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Maple River Education Coalition PAC
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Hearing on "Protecting Children: The Use of Medication in Our Nation’s Schools and H.R. 1170, Child Medication Safety Act of 2003”

Response by Karen R. Effrem, MD
International Center for the Study of Psychiatry and Psychology
Maple River Education Coalition
National Physicians’ Center for Family Resources

May 12, 2003

INTRODUCTION AND SUMMARY:
Many thanks to Chairman Castle for holding this hearing, to Mr. Burns for introducing this vital piece of legislation, and to the Subcommittee for this opportunity to respond to these very important proceedings.

I am a mother of three wonderful children, a board certified pediatrician, and a taxpayer who has been involved in children’s health and education public policy issues for many years.  I strongly agree with the testimony of Dr. Carey and Representative Bryson and I could not more strongly disagree with the testimony of Dr. Clawson.  Some of the very documents and researchers cited by Dr. Clawson will uphold that position.

I will make and support the following points in response to the testimony presented at the hearing:

1)      Attention Deficit /Hyperactivity Disorder (ADD/ADHD) is over diagnosed.

2)  Stimulant medications, as well as other psychotropic medications are over prescribed.

3)      Parents are being coerced to force their children to take stimulant medications and other psychotropic medication.

4)      The diagnostic criteria for ADD/ADHD and for all of the other mental illnesses are vague political and social constructs as admitted by those that define the criteria and there is not near as much agreement about those criteria as purported by Dr. Clawson.

5)      These medications are not at all effective in the long term.

6)      The psychotropic medications, both on and off the controlled substances list, are far from benign; their side effects are rarely adequately explained to parents; and there are no studies defining their effects on the developing nervous systems of growing children, especially those under the age of five years.

7)      No psychiatric illness is caused by naturally occurring deficiencies of any psychiatric drug, but there are many reasons that children may have symptoms of mental illness that are overlooked by both schools and physicians that can be corrected without psychiatric drugs.

8)      Although this bill is a tremendous and incredibly important means to protect our children, it is only a first step.  Left as is, this legislation may have the tragic unintended consequence of creating an incentive for schools to coerce parents to put their children on the other approximately 36 psychotropic medications that are not on the controlled substances list.

STATEMENT:

1)       Attention Deficit /Hyperactivity Disorder (ADD/ADHD) is over diagnosed

• Vera Hassner Sharav, MLS, President, The Alliance for Human Research Protection said in a comprehensive review of children in drug research studies published in April of 2003 in the American Journal of Bioethics [i] said,  “For example, Drs. Benedetto Vitiello, Peter Jensen, and Laurence Greenhill, whose work is supported by pharmaceutical companies and the NIMH, claim that the rate of ADHD in the U.S. is 3% to 5%. They also claim that even if drugs are over prescribed, ADHD is under diagnosed. Greenhill claims, ‘The percentage of U.S. youth being treated with psychostimulants is well within the estimates of the prevalence of ADHD.’ Jensen asserts that ‘only about one-half the children with ADHD are getting treated.’ They deny that there is any problem with over prescribing stimulant or psychoactive drugs for children. But a University of Massachusetts study found that less than one percent of elementary school children in the United Kingdom are diagnosed with ADHD. The study author concluded from that comparative statistic that ADHD may be culturally specific rather than biologically produced.”
  

• According to report by President Bush’s Commission on Special Education entitled A NEW ERA: Revitalizing Special Education for Children and their Families, 90% of students served under IDEA have “high incidence” disabilities such as mental, emotional, specific learning disabilities or “other health impairments.”[ii]
  

• The “other health impairment” category has “increased 319% in the last ten years” (since mental and emotional disorders were added to IDEA in 1991).  “Some of the growth in the other health impairment (OHI) category is the result of the growth in children identified as having ADHD, where a physician's signature is generally sufficient to trigger the eligibility process.”[iii]
  

• Using just the state of Minnesota as an example, the rate of designation for other health impairment, which includes ADHD, has gone up 830% since 1991 when the US Department of Education stated that ADD/ADHD could be part of the disorders covered under IDEA (MN Dept of Children Families and Learning).  It is a case of getting what one subsidizes.[iv]

2)      Stimulant medications, as well as other psychotropic medications are over prescribed.

