Ritalin Controversy : A ‘Miracle Drug’ Gets Closer Look

LaVarne Parker didn’t like what the pills seemed to be doing to her young son, Melvin.

But, she says, officials at his suburban Atlanta elementary school insisted that he take them if she wanted to keep him enrolled there. The doctor who had prescribed them also offered little solace. In fact, she says, he increased Melvin’s dosage.

“He just kept telling me they would help him concentrate in the classroom,” she said.

At home, however, the once-bubbly, bright-eyed youngster who had seldom given her any trouble was becoming hostile and suicidal.

On one especially terrifying occasion, she recounts, he suddenly jumped up from the dinner table in a cold sweat, ran to his bedroom, locked the door behind him and began banging his head against the storm-glass window.

Powerful Drug

“We had to kick in the door to get him away from the window and keep him from hurting himself,” Parker recalled.

The pills in question were Ritalin, a powerful drug that has been found useful in treating hyperactive children suffering from attention deficit disorder--a medically perplexing condition marked by an inability to concentrate.

According to federal estimates, the drug is prescribed for about 4 million schoolchildren in the United States. Many educators and pediatric specialists swear by it, contending that it helps otherwise unteachable hyperactive youngsters cope with classroom demands and become productive students.

But in recent months, the oft-called “miracle drug” has become the target of a growing number of legal challenges by parents and child advocates who claim that Ritalin is being used indiscriminately as a “chemical straitjacket” for unruly schoolchildren--with physical and mental consequences that are often disastrous for the youngsters.

‘Dazed Stupor’

Last month in California, for example, a Glendale mother charged in a $7-million Superior Court suit that her 8-year-old was kept in a “dazed stupor” with Ritalin in the classroom and now suffers permanent brain damage and severe emotional distress.

The latest and potentially most far-reaching legal assault is a $125-million class-action lawsuit filed in Atlanta federal District Court, with Parker as the lead plaintiff on her son’s behalf. It accuses teachers and school administrators of pressuring parents to place their children on Ritalin.

“This drug made the plaintiffs’ children very compliant and less of a problem to the teachers,” the suit contends. “No other intermediary steps were taken to address the learning and behavioral problems (of the children) in school” or to determine whether the problems might stem from other sources, such as family troubles, diet deficiencies or drug or food allergies, it adds.

The suit, which names doctors, educators and the American Psychiatric Assn. but not the drug’s manufacturer, also alleges that physicians have failed to warn the parents of the drug’s potential side effects, which can range in severity from appetite loss and insomnia to abnormally rapid heartbeats and Tourette’s syndrome, according to the manufacturer.

Tourette’s syndrome is a nervous disorder in which the victim may exhibit uncontrollable facial tics, babble profanities and bark like a dog.

A spokesman for the American Psychiatric Assn. said the association was still reviewing the suit and would make no comment. One of the doctors named in Parker’s suit said that neither he nor another doctor named had yet received notification of the suit, and he also declined to comment.

But George Thompson, assistant to the superintendent of the Gwinnett County school district in suburban Atlanta, which is another of the named defendants, said: “Nothing like this has ever arisen here before. What we do not do--and have not done in this case--is encourage anyone to take any specific medication. And even if we did--which we didn’t--a doctor would have to prescribe it, not the school.”

Works With Parents

Thompson said that the school district goes out of its way to assist hyperactive children with attention deficit disorder and to work with parents in fitting the child to a specialized educational program, if such is required.

“We really went the extra mile with Mrs. Parker,” he said. “Every effort was made at every step, from the classroom teacher to the principal to the department of psychological services to provide help for the child involved. But they were denied.

“When you have a problem with a youngster and the parent does not accept the services you are capable of providing, then you reach an impasse and the school has to decide whether they’re going to take the steps necessary to remove the child.”

Parker says that her son, who is now 15 and was on Ritalin for more than four years, remains depressed and suicidal. She says she took him off the drug last year at her own initiative after he burst into the house from play outside one day, flailing his arms wildly and screaming frenziedly: “Get all these people off of me! They’re grabbing at me! Get them off!”

Ritalin, the trademark name for methylphenidate hydrochloride, is a potent amphetamine that has been prescribed for almost three decades to control hyperactivity in children. It is made by the CIBA-GEIGY Pharmaceutical Co. of Summit, N.J.

Gloria Martini, a spokesman for the manufacturer, would not comment on the suit, but said that Ritalin is the “drug of choice” for treatment of hyperactive children with attention deficit disorder. She said also that the company instructs doctors on the proper procedures for prescribing the medicine.

In adults, Ritalin acts as a cerebral stimulant but, for reasons medical authorities cannot fully explain, it has the reverse effect on many hyperactive children.

When properly administered, according to studies, Ritalin and other amphetamines such as Dexedrine and Cylert produce favorable results in 70% to 80% of children with hyperactivity.

“Ritalin is the recommended treatment by experts throughout the country for attention deficit disorder, much as insulin is for diabetes,” said Michael K. Levine, an Atlanta physician and member of the American Academy of Pediatrics.

Effect of Publicity

Levine says that many pediatricians and child psychologists across the nation fear the recent adverse publicity directed against teachers and school officials will prevent them from notifying parents when they suspect a child may have the disorder.

“Then the child will suffer because he will not be getting the help he needs,” said Levine, who has practiced pediatrics for 24 years.

