menu/ ATTENTION DEFICIT DISORDER

do psychoactive drugs really help children - or just make them fit in?

Larry snapped after a weekend with his father.

It was a Tuesday morning, only days before the start of summer vacation, after a pretty successful school year. He dashed through the halls, throwing books and punching other kids and generally disrupting the small school for the learning disabled he attends in Silver Spring, Md. Larry got so wild, finally, that principal William Patterson called his mother to take him home. It turned out that his father, an old-fashioned sort, had taken Larry off Ritalin, the medication the 15-year-old takes for hyperactivity.

The mother was furious with her estranged husband, but for Patterson, who has been teaching dyslexics for 35 years, the episode was just a sad sign of the times. "This young man was so upset, so ashamed that he couldn't behave," Patterson says. "But he is dependent on the drug. He has no inner ability to control himself."

Patterson is an anomaly, and something of an embarrassment to his staff at the Chelsea School. He has the nerve, in this era of the biologization of everything, to think that giving children psychoactive pills is a bad idea. Patterson actually believes he can teach children to control their behavioral problems. At his previous job as headmaster of a boarding school for dyslexics in Massachusetts, he saw to it that Ritalin was banned from the premises. A tall, William Holdenesque 60-year-old, Patterson has enough perspective to view himself as a relic.

"There's no way that I or anybody else can stem the tide of drugs," he says. But he can't help adding: "What are we telling the kids? Take a pill and it will be all better? How about a little heroin?"

The prescription of psychoactive drugs for children has increased roughly threefold in the past decade, a particularly vivid demonstration of the shift in the national Zeitgeist vis--vis psychological health. The defiant message of One Flew Over the Cuckoo's Nest seems quaint now; Nurse Ratched is here to stay. Nearly 3 million American schoolchildren get amphetamines to control their hyperactivity or cut through their lassitude; 600,000 get serotonin reuptake inhibitors like Prozac - now available in a minty liquid for tots - and thousands more get lithium, the antipsychotic-turned-wonder drug.

In some schools, a third of the boys are on Ritalin. There is something paradoxical about teenagers lining up for their noontime stimulant before filing into "Just Say No" lectures. But of course, Ritalin and Prozac aren't exactly the drugs of choice for getting you high. Kids do occasionally sell their extra Ritalin for $5 per pill behind the local high school, but word is it doesn't provide much of a buzz. The pills filing out of the pharmacy warehouses in metallic phalanxes of green, blue, and yellow aren't for fun. They're intended to produce calm, well-adjusted citizens, their brains chemically altered to fit the marketplace that awaits them.

The key that opened the doors of prescription for most of these children is spelled A-D-D. That stands for Attention Deficit Disorder, a peculiarly American malady that is diagnosed roughly ten times as often stateside as in Europe or Japan.

If it weren't for the enormous dimensions of the ADD phenomenon, one might be tempted to suppose the syndrome was a huge hoax by the pharmaceutical companies. The definition of ADD is vague and complicated. In the DSM-IV, the most recent psychiatric diagnostic manual, an ADD patient is so declared when he or she consistently displays six or more symptoms of inattention or hyperactivity. But if these all too common symptoms are markers for ADD, maybe we ought to be putting Ritalin right into the water supply, like fluoride.

An ADD child, according to DSM-IV, "often does not seem to listen ... does not follow through on chores ... has difficulty organizing tasks ... often loses things ... is easily distracted ... is often forgetful ... is often 'on the go' ... often talks excessively." Still, add these symptoms together and you get a child who can't read or pay attention, and is likely to be suffering in class, and maybe at home. In therapeutic circles, the feeling is that the attention being paid to the attention disorder is society's way of showing it cares about children who once were dubbed Fidgety Phils and plunked down in the corner with a dunce cap until they dropped out of school and entered menial jobs, skid row, or prison.

Today an ADD diagnosis can open doors: not only to medication but to federally guaranteed special education facilities, computer chat rooms and parental support groups. Today, particularly if you have enough clout or the cash to hire a private consultant, your ADD kid will be placed in a special classroom, and eventually get non-timed college admission tests - about 40,000 SAT tests were administered this way last year.

A number of psychiatrists, educators, and neurologists have begun to describe ADD as a physiological ailment that arises partly from a unique brain geography. Using the lingo of evolutionary psychology - the totalizing ideology of the '90s - some specialists describe the distracted or jumpy ADD child as an evolutionary remnant, a hunter personality trapped in a culture of desk jockeys.

