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Does ADHD Even Exist? The Ritalin Sham by John Breeding, Ph.D.

Alice, the mother of a seven-year-old son, Nathan, recently visited my office for a counseling session. Nathan had reportedly been different and difficult from the beginning: exhibiting early seizure-like activity, a most challenging temperament, great sensitivity to various types of stimulation, intense frustration, aggressive tantrums, and other apparent developmental difficulties. Alice had taken him to doctors from a young age, obtaining a variety of mostly nonspecific diagnoses of developmental problems. Alice felt unappreciated as a parent, hurt and angry that the Montessori school her son had attended at ages four and five had ultimately rejected him. She felt judged by other parents, whom she felt blamed her for her son's challenging behavior. And she felt unsupported by both camps of opinion regarding "medication": the pro-Ritalin forces challenged her reluctance to use the drug for her son, and the antidrug group vehemently urged her to resist drug use.

Alice's personal stance on the Ritalin issue was clear. While she basically agreed that these "medications" are not good for children, she also felt that, in her family's case, it had been helpful. Nathan had been diagnosed at age five with attention deficit hyperactivity disorder (ADHD), and had taken Ritalin for a year. Alice thought the drug greatly helped her son, slowing him down enough so that he could listen and process information. She and her boyfriend both felt drugs made the boy much easier to be with; further, their own reduced stress eased them so much that they were now able to consider other alternatives for Nathan, such as nutritional supplementation.

Proponents of psychiatric drugs attest that they "work," meaning they alter mood, thought, and action. They also "work," of course, in that they assuage the medical community's expectation that drugs be used to "treat" these children. I believe that fully informed adults should have every right to voluntarily use any drugs they wish, as long as they don't endanger others in doing so. Children, however, are not able to give fully informed consent to drug use - especially those under six years of age, a group in whom we are witnessing a dramatic increase in psychiatric drug prescription.¹ It is, therefore, our responsibility as adults to ensure every possible opportunity for optimal development for our children, to protect and defend our children from powerful toxic drugs, particularly those prescribed for psychiatric purposes.

Like Alice, a large percentage of adults who take psychiatric drugs or give them to their children would prefer to avoid them - and yet they capitulate and use them because the drugs provide relief: from tension, fear, and desperation, as well as from the external strains of judgment and coercion. Lawrence Diller, author of the best-selling book Running on Ritalin, argues that: "The 700 percent rise in Ritalin use is our canary in the mineshaft for the middle class, warning us that we aren't meeting the needs of all our children, not just those with ADD. It's time we rethought our priorities and expectations unless we want a nation of kids running on Ritalin."² Dr. Diller decries the trend (as I do in my book The Wildest Colts Make the Best Horses), contending that this increased reliance on drugs reflects a society in distress. Rather than try to force our children to shrink into situations that do not meet their needs, he states, we need to take responsibility for our society.

Diller himself is, however, torn by the same conflict many parents have concerning Ritalin. On the one hand, he says: "As a citizen I must speak out about the social conditions that create the living imbalance. Otherwise I am complicitous with forces and values that I believe are bad for children." On the other hand, though, he concludes: "As a physician, after assessing the child, his family and school situation, I keep prescribing Ritalin. My job is to ease suffering and Ritalin will help round- and octagonal-peg kids fit into rather rigid square educational holes." ³

This seemingly contradictory stance is the same one Alice and millions of other parents face. It's not as if all parents readily accept the prescription of Ritalin. Alice, in fact, incurred the wrath of her son's neurologist because she refused to give her son Adderall, a combination of three different amphetamine-like stimulants often used as an alternative to Ritalin. Increasingly over the past ten years or so, millions of parents are nagged by their children's physicians: "If your child had diabetes," the doctors taunt, for example, "you'd give him insulin, wouldn't you?"

"What could I say to that?" Alice asked me. Her question was not so much a call for information as it was a need to express her hopelessness. It was encouraging to me that she was angry, for anger is a great antidote to hopelessness. She was mad about the treatment she had received from prior medical and mental health professionals, as well as the lack of support from two opposing drug camps. Before I would hazard a possible response for that neurologist, Alice and I talked about the feelings of relief, guilt, and anger the Ritalin issue had caused for her family. Finally, I gave her what would have been my response: the diagnosis of ADHD is, itself, fraudulent.

