CHILDREN: OUR TREASURE

by Dan L. Edmunds, Ed.D.

CHAPTER ONE: MEETING THE TRUE NEEDS OF OUR CHILDREN DIAGNOSED AS 'ADHD'

How should one look upon Attention Deficit Hyperactivity Disorder (ADHD) and what is the effective way to aid those who are given this diagnosis? There has been considerable debate as to whether or not ADHD is a genuine disorder. Psychiatrist and professor Robert Hedaya (1996, pg. 140) mentions that an examination by Hartmann in 1993 felt that ADHD is actually normal variant of human behavior that doesn't fit into cultural norms.

In addition, there is no objective test for this disorder. Hedaya (1996, pg. 140) mentions that a commonly used test is the TOVA (test of variables of attention), a test where the client must use a computer and hit a target at various points. This test is designed to measure the person's response time and distractibility. However, Hedaya (1996, pg. 140) notes, this tool cannot be relied upon to make or exclude the diagnosis in and of itself. Hedaya (1996, pg. 268) notes that there has been controversy in the use of stimulants for the treatment of ADHD, he states, medications alone do not provide adequate or full treatment in this disorder.

Hedaya (1996, pg. 269) notes that the most serious risk in the use of methylphenidate (Ritalin) for ADHD is that about 1% of these children will develop tics and or Tourette's Syndrome. Hedaya asks the question,” One might wonder-, why use methylphenidate at all?" Hedaya argues that the side effects involved in the use of methylphenidate are mild. However, he notes that side effects include nervousness, increased vulnerability to seizures, insomnia, loss of appetite, headache, stomachache, and irritability. Hedaya (1996, pg. 271) argues that the causation of ADHD lies in problems in dopamine regulation in the brain and states that stimulants work by stimulating dopamine in the brain and thus the symptoms of ADHD are lessened.

However, previously Hedaya states that Zametkin (1995) noted that stimulants have the same effect in both those diagnosed as ADHD and those who are not (Hedaya, 1996, pg. 139). Dr. William Carey of the Children's Hospital of Philadelphia commented at the National Institutes of Mental Health Consensus Conference in 1998 that the behaviors exhibited by those considered ADHD were normal behavioral variations. A Multimodal Treatment Study was conducted by the National Institutes of Mental Health in 1999 in regards to ADHD. Psychiatrist Peter Breggin and the members of the International Center for the Study of Psychiatry and Psychology challenged the outcomes of this study because it was not a placebo controlled double blind study. Breggin also argues that that the analysis conducted of behaviors in the classroom of those children studied showed no significant differences between those children receiving stimulant medications versus those who only were utilizing a behavioral management program (MTA Cooperative Group, 1999a, pg. 1074). Breggin notes that there was no control group in the study of untreated children and that 32% of the children involved in the study were already receiving one or more medications prior to the onset of the study. Of those in the study who were the medication management group, they numbered only 144 of which Breggin finds to be enormously small.

Breggin states that in the ratings of the children themselves that they noted increased anxiety and depression however this was not found to be a significant factor by the investigators. Breggin also believes that the study was flawed in that drug treatment continued for 14 months whereas behavioral management was utilized for a much shorter duration. Breggin argues that the behavioral management strategies, which involved mainly a token economy system, were ineffective as well and did not take into consideration family dynamics but regardless, the study still showed that there was no difference between the populations treated with drugs versus those undergoing behavioral management solely. Breggin notes that many of the children receiving medications had adverse drug reactions, which consisted of depression, irritability, and anxiety. 11.4% reported moderate reactions and 2.9% had severe reactions. However, Breggin also states that those reporting the adverse drug reactions were not properly trained, but were rather only teachers and/or parents.

The study, as Breggin concludes, showed no improvement in the children treated with medications in the areas of academic performance or social skill development. Breggin feels that the study was improper in that all of the investigators were known to be pro-medication advocates prior to and after the study. Breggin states that Ritalin and other amphetamines have almost identical adverse reactions and have the potential for creating behavioral issues as well as psychosis and mania in some individuals. Breggin argues that these medications often cause the very behaviors they are intended to treat. He notes that children treated with these medications often become robotic and lethargic and that permanent neurological tics can result.

