Kids' behavioral drugs at issue; Colorado resolution seeks to discourage use of Ritalin, others

THE BALTIMORE SUN

DENVER -- As a debate over the growing use of behavioral drugs for children intensifies across the country, the Colorado Board of Education has passed a resolution meant to discourage teachers from recommending prescription drugs like Ritalin and Luvox for students.

The resolution, the first of its kind in the country, carries no legal weight. But it urges teachers and other school personnel to use discipline and instruction to overcome problem behavior in the classroom, rather than to encourage parents to put their children on drugs that are commonly prescribed for attention-deficit and hyperactive disorders.

Proponents of the resolution were motivated, in part, by evidence they said suggests dozens of violent crimes in recent years -- including the massacre last spring at Columbine High School -- were committed by young people taking psychotropic drugs.

One of the teen-age shooters at Columbine, Eric Harris, had been taking Luvox, an anti-depressant. There is no evidence that the drug had anything to do with the shootings.

No other states are considering a measure similar to the one in Colorado, where an unusual set of circumstances played a role in the resolution's passage: an elected and fairly conservative school board responding to the outcry from one of the nation's worst school shootings. The resolution reflects broader issues too, as parents, mental health professionals and school officials around the country debate the rising use of behavioral drugs for children.

Experts in children's mental health issues point out that children who take the drugs do so because they were having difficulties. They acknowledge that impulsive or violent behavior is a recognized side effect in a small percentage of people taking the drugs.

But they say that an overwhelming majority of children who use the drugs are benefiting. They contend that the Colorado resolution is irresponsible and perhaps even dangerous because it could lead school personnel to ignore signs of serious mental disorders in children. It also would discourage communication between teachers and parents, they say.

"I hope what happened in Colorado is the exception and not the rule," said Michael Faenza, president of the National Mental Health Association, conceding that he fears other states and school districts might replicate Colorado's efforts.

"Holding up psychotropic medicines as the possible cause of violent behavior is absurd. There's a wealth of information to show that they have helped dramatically."

The use of Ritalin and other psychotropic drugs has steadily increased over the years among school-age children to a current level of about 2.5 million, according to Children and Adults with Attention Deficit/Hyperactivity Disorder, a national nonprofit organization known as CHADD and based in Landover.

In Colorado, increased usage has turned a new focus onto the role that teachers and administrators play in the daily lives of their students. It has also pitted experts who say use is growing because the drugs are beneficial against those who contend that parents and teachers are too quick to seek out prescription medicine as the simplest way to treat children with behavioral problems.

Dr. Stephen Stahl, a professor of psychiatry at the University of California in San Diego, said that because of the complexities of mental disorders and the rapidly changing personalities of children as they grow older, both sides of the psychotropic debate may be right. And wrong.

"There's no blood test for this," he said. "It's not objective. If a kid is acting out in class and a stimulant like Ritalin calms him down, it would be immoral not to give him the medicine."

Another problem complicating the issue, Stahl said, is the location of the school. Typically, he said, in poor areas, mental disorders are underdiagnosed, and often in more affluent school districts, children are overdiagnosed, sometimes making a bad situation worse.

Dr. Peter Breggin, director of the International Center for the Study of Psychiatry and Psychology, a nonprofit research organization in Bethesda, testified at both hearings. He said doctors have become too eager to prescribe psychotropic drugs at the expense of conversations among parents, teachers and children to learn why children are acting in anti-social ways.

"It's a tremendous mistake to subdue the behavior of children instead of tending to their needs," Breggin said in an interview.

"We're drugging them into submission rather than identifying and meeting the genuine needs of the family, the school and the community. It's wrong in principle."

Citing Harris and other young killers who were found to be taking Ritalin and other drugs, Breggin said he is convinced there is a direct link between the drugs and violent acts.

He also asserted that the drug harms children.

Cohen of CHADD and others said the resolution might inhibit teachers from applying their own common sense and experience in the case of a troublesome child by merely telling parents that something is wrong without offering a full range of possible solutions.

"If a child has hearing or vision problems that the teacher identifies, we would expect the teacher to talk to the parents," said Jeanne Mueller Rohner, executive director of the Mental Health Association of Colorado, which opposed the resolution. "It should be the same thing for mental health."

Patti Johnson, the Colorado school board member who organized a hearing on the issue and proposed the resolution, conceded that only a small number of teachers in Colorado have ever insisted on a child taking prescription drugs as a precondition to returning to class. It is largely for them that the resolution was intended.

But in the end, said Andrea Giunta, president of the largest teachers' union in Denver, it might not matter, anyway. By the time most children are diagnosed with an attention deficit or hyperactive disorder, they have been observed and analyzed over time by a team of experts, including teachers, nurses, counselors and school psychologists, she said.

"A teacher shouldn't recommend a specific course of action," Ms. Giunta said. "But what she can do is say, 'This has been my experience with other children when they have displayed this kind of behavior. What you do is up to you.'"

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