• Prescription of psychotropic drugs, particularly Ritalin, for 2 to 4 year old children, increased 300% between 1991 and 1995.[v] Ritalin (methylphenidate), along with amphetamine and methampehtamine are in the stimulant class of psychiatric medications.  Ritalin is the drug most commonly used to treat ADHD
  

• A study published in January 2003 in the Archives of Pediatric and Adolescent Medicine by the same author found a 300% increase in psychotropic drug use in children between 1987 and 1996, that 6% of ALL children in the study were on psychiatric medications, and a sharp rise in use of antipsychotic in poor children.  The latter finding led the author to theorize that medications were being used as a social control tool in low-income populations. [vi]
  

• Data on “‘drug mentions’ that occur during a hospital or office visit when a doctor provides or prescribes a medication, or orders it refilled” was analyzed by the National Center for Health Statistics for a Sacramento Bee story published on June 23, 2002.[vii]  According to that data, stimulants such as Ritalin were mentioned 5.3 million times in the year 2000, which was nearly twice as often as they were mentioned in 1995-1996.  Antidepressant mentions doubled in that same period after already increasing four fold from 1990 to 1995.
  

• “Although SSRI’s had until recently been approved for use only by adults over the age of 18, they have and are being widely and often inappropriately prescribed for children, without medical justification or evidence of safety. What’s more, they are being prescribed to younger and younger children, singly and in combination with stimulants and antipsychotics…FDA statistics compiled by an industry research firm indicate that Prozac ‘was prescribed 349,000 times to pediatric patients under 16-including 3,000 times to infants under 1 year of age.’”[viii]

3)      Parents are being coerced to force their children to take stimulant medications and other psychotropic medication.

ICSPP IDEA task force member, Doretta Hegg, M.A., founder of C.H.I.L.D., sees repetitive intimidation and suggestive coercion employed by schools that panic parents into putting their child on a psychotropic medication. Here are a few examples from around the country of parents who have been willing to speak out:

o       In New York, Patricia Weathers [ix] and the Carroll [x] families were threatened or charged with child abuse for wanting to take their sons off of stimulant medications following adverse reactions. The Carroll family was ordered by a judge to continue the medication despite the drug's severe adverse effects on Kyle's sleep and appetite. According to New York Post reporter Douglas Montero, “Assemblyman Felix Ortiz, the Brooklyn Democrat trying to create a law banning educators from verbally prescribing Ritalin, said that since last week, his office has received 63 phone complaints from parents.” [xi]

o       Neil Bush, brother of President George W. Bush, stated that he endured pressure from a private school in Houston to medicate his son Pierce with Ritalin for ADHD incorrectly diagnosed by the school. “There is a systemic problem in this country, where schools are often forcing parents to turn to Ritalin,” said Bush, 47, who spent years researching the issue. “It's obvious to me that we have a crisis in this country.” Neil Bush also said, “The problem is, it isn't the kids that are broken. It's the system that is failing to engage children in the classroom,” and “My heart goes out to any parents who are being led to believe their kids have a disorder or are disabled.” [xii]

o       Paul Johnston of West Virginia began kindergarten as an exuberant and very normal five year old until the teacher began pressuring his parents to have him evaluated for ADHD. The parents were coerced into starting him on Ritalin, and he was eventually "treated" with a total of sixteen different psychotropic medications and experienced seven hellish years of drug-induced psychosis. He was finally released from an institution after a court battle and was carefully withdrawn from the medication by Dr. Breggin. [xiii]

o       Daniel Salazar’s parents, Raul and Yolanda, were threatened with removal of Daniel from their home in Florida if they did not give Daniel psychiatric drugs. [xiv]

o       Matthew Smith of Michigan died of cardiac effects of stimulant medication after his parents were coerced into starting him on Ritalin.  His father stated, “She [the school social worker] told my wife and I that if we wouldn't consider drugging our son, after the school had diagnosed him with Attention Deficit Hyperactivity Disorder (ADHD), that we could be charged for neglecting his educational and emotional needs.”[xv]

o       Vicky Dunkle of Pennsylvania lost her 14-year-old daughter Shaina to cardiac toxicity from the drug desipramine after the school coerced her into starting that medication for supposed attention problems.[xvi]

4) The diagnostic criteria for ADD/ADHD and for all of the other mental illnesses are vague political and social constructs as admitted by those that define the criteria and there is not near as much agreement about those criteria as purported by Dr. Clawson.

o       The 1999 Surgeon General's Report on Mental Health that Dr. Clawson so frequently quotes says, “The diagnosis of mental disorders is often believed to be more difficult than diagnosis of somatic or general medical disorders since there is no definitive lesion, laboratory test or abnormality in brain tissue that can identify the illness”

o       All of the following quotes are from Attention Deficit Hyperactivity Disorder  State of the Science - Best Practices, Peter S. Jensen and James R. Cooper, Eds, Civic Research Institute, Kingston, N.J. 200

•  “Diagnostic categories of mental disorders are social constructions (Bandura, 1969).  It is essential, therefore, that the mental health field continually question whether diagnostic categories are defined in ways that serve the best interests of the diagnosed.  That is, each of the many aspects of the validity of each diagnosis, including ADHD, must be thoughtfully and persistently questioned.” (p. 1-8,9)