ADHD: Nothing but a Sham

A condition such as diabetes carries detectable physical evidence of disease - abnormal blood sugar levels, evidence of pancreatic malfunction - justifying medical treatment. Families confronted with the "wouldn't you give insulin" argument could begin by asking the neurologist to provide medical evidence that a disease requiring treatment exists. Between 1993 and 1997, neurologist Fred Baughman corresponded repeatedly with the Food and Drug Administration (FDA), the Drug Enforcement Agency (DEA), Ciba-Geigy (now Novartis, manufacturers of Ritalin), and top ADHD researchers around the country - including the National Institute of Mental Health - asking them to show him any article(s) in the peer-reviewed scientific literature constituting proof of a physical or chemical abnormality in ADHD and thereby qualifying it as a disease or a medical syndrome. Through sheer determination and persistence, Dr. Baughman eventually got these entities to admit that no objective validation of the diagnosis of ADHD exists.⁴

Prescribing Ritalin for something that is not a "disease" does not, in my estimation, constitute a legitimate practice of medicine. If ADHD is not a disease, treating it medically constitutes a fraud. Yet many physicians are true believers in medically treating "mental illness," despite the consistent lack of scientific evidence of "mental illness" as a "disease."⁵ Herein lies the conflict for parents like Alice.

The Significance of Oppression Theory

Victims of oppression are not only blamed for their condition, and usually thought to be deserving of their inferior position, they are eventually conditioned to accept it as their reality. As the great American writer James Baldwin stated: "It's not the world that was my oppressor, because what the world does to you, if the world does it to you long enough and effectively enough, you begin to do it to yourself."⁶ In what may be the ultimate power play, a victim is, over time, conditioned to internalize, accept, and ultimately, forget about the very fact that they are oppressed.

There are two specific forms of oppression that are pertinent to the discussion of psychiatric drug use for children. The first is adultism - the systematic mistreatment of young people by adults simply because they are young. Like other forms of oppression, adultism is self-perpetuating: when we are treated poorly as children, we internalize the idea and feelings that life is unfair; that rank and power should be used for personal advantage; and that we are somehow unworthy of respect, incapable of clear thinking, and unable to become our own authority.

The second form of oppression is what I call psychiatric oppression: the systematic mistreatment of people labeled as "mentally ill" - including children diagnosed with fictitious illnesses such as ADHD. Institutionalized in our society, psychiatry is also guided by a worldview that embraces biopsychiatry.⁷ Juxtaposed with adultism, psychiatric diagnosis and treatment enforce the message that an "ADHD child" is inadequate, defective, unworthy of complete respect, and in need of drugs to control and cope with the effects of his or her "illness."

Lies My Doctor Told Me

What exactly does it mean to "help round- and octagonal-peg kids fit into rather rigid square educational holes?" I believe there are at least six fallacies that underlie the rampant prescription of drugs like Ritalin to our children.

1. "Social adjustment is good."

While the ability to adjust socially may be important, it is not always a "good" thing. In its most extreme form, social adjustment leads to conformity and compliance, which has resulted in dire social phenomena, including slavery and genocide. This seems a particularly aberrant notion in a society like ours, which is so deeply grounded in the quest for individualism, free speech and association, and the "pursuit of happiness."

2. "Children must learn to conform."

When a child fails to adjust to school, we should at the very least think about our abilities to consider the child's needs. It is certainly important for children to learn how to get along in various situations, and how to avoid drawing sanction upon themselves. Nevertheless, young children must be enabled to express their unique gifts within their communities. It is a mistake to force our children to fit molds imposed upon them according to the needs and conventions of the adult order.

3. "Failed social adjustment causes suffering."

In our competitive culture, we tend to view mistakes as negatives to be avoided. It is hard to accept the notion that mistakes can be good, and actually, in fact, are the way we learn. We are obsessed with the notions of success and failure. We judge a child's actions as success or failure according to our expectations and demands, not through the eyes of a developing child. Eventually, the child internalizes both the standard and the evaluation: "I failed to live up to the expectations, therefore I am a failure." I would argue that it is not failure that causes suffering, but rather it is oppression - in the form of adultism - which imposes arbitrary standards, and an adult shame-based worldview. This is what causes children to feel and think of themselves as failures, and therein lies their suffering.

4. "A physician's job is to ease suffering."

Certainly it is - through the practice of medicine that incorporates compassion - not labeling, coercion, or guilt.

5. "Ritalin helps children conform."