It has been estimated that at least 3% of the nation’s 45 million preadolescent schoolchildren are afflicted with attention deficit disorder, which also has been known as minimal brain dysfunction, hyperkinetic syndrome and hyperactive child syndrome.

Boys are far more likely to have the condition than girls. It generally is characterized by excessive motor activity, short attention span and impulsive behavior. Affected children usually do poorly in school unless treated.

Many are the parents who feel that Ritalin helped their hyperactive children focus their attention and improve their academic performance.

“You could see it work,” said a suburban Atlanta housewife whose son, now in college, was treated with the drug between the ages of 6 and 8. “It was just amazing.” She added that he was thoroughly diagnosed before the drug was prescribed and that his condition was carefully monitored for any adverse reaction while he used it.

But critics contend that the criteria for determining hyperactivity are so broad--and that so much weight is given to reports of teachers when children are diagnosed by medical specialists--that Ritalin abuse has become rampant in schools.

Dennis Clarke, president of the Citizens Commission on Human Rights International, a nonprofit organization that monitors mental health abuses, said that in some areas of the country the situation is “out of hand” with “doctors who heavily push the drug.”

“In some schools in Maryland, 80%of the kids are on it,” he added.

Ritalin use has grown dramatically in recent years, with annual sales estimated at about $75 million. Utah, Maryland and Georgia are the leading states in per capita consumption.

In Georgia, for example, the consumption rate is 1,218 grams per 100,000 population, according to Andrew Watry, executive director of the Composite State Board of Medical Examiners.

That is about double the rate in California and more than three times the rate in New York, he said.

What is more, a ZIP-code search of Ritalin shipments showed that a handful of affluent Atlanta suburbs accounted for 45%of the total sales in the state, Watry added.

That astonishing figure prompted the board to conduct a more thorough investigation, working with teachers, physicians and parents to uncover the chain of responsibility.

“What we found was that there was a general notion that this drug was a panacea for a lot of behavior problems,” Watry said. “People would seem to think it was a miracle drug and would suggest it for any kid who squirmed in his seat.”

He added: “I actually had a case where several parents told me of a school counselor who was pressuring them to medicate their children and when they asked him for a justification, he would say: ‘We’re playing the percentages.’ That’s playing Russian roulette with children.”

Many school officials maintain that the problems with Ritalin are being blown out of proportion, but John Coale, an attorney with offices in Los Angeles and Washington who represents the plaintiffs in the Parker case as well as in similar suits in Minnesota and Maryland, sees the case much differently. He contends that a “definite disaster” is going on in American schools.

Coale, who has filed lawsuits in such mass-disaster cases as the toxic cyanide cases in Bhopal, India, and the DuPont Plaza Hotel fire in Puerto Rico, said the primary objective of the Ritalin lawsuits is to ensure that schoolchildren are not arbitrarily placed on Ritalin.

“We want the kids protected,” he said. “It’s a horrifying picture when you have little people in schools across this country lined up every day to take a drug--like something out of ‘One Flew Over the Cuckoo’s Nest.’ ”

Coale said that Ritalin is banned in Sweden and subject to stiff controls in Japan and Britain.

Parker, who founded a parents’ advocacy group called CHILD--Children Having Ignored Learning Disabilities--after her embittering lessons with her son’s experience with Ritalin, said hundreds of other parents have called her with similar stories involving their children.

“They say the kids are zombies--they’re nothing” she said. “You’re talking about kids who are going to grow up and, some of them, not be able to put on their own pants. They’re going to be a burden on society forever.”

One of the most poignant calls she received was from a 26-year-old Los Angeles man who, she said, told her that his parents had him placed on Ritalin as a youngster and that he later turned to street drugs.

No Confidence

“Now, he told me, he doesn’t have any confidence in himself,” she said. “He can’t meet girls. He wants to start up a business but doesn’t know how. I thought: ‘Oh, my God, is this what I have to look forward to with Melvin?’ ”

In a report published this year in the Journal of the American Academy of child and Adolescent Psychiatry, a 10-year study of boys treated with Ritalin disclosed that 43%were arrested for felony violations before they were 18.

The report also said that continued use of Ritalin did not seem to improve the academic achievement and peer status of children. It quoted researchers as concluding that “a clinical treatment with Ritalin was found to have no beneficial effect, and there was some evidence to suggest a poor behavior outcome for the drug-treated group.”

In Massachusetts, a 14-year-old boy bludgeoned a classmate to death with a baseball bat last December after withdrawing from Ritalin. His parents said the boy had been using the drug for seven years before but had been neither tested nor monitored during the entire period.

Ritalin critics call the case a classic example of psychotic behavior brought on by Ritalin and aggravated by withdrawal from the drug after long use.

The manufacturer of Ritalin warns in its packaging materials that “chronically abusive use can lead to marked tolerance and psychic dependence with varying degrees of abnormal behavior.” It also cautions that “careful supervision is required during drug withdrawal, since severe depression as well as the effects of chronic over-activity can be unmasked.”

Perhaps the one bright spot in all the recent controversy over Ritalin is the closer scrutiny that prescribing of the drug is getting, says Watry, the Georgia medical board director.

“Parents are asking more questions of the teachers and doctors who may suggest medication is necessary,” he said. “We’re also finding that school systems are a lot more cautious about suggesting to parents that their children need to be medicated.”

He added: “Ritalin is not a bad drug. If we thought the drug wasn’t useful, we would have banned it. But it helps a lot of people. So we don’t want to throw the baby out with the bathwater.”