• “At present, there is growing evidence that two valid dimensions of impairing ADHD behaviors can be identified, but there is no evidence of a natural threshold between ADHD and ‘normal’ behavior. . .Thus, there is little evidence at this time to suggest that there is a natural boundary for the diagnostic category of ADHD.” (p. 1-14)

• “The assumption that the ADHD symptoms arise from cerebral malfunction has not been supported even after extensive investigations.  The current diagnostic system ignores the probably contributory role of the environment; the problem is supposedly all in the child. The questionnaires most commonly used to diagnose ADHD are highly subjective and impressionistic.” (p. 3-2)

•  “No consistent structural, functional, or chemical neurological marker is found in children with the ADHD diagnosis as currently formulated.” (p. 3-7)

o       “DSM-IV criteria remain a consensus without clear empirical data supporting the number of items required for the diagnosis . . . Furthermore, the behavioral characteristics specified in DSM-IV, despite efforts to standardize them, remain subjective . . . ”[xvii] 

o       “Problems of diagnosis include differentiating this entity from other behavioral problems and determining the appropriate boundary between the normal population and those with ADHD”[xviii]            

o       The 2001 World Health Report by the World Health Organization states, “Childhood and adolescence being developmental phases, it is difficult to draw clear boundaries between phenomena that are part of normal development and others that are abnormal.”

o       The New Era report says that children with these “high incidence” ‘disorders’ “cannot be identified on the basis of acuity, physical or neurological findings.”

o       On August 6, 2002, The Netherlands Advertisement Code Commission (Reclame Code Commissie) ruled that the country's Brain Foundation cannot claim that the controversial psychiatric condition Attention Deficit Hyperactivity Disorder (ADHD) is a neurobiological disease or brain dysfunction. The Commission ordered the Foundation to cease such false claims in their advertising.   The Commission stated,  “The information that the defendant presented gives no grounds for the definitive statement that ADHD is an inherent brain dysfunction. Under the circumstances, the defendant has not been careful enough and the advertisement is misleading.”

o       “The language used to present these criteria and procedures exudes the spirit of technical rationality.  The diagnosis comes with its unique code number; references to other complex concepts, e.g., mental age; specifications about precise duration (six months) and the number of symptoms needed; vague references to unspecified research about ‘discriminating power’ and national field trials; and defined levels of severity.  Through these criteria, describing common, everyday behaviors of children, the rhetoric of science transforms them into what are purported to be objective symptoms of mental disorder.  On closer inspection, however, there is little that is objective about the diagnostic criteria.”[xix] 

5)      These medications are not at all effective in the long term.

o       Neither the long-term effectiveness nor the long-term safety of stimulant medications has ever been demonstrated (Gillberg et al., 1997; Jacobvitz et al. 1990; Klein, 1993; Spencer, Biederman, Wilens, et al., 1996) Yet, precisely this information is needed to effectively weight the risks and benefits of treatment and to provide or receive truly informed consent.”[xx] 

o       “Parents and teachers should not expect long-term improvement in academic achievement or reduced anti-social behavior… Teachers and parents should not expect significantly improved reading or athletic skills, positive social skills, or learning of new concepts.” [xxi]

o       “Stimulants do not produce lasting improvements in aggressivity, conduct disorder, criminality, education achievement, job functioning, marital relationships, or long-term adjustment.” [xxii] 

o       “Long term efficacy of stimulant medication has not been demonstrated for any (original emphasis) domain of child functioning.” [xxiii]

o       “...these drugs have almost no effect on academic achievement.” [xxiv]

o       “In FDA’s ‘Background Comments on Pediatric Depression,’ (2000) Dr. Robert Temple, Office of Drug Evaluation at the FDA, acknowledged ‘the preponderance of negative studies of antidepressants in pediatric populations.’” [xxv]

6)      The psychotropic medications, both on and off the controlled substances list, are far from benign; their side effects are rarely adequately explained to parents; and there are no studies defining their effects on the developing nervous systems of growing children, especially those under the age of five years.

o       According to research highlighted by psychiatrist, Dr. Peter Breggin in his book Talking Back to Ritalin, these medications actually cause the same symptoms they are supposed to treat - hyperactivity, impulsivity and inattention, which can lead to a vicious cycle of incorrect and dangerous dosage increases. [xxvi]

o       These drugs work by altering brain function, causing a short-term change in behavior that may actually interfere with learning. They produce rote compliance in structured environments at the cost of spontaneity, creativity and social interaction. The stimulant drugs also impair flexible problem-solving and divergent thinking. James Swanson, a researcher for the U.S. Department of Education and leading Ritalin advocate, stated in a 1992 review of the medical literature that this type of "cognitive toxicity may occur at commonly prescribed clinical doses of stimulants," and in up to 40% of patients. [xxvii]