Such pseudoscientific piffle is ubiquitous in ADD circles - particularly, it seems, among medical doctors. Edward Hallowell and John Ratey, two Harvard Medical School psychiatrists who have done as much as anyone to raise ADD's profile, claim in their book Answers to Distraction that ADD diagnoses are prevalent in the United States for genetic reasons: "Our forebears were restless movers and shakers," they write. "This probably selected a gene pool of people who are chronically curious and willing to risk traveling down new pathways of exploration."

And who, if they were alive today, would presumably meet the elastic DSM-IV definition of ADD. "Two thousand years ago my son would have been roaming the plains hunting," says Tony Meunier, an Arlington, Va., librarian. "Twenty years ago he would have dropped out of high school. But kids can't afford to do that now."

Meunier invites me to a meeting of the local chapter of CHADD - Children and Adults with Attention Deficit Disorder - a 40,000-member national group created in 1987 with nearly $1 million in backing from the makers of Ritalin. CHADD lobbies for ADD patients as a disability group and provides shoulders to cry on for ADD parents. The theme of the evening meeting, in the pastel conference room of an Arlington hospital, is "How to Survive the Summer With Your Teenager."

If your kid is the one who's struggling in school, an inexpensive drug that doesn't seem to cause any long-term damage can seem very appealing. Meunier, the chapter's coordinator, leads seven other women in a talk about ways to get the kids focused on something so the heat and boredom of summer don't send them hurtling off the walls. Meunier has explained to me that CHADD is no advocate of blanket medication. "Most parents don't fool around with these drugs," she says. "That's a myth that's overstated."

Her 12-year-old, who has learning difficulties, went through a brief trial of Ritalin but didn't improve; Meunier now spends hours each night helping him organize his homework and his life. But listening to the women at the CHADD meeting, I get the sense that parents too overworked to put in the hours with their difficult children tend to move toward the Ritalin solution.

"I've got a husband and three kids who are ADD, but they refuse to take any medication," says an angry woman in a business suit. "Hell, I'm ready to take Prozac at this point."

"Listen, I am taking it," says a woman in a plaid pant suit.

"How do you get your kid to do his homework?" the angry woman asks Tony.

"We work with him till he's finished," Tony says. "It's been a lot of work."

"Is he on medication?"

"No."

"We give our daughter Ritalin to do her homework," interjects the woman in plaid, "but then she has trouble sleeping."

If the ADD community includes parents who feel the need to dull their children's roughest edges enough to squeeze them onto the career track, the pharmaceutical industry is there to help. Ritalin was administered to control wild kids in the 1970s, but today's ADD child is just as likely to be the quiet, spacey type. Children are younger, now, when they leave the home and enter the structured, less tolerant worlds of daycare and school. As students, they are pressured to perform without as much support from their frequently absent parents.

"The human gene pool cannot change for cultural or economic reasons in 25 or 30 years," Lawrence Diller writes in a recent Hastings Center Report. "Thus relatively greater numbers of children and adults may be found wanting in their abilities to concentrate given the current pressures of their academic and work environments."

One solution is a pharmaceutical assault on inefficient personality types - Ritalin for the hyperactive, Prozac for the introverts. Peter Kramer, author of Listening to Prozac, remarked in a recent interview about the "eerie confluence between what Prozac does and what society demands."

Vassar psychology professor Ken Livingston describes the paradigm even more grimly in a recent issue of The Public Interest: "In late 20th century America, when it is difficult or inconvenient to change the environment, we don't think twice about changing the brain of the person who has to live in it." It's all very well and good to make high-minded pronouncements about the hypocrisy of American life. But if your kid is the one who's struggling in school or making life impossible at home, an inexpensive drug that doesn't seem to cause any long-term damage can seem very appealing.

"I don't want to give her Ritalin if it's only because it would make everyone's life easier, including mine," says Lynne, a suburban parent whose 10-year-old daughter, Alissa, is ADD-diagnosed.

But whatever the justification, she does plan to go to Ritalin. Alissa's grades are passable, but the girl is unhappy with her performance and can't seem to do anything about it. The public school she attends has budget problems and growing classrooms.

"Life's going to be so tough for her," Lynne says. "If Ritalin would truly help, we owe it to her to give it a shot. Figuratively."

A conscientious parent, lacking a firm conviction one way or another about medication, may feel cornered into choosing it. And it may be the right choice. But on a broader social level, the drift toward fiddling with brain chemistry is deeply alarming. In John Ratey's recent book Shadow Syndromes, he lumps almost everyone into one or more chemical or physical brain types, and urges us all to make use of the growing psychopharmacopia, even if we don't make the cut of a DSM disease.

