TALES FROM EAST TEXAS/Carol Countryman

The Pill that Teachers Push

It wasn't until Debra saw the line of children snaking around the school nurse's office one afternoon, that she realized something was dreadfully wrong. Her mouth dropped open in dismay as she watched each kid step forward to receive his or her daily dose of school success, which came in a little pill--Ritalin. Debra felt a stab of guilt because her son was among them.

It was then that Debra began researching the drug, reading everything she could get her hands on, asking questions of everyone she could. And it was then that she decided to take her son off the drug. "I was shocked to see the number of kids who were waiting for the medicine," Debra says, recalling that, at one point when trying to fill her son's Ritalin prescription, all the pharmacies in her East Texas county were out of the drug. "There were so many kids on Ritalin in our county, that we ended up having to call five different pharmacies to see if they had the drug. We finally found one in another county and had to drive there to get his Ritalin."

A plethora of recent news articles, books, and medical and government reports seem to support Debra's fears, reporting that American school children are taking psychotropic drugs such as Ritalin in record numbers, with the U.S. manufacturing and consuming five times more than any other country. A study last year by Johns Hopkins University estimated 1.5 million American children between the ages of 5 and 18 have Ritalin prescriptions, more than doubling the number since 1990. The study suggested that if this trend continues, some 20 million children could be consuming Ritalin on a daily basis by the year 2000.

"My son was difficult," Debra admits. "His teachers had a hard time with him. His first grade teacher wanted him medicated, but I resisted. By third grade, though, the school called me in for a meeting and they had all his teachers there insisting that Ritalin would be best for him."

Debra finally relented and took her son, along with a letter written by his teacher, to a local doctor, who, after a brief visit, prescribed the psychotropic drug, Cylert, for her son. The drug worked, Debra says, but only briefly. They had to monitor his blood every six weeks to insure there was no damage caused by the drug.

But after about six months, Cylert no longer worked. He was the same kid with the same problems, Debra says. The doctor then switched Debra's son to Ritalin. After two years on the drug, however, his growth had nearly ceased, he was having difficulty sleeping, suffered from severe headaches and experienced other daily maladies that Debra later discovered may have been caused by the drug.

Debra decided on her own to take her son off the drug. "The teachers were furious. They called me to the school and told me I couldn't take him off it without the doctor's permission. They stepped up the pressure on me to keep medicating him." Debra recalled feeling helpless. "They [the teachers] wouldn't listen to me, they were all against me and my decision. They just never understood that I was afraid for my son."

There's no question that parents are pressured to put and keep their kids on Ritalin, says Fred Baughman, M.D., a California-based neurologist and outspoken national critic of Ritalin.

"Teachers make pronouncements that a kid is hyperactive and gets the whole school team behind it--the counselor the psychologist, etc--all against parent. It often turns into a face-off."

But Dr. Milton Cardwell, developmental pediatrician and director of the North Texas Center for Learning and Behavior, a division of Baylor Medical Center, feels teachers are getting a bad rap.

"It's very often the teacher who is the first to see the symptoms of the disorder," Cardwell explained, though adding that, while teachers and schools should describe behaviors and academic problems they see, they should not make medical decisions.

Richard Adams, M.D., health director for the Dallas Independent School District, advises teachers and school nurses not to make medical pronouncements to parents. "My message to teachers is to never, ever coerce parents into thinking their child needs medication," Dr. Adams says. "But with 17,000 teachers, I'm sure it occasionally happens." Dr. Adams correctly points out that teachers cannot prescribe Ritalin, only physicians can.

Catch-all diagnosis

Cyndie says she fought a yearlong battle with her rural East Texas school district to keep her son, Stephen, off the drug. In the end, she says, she had to file a complaint with the Department of Education s Office of Civil Rights to stop what she perceived as harassment.

It wasn't long after he began first grade that Stephen's teacher recommended to his parents that he be diagnosed for attention deficit disorder and medicated. Cyndie was against medicating her child, opting instead to deal with his behavioral problems through discipline.

As the year progressed, Stephen was getting into more and more trouble at school. The teacher complained that he would talk while she was lecturing and that he couldn't sit still. Stephen's conduct grade was lowered, knocking him off the honor roll. Within a couple of months Stephen's teacher put him in permanent time-out by placing his desk at the back of the room facing the wall, his back facing the backs of the other students and the teacher. He sat this way the entire year.

"I didn't know what to do," Cyndie confesses. "I always sided with the teacher. We punished him at home, privileges were taken away. We even spanked him when he got paddled at school. During this entire period, the teacher kept telling us that he was hyperactive and needed Ritalin. She was insistent upon it."

But Cyndie, a dental hygienist, and her mother, a nurse, were very concerned about the effect Ritalin had on a child. For a year they researched the drug and read every article they could get their hands on about ADD. "I just couldn't put him on the drug," Cyndie says. "I was so scared that there could be long-term effects."

The following year was even worse for her Stephen. Because he was in the "loop" program, he had the same teacher in second grade as he had in first. Within days problems began to occur. Within weeks, he was again in permanent time-out. But this time his mother could see a definite change in her son. "He was depressed, he hated school, he hated his teacher," she says. "I was called in for several conferences. He was getting paddled and I wasn't informed about it. I also learned that he was being called 'stupid' by his teacher in front of the class. She was still telling me he needed Ritalin. Finally, I consented to have him tested."

Armed with a stack of evaluation sheets from the teachers and other school personnel, Cyndie took Stephen to a pediatrician for evaluation. But a thorough examination by a variety of doctors and the county's special education diagnostician concluded that he did not have attention deficit disorder (ADD), nor was he hyperactive. Instead, he tested as intellectually a grade or two higher than his second grade level.