Not always. Sometimes it makes them "psychotic," sometimes it makes them aggressive. Other times Ritalin makes children anxious or nauseous. It can make some children feel suicidal. And for some children, Ritalin has been a deadly prescription. ⁸ When it "works" well, the child is observed to produce better in the classroom. This, the research shows us, is the only positive short-term outcome. There are no positive long-term effects in any aspect of child functioning - social, behavioral, or academic - associated with the use of Ritalin.⁹

6. "Therefore, giving your child Ritalin lets me ease her suffering."

In an 1854 speech on the Kansas-Nebraska Act, Abraham Lincoln said, "I would consent to any great evil, to avoid an even greater one."¹⁰ Many parents feel the compulsion to punish or discipline their child in hopes that even greater misfortune might not befall them. Given the reality of today's oppressive society, and its lack of resolve to truly meet the needs of our children, the argument goes, Ritalin may seem a better choice than continued pressure, disapproval, and sanction.

This "ease the suffering" argument reveals one of the most consistent justifications for the use of psychiatric drugs for children: on one level or another, Ritalin absolves each person of his or her responsibility. The child is not responsible, he's "sick." Parents, doctors, the community, the medical and educational institutions - the society at large - are relieved of their duty to meet the real needs of that child. We prescribe drugs; the child conforms; the educational and medical institutions don't have to change; and our standards of "normalcy" are passed on to the next generation of drug-assisted children learning to fit into the mandated square hole. We have endless justifications that allow us to conform to oppression with a seemingly clear conscience, while an estimated 5,000,000 children are on methylphenidate, and another 3,000,000 on other toxic drugs - given to them by adults who care for them. Some may call this "medicine," but a growing group of parents and others are beginning to see it as institutionalized child abuse.

Suffer the Children?

Although ADHD does not exist as a real disease, it is a very real label imposed on children, with very real consequences for the child. On a physical level, the recommended drugs are toxic, and they have a long list of deleterious effects.¹

Regarding Ritalin, the fact is that "methylphenidate looks like an amphetamine (chemically), acts like an amphetamine (effects), and is abused like an amphetamine (recreational use, Emergency Room visits, pharmacy break-ins)."² (parentheses mine)

On a psychological level, Ritalin produces two especially harmful effects. It deprives a child of the right to develop a character and a way of living with self and world, in a drug-free state. Ritalin also creates a burden of shame, a conviction that a child who is on this drug is somehow defective, unworthy, and neither lovable nor even acceptable in his or her "natural" state.

These stimulant drugs for children truly are about enforcement of our culture's preeminent value: productivity.³ Amphetamines, as we have learned over the course of the past century, increase output. But of course, with amphetamines, the trajectory is usually crash and burn. In the US, millions of adults, and an alarmingly increasing number of children, take psychiatric stimulants like Prozac to "keep going and going." Similarly, we give children as young as two years of age stimulant drugs to help their "impaired" productivity. But wherein lies the suffering, in the "failure" to produce or achieve, or in the so-called remedy we prescribe?

¹Peter Breggin, Talking Back to Ritalin (Monroe, Maine: Common Courage Press, 1998).^{2 Mary Eberstadt, "Why Ritalin Rules," Policy Review 94 (1999): 24-44.}

3 See John Breeding's new e-book, The Necessity of Madness and Unproductivity: Psychiatric Oppression or Human Transformation? (Online Originals, 2000), for an explanation of how psychiatry acts to enforce our social mandate of relentless productivity.

Ritalin Use - Simply Out of Control

Psychiatric drug use by children in US schools is turning into an enormous problem. In 1970, an estimated 150,000 US children were taking Ritalin. By 1980, the estimates were between 270,000 and 541,000 - double the numbers of a decade before. By 1990, the numbers doubled again; close to 900,000 children were on Ritalin. The Drug Enforcement Agency (DEA) estimates there was a 700 percent increase in the production of Ritalin between 1990 and 1997, 90 percent of which was consumed in the US.

Based on the available data, a realistic estimate of the number of school-age children on Ritalin today in the US is 5 million. Considering that Ritalin - like other amphetamines, a Schedule II controlled substance that carries a significant risk of abuse - represents 70 percent of the total prescriptions for amphetamine-like drugs, it is reasonable to estimate that over 7 million US schoolchildren are on some sort of stimulant drug. We can add close to 2 million children now on so-called antidepressants, so it appears that over 8 million children in this country are on psychiatric drugs today. According to census data from 1999, the US population for ages six to 18 is just under 51.5 million, meaning approximately 15 percent of our schoolchildren are on psychiatric drugs. In many schools and districts, the estimations are quite higher, as much as 20 or 40 percent. A study reported this year in the Journal of the American Medical Association revealed that Ritalin prescriptions for two to four year olds increased 200 to 300 percent between 1991 and 1995.¹

In an era when we are constantly told to protect our children from drug abuse, it seems there are some very disturbing exceptions to the rule.