o       Other very worrisome side effects include sleeplessness, weight loss, growth retardation including decreased brain growth, heart damage including cardiac arrest, atrophy (shrinkage) of the brain, psychosis, and violence. [xxviii] Particularly concerning is a 1986 study that showed cortical atrophy in 50% of a group of 24 young adults who had been on Ritalin for several years in their childhood. [xxix] Dr. Breggin reiterates this concern by saying, “Brain structural abnormalities found in children diagnosed with ADHD and treated with stimulants - to the extent that they are valid findings - are almost certainly due to the stimulants and other psychiatric medication to which they have been exposed. These studies add to the accumulating evidence that psychostimulants cause irreversible brain damage.” [xxx] 

o       Psychosis is one manifestation of the kind of brain damage that can occur from use of the stimulants. The risk of psychosis is listed in the package insert, but receives little attention from physicians and is rarely discussed with parents. Psychosis may happen as a toxic reaction to the stimulant medications or as they are withdrawn after long-term use. Previously thought to occur in 1% of patients on the stimulants, a 1999 study from the Canadian Journal of Psychiatry showed that the incidence of drug-induced psychosis is closer to 9% and that is probably an underestimate.[xxxi]  A 1993 study by Koek and Colpaert states that Ritalin “induces a psychopathology that seems to mimic schizophrenic psychosis more closely than amphetamines and cocaine.” [xxxii] These schizophrenic-like and manic-like reactions to stimulants are thought to lead to violence as well as depression and suicide. [xxxiii]  All four of the perpetrators of the major school shootings were taking psychiatric drugs, some including Ritalin, at the time of their crimes. [xxxiv]

o       The package insert for Ritalin confirms that there are no long-term studies on the effects of these medications on young children's growing brains. It says in the “WARNING" section, "Sufficient data on safety and efficacy of long-term use of Ritalin in children are not yet available," and Ritalin should not be used in children under six years, since safety and efficacy for this age group have not been established.” Yet, both of these warnings are routinely ignored as described by the Zito study in item 2 above. 

o       “In 1991, Dr. Robert King and colleagues at Yale published one of the few reports about the emergence of self-destructive, suicidal behavior in children and adolescents during treatment with Prozac. They noted the need to study the incidence of medication-related agitation, self-injury and emerging suicidal obsession in children taking SSRIs. But neither NIMH nor the FDA has initiated such study.” [xxxv] 

o       Prozac (as has been shown above) generated more adverse drug reaction reports than any drug in America, including 2,000 reports of suicide deaths linked to Prozac which, by the agency’s own calculations reflects but a fraction of the likely number of suicides.” [xxxvi]

o        “Until the introduction of the atypical antipsychotics, clozapine (Clozaril) and olanzapine (Zyprexa), the condition [adult onset diabetes] was rare in children and adolescents At the August 2001 meeting of American Psychiatric Association, Dr. Frank J. Ayd,313 an internationally renowned psychopharmacology expert, and editor of the International Drug Therapy Newsletter, presented findings of his review of the literature for atypical antipsychotics. He found a “startling” association between initiation of treatment with olanzapine and new-onset diabetes in adolescents:  ‘New-onset diabetes after antipsychotic treatment initiation is startling, since the use of atypical antipsychotics has become the first line of treatment for schizophrenia…Twenty-six case reports were analyzed, of which 14 reports of diabetes, diabetic ketoacidosis (DKA) or worsening diabetic blood glucose control after initiation of olanzapine were found. Five (36%) of these patients developed DKA. Seventy-nine percent of the patients were compelled to discontinue their antipsychotic. Eighteen percent of the patients who discontinued their medications required long-term insulin; 18% required long-term oral hyperglycemic treatment.’”[xxxvii] 

o       “The drug company which makes Seroxat [the British version of Paxil], the antidepressant which thousands of people say they cannot give up because of severe withdrawal effects, is to drop the claim on its patient leaflet saying the drug is not addictive. The admission of a change of policy from GlaxoSmithKline, Britain's biggest pharmaceutical company, comes in a BBC Panorama programme to be shown on May 11.”[xxxviii]

o       “Numerous reports have linked these drugs to serious adverse effects and potential long-term harm. TCAs have been linked to cardiac arrhythmias, and “sudden death.”[xxxix]

o       “The neuroleptic drugs used since the 1950s ‘worked’ by hindering normal brain function: they deemed psychosis, but produced pathology often worse than the condition for which they have been prescribed—much like physical lobotomy which psychotropic drugs replaced. But for forty years psychiatry denied that these drugs caused debilitating neurological, cognitive and motor impairment (Parkinson’s symptoms). … Psychiatry steadfastly denied the emergence of disabling drug-induced side effects such as tardive dyskinesia (TD), the second most pervasive drug-induced pathology…In fact, TD is a debilitating (often irreversible) condition caused by neurological damage, characterized by disfiguring involuntary muscle movements of the face and neck. Recent research findings corroborate earlier reports linking TD to a deterioration of cognitive functions.  It is estimated that TD afflicts 40% to 60% of patients taking neuroleptics over time its incidence rate increases with each year.”[xl]

7)      No psychiatric illness is caused by naturally occurring deficiencies of any psychiatric drug, but there are many reasons that children may have symptoms of mental illness that are overlooked by both schools and physicians that can be corrected without psychiatric drugs.

