as a result of stimulant medication if we see |
| member of the Royal College of General Practitioners | | | | academic progress. Barkley also says that 'low and |
| in 1998 stated, "ADHD is fraud intended to justify | | | | moderate doses of methylphenidate do reduce the |
| starting children on a life of drug addiction." The U.S. | | | | frequency of aggression and noncompliance in groups |
| Surgeon General Report declares, "the exact etiology | | | | of children but have no appreciate effect on either |
| of ADHD is unknown." Lastly, Dr. Joe Kosterich, | | | | direction on prosocial or nonsocial behaviors." So, I will |
| Federal Chair of the Australian Medical Association | | | | acknowledge that stimulants can help with short-term |
| states, " "The diagnosis of ADD is entirely subjective.... | | | | behavioral inhibition, but what about long term? This is |
| There is no test. It is just down to interpretation. | | | | my main concern, with the side effects and without |
| Maybe a child blurts out in class or doesn't sit still. The | | | | evidence of a long-term result and without knowledge |
| lines between an ADD sufferer and a healthy | | | | of long-term results on growth and cardiovascular |
| exuberant kid can be very blurred." What we are | | | | development, is this really the best option? Barkley |
| experiencing are children in conflict. We cannot blame | | | | states, " Few studies employing rigorous methodology |
| and denigrate the child and not respect his dignity. We | | | | have evaluated the long term efficacy of stimulant |
| cannot label and suppress behaviors. If a child is | | | | medication. Those that have examined the issue have |
| conflict, we must take responsibility to see why this | | | | generally found little advantage of medication over no |
| child is in conflict and to use responsible and carefully | | | | medication when evaluated over extended periods |
| planned interventions to aid this child in being | | | | (Pelham, 1985, Weiss & Hechtman, 1993) Children |
| successful. Some believe that they see enormous | | | | who had been on drugs but were off at the time of |
| benefits from children on medication. I will give them | | | | follow-up were not found to differ in any important |
| this benefit, only if we see suppression of behavior, | | | | respect from those who had never received |
| basically chemical restraint, and the creation of | | | | pharmacotherapy." |
| zombies as our idea of 'progress' or 'success'. But | | | | Another concern is the effects in mood, I worked with |
| once again, we are taking normal children and drugging | | | | one child who was already experiencing social |
| them to suppress their behaviors. In order to achieve | | | | withdrawal and was going through the trauma of losing |
| such a 'result', just what is going on in this child's body? | | | | a loved one. After receiving stimulant medication, this |
| Stanley I. Greenspan, a clinical professor of psychiatry | | | | intensified. Wender states, "Instead of becoming high or |
| at George Washington University states that, " The | | | | excited, these drugs in general calm down ADHD |
| growing use of medication on their own is a | | | | children and sometimes they may even become |
| worrisome trend while more and more people on | | | | somewhat sad." Barkley states, "some children may |
| Prozac or Ritalin are becoming bolder and less | | | | evidence various mild negative moods or emotions in |
| distractible, at the same time, more and more people | | | | reaction to stimulants...Some children describe feeling |
| are altering their moods without understanding what is | | | | 'funny', 'different' or dizzy as a function of medication." |
| happening to them or how it relates to their core | | | | What about self-esteem and confidence, Greenspan |
| personalities." | | | | acknowledges that creativity can be affected, and |
| He also states, "given appropriate nurturing, many | | | | Barkley states, " some concern has been raised that |
| affected children may not require medication." | | | | diminished self-esteem could be a emanative effect of |
| University of South Florida Professor of Psychology, | | | | methylphenidate as children may attribute the source |
| Diane McGuinness comments, "The first factor of | | | | of their success while on medication to external rather |
| being put on drugs is to attribute your bad behavior to | | | | than internal factors. |
| factors beyond your control. Drugs become a | | | | |