¹ Zito et al., "Trends in the Prescribing of Psychotropic Medications to Preschoolers," JAMA 283 (2000): 1025-1030.

Ritalin Abuse (San Francisco Chronicle, March 24, 2006)

The Food and Drug Administration's pediatric advisory committee earlier this week not surprisingly failed to support an earlier recommendation to affix black-box warning labels of sudden death on bottles of Ritalin, the FDA's most severe action short of banning the use of the drug for attention deficit hyperactivity disorder (ADHD). There were moments at Wednesday's hearing that looked staged, and as if they were intended to get a different verdict from a friendlier jury.

The pediatricians obliged, in contrast to last month's renegade activist panel of cardiologists, led by Steven Nissen, who was also instrumental in bringing to light the Vioxx scandal.

That advisory committee's warning recommendation shocked FDA officials and reopened a Pandora's box of concerns about side effects and overuse of Ritalin. The real dangers from Ritalin, however, were not even mentioned by the committee members. That is the growing concern among frontline doctors, like me, of increasing signs of prescription-stimulant abuse by teenagers and college students.

In my own practice, many teenagers and young adults have told me they had already tried a stimulant, usually Adderall, which is an amphetamine, on their own. They liked the effects and wondered if they had ADHD? One high-school senior told me he had been able to buy or trade for Adderall for the last two years, taking the pills before important exams, like the SAT, and for big projects. He never saw a doctor until meeting with me.

My two sons, one a freshman in college and the other a high-school senior, report the wide availability of these drugs at their schools, especially around exam time.

So what's the problem here? Do all these kids have ADHD because they think they do better by taking these drugs? Not true. It has been known for decades that these medications will improve anyone's performance on repetitive and boring tasks. It is not as clear whether they improve test-taking abilities, but the high interest in the illegal use of these drugs suggests, at least "on the street," the belief that they do.

Until two weeks ago, my concerns about prescription-stimulant abuse were based only on rumor and anecdote. Now, the first hard data come from a study funded, not surprisingly by Eli Lilly, the maker of Strattera, the only nonstimulant approved for the treatment of ADHD (but also vetted by the officials at the Drug Enforcement Administration). The study, published in the journal Drug and Alcohol Dependence, uses a government survey of 54,000 people from 2002 and projects that, nationwide, 21 million individuals have misused a prescription stimulant at least once. Some 3 million have abused only prescription stimulants, and 75,000 young people between the ages of 12 and 25 meet psychiatric criteria for addiction and drug abuse. Since 2002, rates of prescription stimulants to adults have continued to rise, suggesting that this number of 75,000 may be higher today.

With the suggested black-box warning, the committee clearly wanted to get the nation's attention, not only about the cardiovascular risks of the prescription stimulants, which include other well-known drugs such as Adderall and Concerta, but also to alert everyone to their potential overuse in children. The panel kept referring to a study where 1-in-10 11-year-old boys around the country take Ritalin or its equivalent.

The possibility of dying from Ritalin is extremely small for a child without a pre-existing heart condition (on the order of 0.0002 percent). However, 75,000 prescription-stimulant addicts dwarf the number of children who died taking the drug. It also represents a real, not an hypothetical, risk such as that for heart attack and stroke, which so worried the FDA cardiovascular committee.

Of those who casually misused Ritalin, according to this survey, 1 in 10 went on to develop tolerance and addiction to the drug. If one recalls the graffiti on the walls of San Francisco's Haight-Ashbury in the 1960s that read "Speed Kills," the concerns about a 10 percent-addiction rate are indeed chilling.

There have been three previous waves of doctor-prescribed stimulant abuse since World War II, the last being Dexedrine for weight reduction in the 1970s. In every previous case, American society, through congressional hearings and state laws, decided that the overall harm of prescription stimulants to the society was greater than the good they provided.

With the case of ADHD, the decision may have to be bifurcated. Ritalin has had a 70-year history of safety with preteens. No kid under the age of 13 has ever become addicted. But if history is a guide, the real risk from Ritalin to our country will be for Johnny's older brother doing this drug on his own, illegally, while away at college. The safe use of these drugs in young adults and teenagers will require much stricter legal controls on prescribing. Unfortunately, it will likely take increasing drug-abuse casualties and young people's deaths to mobilize the necessary public pressure to make that change.