Here are some examples in the main categories: 

o       Medical

• Other undiagnosed illnesses [xli]

• Reactions to medications for almost any illness [xlii]

• Nutritional/Metabolic [xliii] 
  

• Artificial colors in food 

• Hypoglycemia 

• Food allergies and intolerances

• Vitamin, mineral, and essential fatty acid deficiencie

• Hormonal imbalances - esp. thyroid

• Amino acid imbalances 

• Inherited metabolic disorders
  

• Environmental allergies and toxicity [xliv]

• Pesticides and chemicals used in homes and schools

• Pollution

• Radon

• Hormones and antibiotics in meat

• Heavy metal toxicity

• Lead and cadmium

• Mercury - from vaccines and dental fillings [xlv]  
  

• Vaccine reactions [xlvi]

• Overuse of antibiotics / yeast [xlvii]

o       Educational

• LLITERACY – “…up to 90 percent of children identified as SLD have reading as their primary area of difficulty.” [xlviii]
  

• Increase in per pupil funding for schools (IDEA and Elementary and Secondary Education Act) - Schools may exempt IDEA children from the federally mandated assessments that determine the majority of federal funding states and school districts receive based on “adequate yearly progress” [xlix] under the ESEA. This is done frequently for minority students, which is one reason so many minority students are labeled as emotionally disturbed or mentally retarded. [l]  The per pupil funding in IDEA was changed in the 1997 reauthorization to prevent over-labeling, but that did not go into effect until 2000, so it is unclear that it has helped.
  

• Outcome based education via federal mandates - These mandate the teaching of a psychosocially based curriculum [li] that creates cognitive dissonance in children when taught by the schools to believe things other than those on which they have been raised. [lii] This curriculum also deprives poor children of the academic basics that they desperately need to obtain a better life. The boredom and frustration can lead to behavior problems and even violence. [liii]
  

• Attempt to gain correct thought and action based on federal curriculum [liv] - Much personal and psychological data is collected on students via surveys and assessments. [lv] One example from the Cornell Review and Fox News, which documented in January, 2002 is a stunning example of grading based on attitudes, which could easily lead to labeling and drugging: “School officials in Ithaca, N.Y., are requiring that first- and second-graders there be graded on their tolerance, reports the Cornell Review. The kids will get grades based on how well they 'respect others of varying cultures, genders, experiences, and abilities.' The grade will appear on report cards under the heading 'Lifelong Learning Skills.' It appears well before social studies, science, reading, or writing.” [lvi] Lifelong Learning is part of the School to Work program, which also passed in 1994. STW tracks children into jobs chosen by big business and the government. Success in this system depends not on what one knows, but rather what one thinks and believes. [lvii] 
  

• Effort to gain academic advantage (e.g. untimed tests)

• Boring, ineffective, and unsafe classrooms

o       Societal

• Behavior control tool for parents and teachers

• Societal changes and pressures 

• Divorce 

• Daycare 

• Teen parenthood

• "Hurried" child 

• Television and video games

• Temptation for people to want to receive Social Security disability income

• Feminism - The War Against Boys [lviii] 

• Drug company profits

8)      Although this bill is a tremendous and incredibly important means to protect our children, it is only a first step.  Left as is, this legislation may have the tragic unintended consequence of creating an incentive for schools to coerce parents to put their children on the other approximately 36 psychotropic medications that are not on the controlled substances list.

o       Psychiatric drugs on the controlled substances list [lix] – Total 8-14 if counting various forms and brands of methylphenidate, methamphetamine, and amphetamine

• Schedule II – Ritalin, Focalin, Concerta, Metadate (all forms of methylphenidate), Desoxyn, Gradumet (forms of methamphetamine) Dexedrine, Dextrostat (forms of d-amphetamine), and Adderall (combination of amphetamine and d-amphetamine)

• Schedule III – Tranxene, Valium, Ativan, Xanax

• Schedule IV – Cylert

o       Drugs NOT on the controlled substances list [lx] – Total 36

• ADHD – Straterra, whose side effects are largely unknown because it has only been on the market since January of 2003, but is already gaining considerable market share.