In his textbook, Attention Deficit Hyperactivity Disorder, Russell Barkley, an advocate for the use of methylphenidate in the treatment of ADHD, notes that there is little improvement in academic performance with the short-term use of psychostimulant medication. Barkley also acknowledges that the stimulant medications can affect growth hormone but at present there is not any knowledge of the long-term effects on the hypothalamic-pituitary growth hormones. Barkley (1995, pg. 122) also states, at present there are no lab tests or measures that are of value in making a diagnosis of ADHD.

Sidney Walker, III, (1998, pg. 25) a late board-certified neuropsychiatrist comments that a large number of children do not respond to Ritalin treatment, or they respond by becoming sick, depressed, or worse. Some children actually become psychotic - the fact that many hyperactive children respond to Ritalin by becoming calmer doesn't mean that the drug is treating a disease. Most people respond to cocaine by becoming more alert and focused, but that doesn't mean they are suffering from a disease treated by cocaine. It is interesting to note Walker's analogy of Ritalin to cocaine. Volkow and his colleagues (1997) observed in their study, (methylphenidate, like cocaine, increases synaptic dopamine by inhibiting dopamine reuptake, it has equivalent reinforcing effects to those of cocaine, and its intravenous administration produces a high similar to that of cocaine. Walker (1998, pg. 14-15) that in addition to emotional struggles of children leading to ADHD-like behavior, that high lead levels, high mercury levels, anemia, manganese toxicity, B-vitamin deficiencies, hyperthyroidism, Tourette's syndrome, temporal lobe seizures, fluctuating blood sugar levels, cardiac conditions, and illicit drug use would all produce behaviors that could appear as what would be considered ADHD however Walker feels that these issues are most often overlooked and the person is considered to be ADHD.

F. Xavier Castellanos states at the 1998 Consensus Conference that those children with ADHD had smaller brain size than those of children who were considered to be normal. However, Castellanos reported as well that 93% of those children considered ADHD in the study were being treated long term with psychostimulants and stated that the issue of brain atrophy could be related to the use of psychopharmacological agents. Dr. Henry Nasrallah from Ohio State University (1986) found that atrophy occurred in about half of the 24 young adults diagnosed with ADHD since childhood that participated in his study. All of these individuals had been treated with stimulants as children and Nasrallah and colleagues concludes that cortical atrophy may be a long term adverse effect of this treatment. Physician Warren Weinberg and colleagues stated, a large number of biologic studies have been undertaken to characterize ADHD as a disease entity, but results have been inconsistent and not reproducible because the symptoms of ADHD are merely the symptoms of a variety of disorders. The Food and Drug Administration has noted (Walker, 1998, pg. 27) that they acknowledge that as of yet no distinct pathophysiology (for ADHD) has been delineated.

There has been concern as well about the addictive component of psychostimulants. The Drug Enforcement Administration (1995c) reports that it was found that methylphenidate's pharmacological effects are essentially the same as those of amphetamine and methamphetamine and that it shares the same abuse potential as these Schedule II stimulants.

Breggin states that psychiatrist Arthur Green in the Comprehensive Textbook of Psychiatry published in 1989 reported that all commonly diagnosed disorders of childhood can be linked to abuse and/or neglect. Abuse and neglect produces difficulties in school, such as cognitive impairment, particularly in the areas of speech and development, combined with limited attention span and hyperactivity. (Breggin, 1991, pg. 274)

Being that ADHD is a subjective diagnosis and that stimulant treatment has been shown to have risk as detailed above, what is the effective alternative to aiding those who have been diagnosed ADHD and what actually is underlying the difficulties that these individuals may be manifesting? Psychologist and educator Michael Valentine (1988) suggests that it is necessary to “love your children, care about them, do as much as possible to have them grow and develop, teach them social skills, and teach them how to identify and express their feelings and to become uniquely human; but at the same time, care about them and love them enough to give them guidance, structure, limits, and control as they need it.