Once the results were in, the doctor confided to Stephen's parents that the small, rural East Texas school their son attended was referring an average of two children per week for diagnosis of ADD. The school only has 200 children enrolled from K-12. (The school did not respond to repeated phone calls for comment.)

"I knew then that it wasn't all Stephen's fault," Cyndie says. "I began talking to other parents and was stunned by the number of them whose children were on Ritalin." When Cyndie began investigating, she says she discovered that the other parents were pressured by the teacher and the school's principal to have their children put on the drug.

Pam was one of the parents also pressured by the school to put her son, Wesley, on Ritalin. "His first grade teacher suggested it," Pam recalls. "She says that her children were on the drug and gave me the name of the doctor she used."

The following year, Pam says, the teacher insisted Wesley be evaluated for ADD. Pam says she made the appointment with the doctor, who diagnosed her son as ADHD (attention deficit hyperactive disorder) after only ten minutes in the office. "When I put him on Ritalin, there was a full change in him," she admits. "He did good in school, he was mellow, and a lot more pleasant."

But Wesley experienced side effects, Pam notes, including headaches, nausea, and stunted growth.

"I didn't tell the school I had taken him off," Pam says. "But they knew. The principal called me and told me that I couldn't take him off of it. They told me that if I didn't put him back on the drug, then they would take him out of mainstreamed classes and put him only in special education." Pam fought the school over the move, but lost.

In an interview in last December's Good Housekeeping magazine, Dr. David Kessler, dean of the Yale University School of Medicine and former commissioner of the Food and Drug Administration, acknowledged that Ritalin is a very important drug for persons truly afflicted with ADD. "Well prescribed, it [Ritalin] can make the difference between a functioning child and a child who has very significant problems," Kessler told the magazine. "The hard thing is to determine for which child it is appropriate. It's widely over-prescribed."

Dr. Cardwell concurs with Dr. Kessler, warning that a 10-minute evaluation in a doctor s office is insufficient to diagnose ADD or ADHD. "The child must be fully and thoroughly evaluated by qualified personnel in the area of developmental behavior," Dr. Cardwell says. Once that is done and it is determined that the child does have ADD or ADHD, then medication is only one component of the child's management. The child, parents and teachers also will need further understanding about how the disorder affects him or her in the classroom and the use of well-known and well-documented classroom strategies for helping with it.

Dr. Cardwell points out that many of these children often have other developmental variations, such as problems with language development, motor skills, and memory, that often accompany ADD, making full evaluation critical.

Erin, whose son attends the same school as Cyndie's and Pam's children, is thankful the teacher advised her to have her son tested for ADD. "It was the best thing that could have happened," Erin says. "Before Craig was on Ritalin, he couldn't concentrate, couldn't finish his work. He was frustrated and acting out. The minute we put him on Ritalin, he was a changed kid."

Erin offers Craig's scores on the Iowa Test of Basic Skills as proof, showing that his score jumped 40 points after Ritalin. "He's currently making straight one-hundreds in all of his classes. His diagnosis and treatment has been a godsend."

This kind of success has earned Ritalin the nickname Vitamin R, leading it to become the favored drug among high school and young college students, who look to the drug to boost scores on standardized examinations. Some parents have been known to push doctors into ADD diagnoses so the student can use the disorder to their advantage under the Americans with Disabilities Act (ADA), which allows ADD students in some cases to take exams privately, with no time limit.

But the rise in Ritalin's popularity, not just among teachers, parents, and physicians, but among recreational drug users, prompted the Drug Enforcement Agency last year to issue a warning about the drug. According to the DEA, some children are dealing their Ritalin in the school yard to classmates who are crushing and snorting the powder like cocaine. This led to two recent deaths, the DEA warned.

The state of Tennessee is so worried about the rising use of Ritalin in public schools, whether by prescription or bought illegally, that the legislature recently set up a task force to study its overuse and possible solutions to the problem.

Dr. Cardwell acknowledges that though there may be some isolated instances of abuse, it is not widespread. Cardwell, armed with stacks of medical statistics and studies, points to other reasons for the increased usage of Ritalin.

"There are simple explanations for the increased number of prescriptions for Ritalin," Dr. Cardwell states. "There is an increased awareness of the condition of ADD, so more people are now referred and evaluated. There is also the recognition that there is ADD without hyperactivity, which is more common in girls--the daydreamers who are inattentive, but not behavior problems. This recognition has led to more of those children being found, referred and diagnosed. And, it used to be thought that kids outgrew this condition in their mid-teens. We know now that a fair number of them don't outgrow it and may continue to need and benefit from the medication for longer periods, adding to the seemingly increased usage of the drug."

Rights and wrongs

Debra, whose son is now a teenager and off Ritalin, opted instead to use holistic means to treat her son's ADD. She said that her son's behavioral problems persisted in school even while he was taking the drug. "I don't blame the teachers," Debra says. "They do everything they can do to help the kids, and to teach. For many, they see Ritalin as the only answer, because I think they just aren't trained on how to handle the difficult child."

But Cyndie is still smarting from her son's ordeal. "I feel that I was harassed to put my son on Ritalin, and when that didn't work, they decided to make things very difficult for him and me so that we would see that he needed the drug," Cyndie says. In October, Cyndie transferred her children from that school to another district, where, she reports, Stephen is doing well and has had no discipline problems.

"I just wish that parents were informed of their rights when dealing with the schools," Cyndie says. "I feel my child has a right to an education without medication."

Carol Countryman is a freelance troublemaker living in Tool, Texas.