•  “Shire Pharmaceuticals has suffered a blow after Eli Lilly posted better than expected sales of a rival to the company's number one Adderall hyperactivity drug.
  Industry experts said news that Eli Lilly's Strattera attention deficit and hyperactivity disorder drug had achieved sales of $55 million since its US launch in January had damaged Shire's share price.
  Straterra's performance had exceeded expectations, and projected over the rest of the year, these early sales figures could considerably undermine Adderall's market share.” [lxi]
  

• SSRIs for Depression, Panic, Obsessive Compulsive Disorder, and Anxiety - Paxil, Prozac, Luvox, Zoloft, and Celexa

• Note the concerns about suicide, violence and addiction/withdrawal with these drugs listed in item 6 above.

• Eric Harris of Columbine; Kip Kinkel of Springfield, Oregon; and Jason Hoffman of San Diego were all on this class of medication at the time of their school shootings.  

• Other Antidepressants - Effexor, Remeron, Serzone and Wellbutrin

• Monoamine Oxidase Antidepressants - Nardil and Parnate (not often used anymore in children)

•  Tricyclic Antidepressants - Norpramin, Sinequan, Surmontil, Aventyl, Elavil, and Vivactil (not used as often since the SSRIs came on the market, but still used in children)

• Note the concerns regarding cardiac arrhythmia and sudden death with these drugs and that Shaina Dunkle died of this toxicity after being coerced by her school to take desipramine (Norpramin)

• Anti-Manic Agents - Depakote, Eskalith, Lithobid, Zyprexa

• Note the discussion of adult onset diabetes due to Zyprexa, which is also used to treat psychosis in children and adolescents as discussed in item 6 above.

• Miscellaneous Antipsychotic Agents - Clozapine, Clozaril, Geodon, Haldol, Loxitane, Moban, Navane, Risperidal, Seroquel

• Note the concern about adult onset diabetes in children due to Clozaril as discussed in item 6 above.

• Phenothizines - Compazine, Serentil, Stelazine, Thorazine

• Note the strong concern about tardive dyskinesia, motor and cognitive impairment due to these drugs as discussed in item 6 above.

• Antipanic – Klonopi

RECOMMENDATIONS:

1)      Due to the possibility of coercion with drugs that are not on the controlled substances list; that drugs not on the controlled substances list have caused serious side effects such as psychosis, suicide, violence, addiction, diabetes and neurological problems; that there are no long term studies on the safety or effectiveness of any of these medications in growing children; and because the decision to have a child take these drugs should be solely between parents and medical providers, all of the groups that I represent strongly recommend that HR 1170 be changed to prohibit coercion with any psychiatric drug.

2)  The penalty of “as a condition of receiving funds under any program or activity administered by the Secretary of Education” is very welcome because a prohibition without teeth would be meaningless.  Please do not take this language out as was done in HR 1350 or consider a stronger penalty such as loss of some percentage of funds for each occurrence of coercion.

Thank you for your consideration.

ENDNOTES:

(1) Sharov, V., (2003) Children in Clinical Research: A Conflict of Moral Values, The American Journal of Bioethics 3(1):InFocus. http://bioethics.net/in_focus/sharav.pdf, p. 15

(2) Presidential Commission Report - A NEW ERA: Revitalizing Special Education for Children and their Families7/02, p. 21at http://www.ed.gov/inits/commissionsboards/whspecialeducation/reports/pcesefinalreport.pdf

(3) Ibid, p. 23

(4) MN Dept of Children Families and Learning data from annual reports on students receiving IDEA funds

(5) Zito, J., et al. (2/23/00) Trends in the prescribing of psychotropic medications to preschoolers. Journal of the American Medical Association, 283:1025-1030

(6) Zito, J., et al, (1/13/03) Psychotropic Practice Patterns for Youth A 10-Year Perspective. Archives of Pediatric & Adolescent Medicine, 157:17-25

(7) Griffith, D., Pills or Patience? (6/23/02) Sacramento Bee, 6/23/02 at http://www.sacbee.com/content/news/story/3313233p-4344565c.html

(8) Sharav, p. 27 of pdf

(9) Montero, D., (8/7/02) I was forced to dope my kid, New York Post at http://www.nypost.com/news/regionalnews/54243.htm last visited 8/30/02

(10) Karlin, R., (7/19/00) Court orders couple to give son drug (Ritalin) after school turns parents in, Albany Times Union

(11) Montero, D., (8/14/02) Bush's Bro: My Son was a Victim of School Rx, New York Post at http://www.nypost.com/seven/08142002/commentary/54735.htm last visited 8/30/02

(12) Ibid.