"The negative emotions that accompany subtle differences in the brain may not be so harmless as we have long assumed," Ratey writes.

Taking a pill to modulate depression or anger "is not an 'escape' or a 'quick fix,' but can be a gesture of responsibility toward the family." In other words, Ratey seems to suggest, the responsible citizen, like the epsilon of Huxley's Brave New World, has the duty to take pills to combat inappropriate behaviors and feelings.

But guess what? A lot of kids don't want to take their medicine. For four juniors I found hanging out near Bethesda-Chevy Chase High School in an affluent suburb of Washington, refusal is rebellion. "People should talk to their kids, not just give them pills," says David, 16, who says he was urged to take antidepressants because he was staying in his room all the time after his alcoholic mother left the family.


"They thought I was depressed or gothic or something," he says. "I think I was just unhappy."


Mary - a thin, pale, heavily made-up girl with dark hair and plucked eyebrows - took Prozac and then Zoloft for depression but says neither worked. She understood the logic behind the drugs: "When something happens to me, I take it harder than other people because, like, they have more serotonin circulating in their brains." But "it was so annoying to take them every day. They made me feel shaky. Zoloft made my head twitch."

Jacqui Barron, student services administrator at the Chelsea School, finds herself fighting the resistance of children every day as she makes the rounds distributing the blue and yellow Ritalin pills. "Being hyper with your mind rolling around the room is kind of a high," says Barron. "The children feel the drug subduing their minds, and it's less fun." Still, "most of them accept it. They know they couldn't participate in class without their medicine."

Patterson is forced to agree, sort of. "Ritalin improves the learning environment for other kids because the child is no longer tapping a pencil or looking out the window or pulling the hair of the child in front of him. But I don't know of any studies that have shown a real improvement in performance. Do they act better? Yes, because they're drugged."

At Chelsea, a publicly funded independent school for children from D.C. and suburban Maryland, Patterson can't control Ritalin intake - indeed, he has clashed with parents who told him to mind his own business. At his previous job at the Linden Hill School in Massachusetts, which he left after 11 years in 1993, Patterson took an incoming student body that was 90 percent amphetamine-reliant and banned the drugs altogether, engaging the children instead in a highly structured program of instruction and athletics.

"As far as I know, only one of them went back on Ritalin after he left," Patterson says. At Chelsea, Patterson works around the drug, focusing on developing mental discipline in his charges. "A muscular grooving of the stroke" is how he describes the learning process for dyslexics. As for his anti-drug message, it falls on deaf ears. "If you don't want to seem ridiculous," he says when we part, "I wouldn't quote me too much."

Of all the creatures in my childhood menagerie, the wildest was a skinny, stuttering kid named Billy. I don't doubt that today he would have been considered an ADD patient, though I think of him more as a hummingbird than a hunter. Billy's face, as I recall it, was always beet red; he was either laughing hysterically at one of his inane pranks or crying because one of us had slugged him in exasperation. By age 12, when my friends and I had reached the age of feigned sexual sophistication, Billy was still into fart jokes. He had a certain asinine genuineness that I'll always remember, and cherish, in a way.

If Billy were a kid today, both of his parents would probably be working full time, and his nanny would be feeding him Ritalin for an after-school snack. Picturing Billy's mother, a friendly, tired-looking lady with worried blue eyes, I understand why so many of today's choosy mothers choose mind control drugs. Still, I mourn the clown terror Billy, source of so much aggravation and fun. The playground is a poorer place without him.

Copyright 2002 Arthur Allen

author

Arthur Allen is a Washington-area writer whose work appears in the Washington Post magazine and the New Republic. This article first appeared in Salon.com, a superb online magazine. An online version remains in the Salon.com archives.

* * *

What I hear you asking for [is] not just a cure but a reason why this has happened to you it would be easy for me to claim that your sickness is meaningless, that it is just the result of some random disruption in your body. That is more or less what medical training drums into us ...

Patients want to know why they hurt its deeper implications refuse to remain buried. They are not content just to be told why the stomach, the intestines, or the breast hurts even after you salve the ulcer, unblock the intestine, or cut out the breast tumour, the patient returns with trouble in his eyes ...

There seems to be a hole in the middle of everyday life, as if a rock had been thrown through a plate-glass window ... On the surface, all my patients are seeking help because they are ill, sometimes gravely but what often shocks me is that many seem, in some barely concealed way, relieved {the disease can also open] opportunities denied to him by ordinary life ...

Sickness has always had an element of escapism in it. As children we were coddled by our mothers whenever we ran a fever, and seriously ill adults are given 'intensive care'. But if a terminal illness is seen as escapism at its ultimate, one cannot help but ask, Is this life so terrible that escape is its greatest reward? ...