Valentine advocates a psychosocial approach to aiding children and adolescents who would be considered to be ADHD. Psychiatrist Peter Breggin also advocates this approach and feels that it is necessary for parents to feel empowered and for their to be a compassionate therapeutic adult in the lives of these children. Breggin (1998, pg. 308-310) feels it is necessary to examine the effects of institutionalization and placement on children as well as the effects of psychiatric stigmatization (that is, the effects on esteem of receiving the label of ADHD itself). It is necessary to examine the experience of the child and if they have suffered physical, sexual, or emotional abuse from adults, or have experienced peer abuse. It needs to be examined if they have an appropriate educational setting and if any conflicts exist with instructors or if the educational environment is stressful to them.

Psychiatrist William Glasser (2003, pg. 31-32) comments in this regard, pediatricians are being called in to diagnose schoolchildren who do not cooperate in school because they don't like it as having attention deficit disorder or attention deficit hyperactivity disorder. Treating them with a narcotic drug is only confirming what many psychiatrists and pediatricians already believe: that it's better to use drugs than to try to apply their prestige and clout in the community to the real problem: improving our school s so that students find them enjoyable enough to pay attention and learn in an environment where drugs are not needed. This misguided psychiatric effort has created an epidemic of drug treated mental illness in the schools.

Breggin continues that it is also necessary to examine the environment the child lives in and the stressors around them. It is necessary to build relationship and collaboratively design structure and limits with the child or adolescent (Breggin, 1998, pg. 318) Breggin feels it is necessary to train parents in relationship building with their children and in working through situations of conflict. He states, parent management training has consistently proven successful in improving parent self-esteem, in reducing parent stress, and in ameliorating ADHD-like symptoms, especially negative attitudes toward parental authority and aggression.

David Stein (2001, pg. 236-238) has detailed a drug free approach to aiding children who are diagnosed as ADHD who Stein prefers to call highly misbehaving children. In this program, known as the Caregiver's Skills program, Stein states it is necessary to treat your child as normal and not diseased. He states that the children should not be taking any medications, as they are risky for the child's health and merely blunt behaviors. Stein argues, if the behaviors don't occur, we can't help (them) learn new habits.

The program encourages social reinforcement rather than material reinforcement, encouraging parents to refrain from excessive prompting and coaxing. The program encourages development of target behaviors and consistent encouragement and social reinforcement as well as consistent consequences for misbehavior. The program encourages the self-assessment and evaluation of the child of their own behaviors.

REFERENCES:

Barkley, Russell, Taking Charge of ADHD, Boys Town, NE, Boys Town Press, 1995)

Breggin, Peter R., Reclaiming Our Children, Perseus, Cambridge, MA, 2000)

Breggin, Peter R., Talking Back to Ritalin, Common Courage Press, Monroe, ME, 1998)

Breggin, Peter R., Toxic Psychiatry, St. Martins Press, New York, 1991)

DuPaul, Barkley, and Connor, Stimulants (article appearing in text Attention Deficit Hyperactivity Disorder, 1998).

Glasser, William, Psychiatry Can Be Hazardous to Your Mental Health, Harper Collins, New York, 2003)

Hedaya, Robert J., Understanding Biological Psychiatry, W.W. Norton, New York, 1996)

Nasrallah, H.J., Loney, S. Olson, M. McCalley-Whitters, J. Kramer, and C. Jacoby, Cortical Atrophy in Young Adults with a History of Hyperactivity in Childhood, Psychiatry Research, 17:241-246, 1986)

National Institutes of Mental Health Consensus Conference Statement, 1998

Stein, David, Unraveling the ADHD Fiasco, Andrews McMeel, Kansas City, 2001)

Walker, Sidney, The Hyperactivity Hoax, St. Martins Press, New York, 1998)

Weinberg, Warren et al., Attention Deficit Hyperactivity Disorder: A Disease or a Symptom Complex, Journal of Pediatrics, 130, 665-6

CHAPTER TWO: THINKING OUTSIDE THE BIO-PSYCHIATRIC PARADIGM

As a person working within the mental health profession, I once challenged colleagues to examine the work that they do without using the terms 'mental illness', 'treatment', 'diagnosis' or the like. I could see that initially this was a challenging exercise, however the key terms that came forward were: conflict resolution, mediation, coaching, guiding.