(13) (June, 2002) A Parent's Nightmare: Losing a Child to Drug-Induced Psychosis, Education Reporter at   http://www.eagleforum.org/educate/2002/june02/drug-induced.shtml last visited 5/13/03

(14) Eakman, B., (September, 2002) Uncle Sam’s Classrooms, Chronicles, pp. 40-42 at http://www.beverlye.com/classroom_20000821.html last visited 5/13/03

(15) http://ritalindeath.com/homepage.htm last visited 5/13/03

(16) http://ritalindeath.com/crusade.htm last visited 5/13/03

(17) American Psychiatric Association Committee on the Diagnostic and Statistical Manual (DSM IV- 1994), pp.1162-1163

(18) NIH Consensus Development Panel, (2000) p. 183

(19) Kirk, S. and Kutchins, H. (1992). The selling of science in psychiatry, New York:  Aldine DeGruyter

(20)  Jenson and Cooper, p. 10-8

(21) Swanson, J., (circa. 1993) Research synthesis of the effects of stimulant medication on children with attention deficit disorder: A review of reviews.  Executive Summary prepared for Division of Innovation and Development , Office of Special Education Programs, Office of Special Education and Rehabilitative Services, U.S. Department of Education, Washington D.C. as quoted in Breggin, P., (2001) Talking Back to Ritalin, Cambridge, Massachusetts, Perseus, pp. 125 and 127

(22) Popper, C. and Steingard, R. (1994) Disorders usually first diagnosed in infancy, childhood or adolescence in Hales, R. et al (Eds.), The American Psychiatric Press Textbook of Psychiatry, 2^nd Edition, Washington, D.C., American Psychiatric Press, pp. 729-832 as quoted in Breggin, p.125   

(23) Richters, J., et al. (1995) NIMH collaborative multisite, multimodal treatment study of children with ADHD: I. Background and Rationale, Journal of the American Academy of Child and Adolescent Psychiatry, 34, pp. 987-1000 as quoted in Breggin, p. 125

(24) Barkley, R. and Cunningham, C. (1978) Do stimulant drugs improve the academic performance of hyperkinetic children? A review of outcome studies. Clinical Pediatrics, 8, pp. 137-146 as quoted in Breggin, p. 129  

(25)http://www.fda.gov/cder/pediatric/antidepressant_wr_template.htm.as quoted in Sharav, p. 16

(26) Breggin, p. 40

(27) Ibid., pp. 49-50

(28) Ibid., p. 32

(29) Nasrallah, H., et.al., (1986) Psychiatry Research 17:241-246, as quoted in ibid., p.67

(30) Ibid., p. 69

(31) Cherland and Fitzpatrick, (October, 1999) Canadian Journal of Psychiatry, as quoted in ibid., p. 45

(32) Koek, W., and Colpaert, F.C., (1993) Journal of Pharmacology and Experimental Therapeutics, Vol. 267, p. 181-191, as quoted in ibid, p. 46

(33) Ibid., p. 47

(34) See Farber, B., (July 2, 2001) The Link Between Anti-depressants and Mayhem, Newsmax.com, at http://www.newsmax.com/archives/articles/2001/7/2/181622.shtml

(35) King RA, Riddle MA, Chappell PB, Hardin MT, Anderson GM, Lombroso P, Scahill L. (1991).
Emergence of self-destructive phenomena in children and adolescents during fluoxetine treatment. Journal of the American Academy of Child & Adolescent Psychiatry, 30:179-86, as quoted in Sharav, p. 28 of pdf 

(36) FDA Center for Drug Evaluation and Research. ADR reports for Prozac between 1987-1995.
Document HFI-35. Obtained by Prozac Survivor's Support Group, Inc. under the US Freedom of Information Act. A summary version of the FDA statistics is available online at: http://www.cris.com/~shddemon/prozac.reactions

(37)Ayd, FJ. 2001. Research Presented at Annual Meeting. Psychiatric Times (August) Vol. 18.
Accessed Feburary 25, 2003 online at: http://www.psychiatrictimes.com/p010823.html as quoted in Sharav, p. 37 of pdf

(38) Bosley, S. (May 3, 2003) Seroxat maker abandons 'no addiction' claim - Firm agrees to alter leaflet to patients after complaints. At http://www.guardian.co.uk/Print/0,3858,4660951,00.html

(39) See, for example, Wilens TE; Biederman J, Baldessarini RJ, Geller B, Schleifer D, Spencer TJ, Birmaher B, Goldblatt A.. 1996. Cardiovascular effects of therapeutic doses of tricyclic antidepressants in children and adolescents. Journal Of The Association Of American Child & Adolescent Psychiatry. 35: 1491-501; Mezzacappa E, Steingard R, Kindlon D, Saul JP, Earls F.