It is disturbing to think that our culture provides us with so little opportunity to confront the basic meaning of life that sickness and death have filled the void by becoming conversion experiences ... I'd rather live six months with this cancer [one patient told me], than seven years the way I was ... People have to be transformed before the crisis ... Pain is basically a signal of where healing should begin ... turning inward starts to dissolve that conditioning ...

Although no larger than a man's clenched fist, the heart does enough work in a day to raise a one-tonne weight to the height of a five-storey office building yet, elaborate as it is [it can be] battered by the nothing of a thought ... Perception is the first and most important step in turning the raw data of the universe into reality this 'fusing' of 'me' and things 'out there' is what makes the lens of perception magical.

Michael Crichton writes in Travels: 'These patients were telling me stories of events that had affected their hearts in a metaphysical sense. They were telling me love stories. Sad love stories, which had pained their hearts. Their wives and families and bosses didn't care for them. Their hearts were attacked. And pretty soon, their hearts were literally attacked ...

- from Unconditional Life: Discovering the Power to Fulfil Your Dreams, by Deepak Chopra

Recently the term PLACEBO was inverted into a new term, NOCEBO, to describe the negative effects of a doctor's opinion ...

[Medical assistance should be associated with healing] If a patient regards any treatment as violence, then his body will be flooded with negative emotions and the chemicals associated with them. It is well documented that in a climate of negativity, the ability to heal is greatly reduced - depressed people not only lower their immune response, for example, but even weaken their DNA's ability to repair itself ...

Doctors push patients into predictable thinking all the time, because medical school training is focused entirely on the horizontal axis."

- from Quantum Healing: Exploring the Frontiers of Mind / Body Medicine by Deepak Chopra

The biochemistry of the body is a product of awareness. Beliefs, thoughts, and emotions create the chemical reactions that uphold life in every cell. An aging cell is the end product of awareness that has forgotten how to remain new ...

Perception appears to be automatic, but in fact it is a learned phenomenon. The world you live in, including the experience of your body, is completely dictated by how you learned to perceive it. If you change your perception, you change the experience of your body and your world ...

A meticulous 1987 study from Yale, reported by MR Jensen, found that breast cancer spread fastest among women who had repressed personalities, felt hopeless, and were unable to express anger, fear, and other negative emotions. Similar findings have emerged for rheumatoid arthritis, asthma, intractable pain, and other disorders ...

Major factors that accelerate aging: depression, lack of daily routine, lack of regular work routine, job dissatisfaction. Minor: inability to express emotions ...

Valliant was among the first researchers to establish that depression often leads to premature aging, chronic illness, and early death. Generally, at the root of depression is a kind of emotional numbness ...

Being holistic, exercise sends chemical messages back and forth between the brain and various muscle groups; part of this flow of biochemical information stimulates the production of catecholamines. Thus, whenever a doctor writes a prescription for an antidepressant, Boritz declares, he is handing out a proxy for the body's own inner prescription, which is filled by exercise.

The basic fuel of the body is glucose, or blood sugar, which is the brain's only food. Burning a sugar cube over a gas flame yields a flash of light and heat and a greasy lump of carbon, but the same sugar burned in the brain produces all the thoughts and emotions we have.

The Sistine Chapel and Beethoven's Ninth are accomplishments of burning sugar ... A message is not a thing, and yet your body turns it into a thing. This is how nature operates behind the illusion of physical reality ...

If you hear the words I love you and your heart starts to pound, an ... astonishing metamorphosis has taken place. An emotion in another person's mind has been transformed into molecules of adrenaline rushing through your bloodstream ...

Child psychologists have found that young children are much more deeply influenced by ascriptive statements from their parents than by prescriptive statements in other words, telling a child WHAT HE IS makes a much deeper impression than telling him WHAT TO DO ...

Pain in the present is experienced as hurt. Pain in the past is remembered as anger. Pain in the future is perceived as anxiety. Unexpressed anger, redirected against yourself and held within, is called guilt. The depletion of energy that occurs when anger is redirected inward creates depression ...

The emotions that frighten us are the complex ones, because they overwhelm the natural release mechanism. You cannot simply release guilt or depression. They are secondary formations that arose once you forgot how to release hurt.

Music is metabolized in the same way as narcotics in that it creates the release of endogenous narcotics in the body. Exhilarating music creates natural anti-depressants in the body.

- from Ageless Body, Timeless Mind: A Practical Alternative to Growing Old by Deepak Chopra

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