1998. Tricyclic antidepressants and cardiac autonomic control in children and adolescents. Journal Of The Association Of American Child & Adolescent Psychiatry. 37 52-9.  Also see, for example, Riddle MA, Geller B, Ryan N. (1993) Another sudden death in a child treated with desipramine. Journal Of The Association Of American Child & Adolescent Psychiatry, 32:792-7. See also, Kutcher, S. 1997. Practitioner review: the pharmacotherapy of adolescent depression. Journal of Child Psychiatry. 38: 755-67; Swanson J. M., Kraemer, H. C., Hinshaw, S. P., Arnold, L. E., Conners, C. K., Abikoff, H. B., et al. 1997. Death of two subjects due to imipramine and desipramine metabolite accumulation during chronic therapy: a review of the literature and possible mechanisms. Journal of Forensic Science. 42: 335-9; and Varley, C. K. and McClellan, J. 1997. Case study: two additional sudden deaths with tricyclic antidepressants. Journal Of The Association Of American Child & Adolescent Psychiatry. 36: 390-4 as quoted in Sharav, p. 16.

(40) See, Miller LG, Jankovic J 1990 Neurologic approach to drug-induced movement disorders: a study of 125 patients. South Med J. 83:525-32; Braus DF, et al. 1999. Antipsychotic drug effects on motor activation measured by functional magnetic resonance imaging in schizophrenic patients. Schizophrenia Research. 39:19-29; Muscettola, G. et al.1999. Extrapyramidal syndromes in neuroleptic-treated patients: prevalence, risk factors, and association with tardive dyskinesia.

Journal of Clinical Psychopharmacology. .Jun, 19:203-8. Also see McShane R, Keene J, Gedling K, Fairburn C, Jacoby R, Hope T. 1997. Do neuroleptic drugs hasten cognitive decline in dementia? Prospective study with necropsy follow- up. British Medical

Journal, 314: 266-271; Paulsen, JS. et al. 1994.Neuropsychological impairment in tardive dyskinesia. Neuropsychology. 8: 227-241; Waddington JL, Youssef HA. 1996. Cognitive dysfunction in chronic schizophrenia followed prospectively over 10 years and its longitudinal relationship to the emergence of tardive dyskinesia. Psychological Medicine. 26: 681-688 and

Sachdev P, Hume F, Toohey P, Doutney C. 1996. Negative symptoms, cognitive dysfunction, tardive akathisia and tardive dyskinesia. Acta Psychiatrica Scandinavica, 93:451-459.  All are as quoted by Sharav, p. 38.

(41) See any pediatric or internal medicine textbook.

[42) See any edition of the Physician's Desk Reference or any pharmacology textbook.

(43) See, for example, Murray, M. and Pizzorno, J., (1998) Encyclopedia of Natural Medicine, Revised 2nd Edition, Rocklin, CA, Prima Publishing pp. 273-281

(44) See, for example, Rapp, D., (1996) Is This Your Child's World? - How You Can Fix the Schools and Homes That Are Making Your Children Sick, New York, Bantam

(45) Cave, S., (2001) What Your Doctor May NOT Tell You About Children's Vaccinations, New York, Warner Books, p. 39-56

(46) Ibid., pp. 57-78

(47) Crook, W., (1991) Help for the Hyperactive Child, Jackson, TN, Professional Books

(48) A New Era, p. 22

(49) See The No Child Left Behind Act of 2001, Section 1111, (b)(2)(C)

(50) See (2002) Minority Students in Special and Gifted Education, Washington D.C., National Academy Press, especially Chapter 2 at http://books.nap.edu/books/0309074398/html/index.html

(51) See the Goals 2000 chapter of Quist, A. (1999) The Seamless Web. Mankato, MN Maple River Education Coalition

(52) Eakman, B., (September 2002) Bushwhacking Johnny, Chronicles Magazine, pp. 41-43 at http://www.beverlye.com/bushwhack_20020902.html

(53) Brunner, M., (1993) Retarding America, Imprisoning Potential, Halcyon House as quoted in Eakman, B. (1998) Cloning of the American Mind: Eradicating Morality through Education, Lafayette, LA, Huntington House p. 385

(54) See Quist, A. (2002) FedEd – The New Federal Curriculum and How It’s Enforced. St. Paul, MN The Maple River Educaiton Coalition

(55) See Effrem, K. Data Privacy Chapter of Quist, A., (1999) The Seamless Web, Mankato, MN Maple River Education Coalition at http://www.edwatch.org/seamless_web.htm

(56) Fox News (1/7/02) Education Priorities at http://www.foxnews.com/story/0,2933,42242,00.html

(57) See Chapman, M., and Bachmann, M., US Policy embraces State-Planned economy, Maple River Education Coalition at http://www.edaction.org/upda0219.htm

(58) See Sommers, C. (2001) The War Against Boys: How Misguided Feminism is Harming Our Young Men, Touchstone

(59) (2003) Physicians’ Desk Reference, 57^th Edition, Montvale, NJ, Thomson PDR, pp. 208 and 213

(60) Ibid., p. 213

(61)Shire slips as Lilly positive on rival drug (April 25, 2003) at http://www.datamonitor.com/~aa81043764464e2ab7ab752e7b4f6216~/healthcare/news/
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