These terms become important when we realize that those who have been labeled as seriously distressed and 'mentally ill' are individuals who have undergone conflict in their lives. These individuals are seeking a voice. Their actions are not random, but rather seek to communicate their experiences. Some individuals who have endured serious trauma begin to speak of their experiences in a metaphorical sense. The role of the therapist should be to help this individual find meaning in this experience, uncover unmet needs, and to listen and be able to understand this experience.

Biological determinism and the theory of distress arising from so-called chemical imbalances is a popular and majority idea in the mental health field today. However, there is no evidence to support such a concept. Such an idea helps to further the profits of the pharmaceutical industry who are able to make lifelong mental patients in need of their products through the promulgation of such chemical imbalance concepts. The President of the American Psychiatric Association recently stated that there is no 'clear cut test" to demonstrate chemical imbalances. Dr. Eliot Valentstein goes further to state, "Elliot Valenstein, Ph.D. says, “[T]here are no tests available for assessing the chemical status of a living person’s brain.” The late Dr. Loren Mosher who had headed Schizophrenia research for the National Institutes of Mental Health stated, “…there are no external validating criteria for psychiatric diagnoses.”

Psychiatry has an oppressive history. In the early 1900's the theory of the day was the concept of improper blood flow to the brain causing mental illness which led to the invention of oppressive treatments such as the 'swivel chair' which was designed to redistribute blood flow to the brain. In Nazi Germany, psychiatry was used as a tool of social control as well as in the Soviet Union where political dissenters were labeled mentally ill and institutionalized. The leader of the Bosnian Serb militia was Radovan Karadzic, a psychiatrist. Psychiatry has been used to oppress gay and lesbian persons who until 1973 were designated 'mentally ill' and African-Americans have also been oppressed as early psychiatry considered them to be suffering from mental illness known as "negritude" and had lower intelligence than that of Caucasian persons. Journalist Robert Whitaker in his text, Mad in America details the oppression that continues to this day in mental institutions in our own country.

Today’s mental health profession has been commandeered by biological psychiatry. Biological psychiatry has sought to look upon the behaviors and emotional world of our children and adolescents as the result of ‘broken brains' and views children expressing distress as somehow disordered. Many children today who show any type of inappropriate behaviors are often immediately being labeled as ADHD and being prescribed stimulant medications such as Ritalin, Adderall, or Dexedrine among others. There is no test for ADHD and neurological testing shows these children to be perfectly normal. Dr. William Carey of Children's Hospital in Philadelphia states, "common assumptions about ADHD include that it is clearly distinguishable from normal behavior, constitutes a neurodevelopmental (brain) disability, is relatively uninfluenced by the environment (home, school)...all of these assumptions...must be challenged because of the lack of empirical support and the strength of contrary evidence...what is now described in the US as ADHD is a set of normal behavioral variations. This discrepancy leaves the validity (of ADHD) in doubt. The U.S. National Institutes of Health Consensus Development Conference on ADHD in 1998 reported, " we have do not have an independent, valid test for ADHD, and there are no data to indicate that ADHD is due to a brain malfunction...and finally, after years of clinical research and experience with ADHD, our knowledge about the cause or causes of ADHD remains speculative." Further, Dr. Edward C. Hamlyn, a founding member of the Royal College of General Practitioners in 1998 stated, "ADHD is fraud intended to justify starting children on a life of drug addiction." The U.S. Surgeon General Report declares, "the exact etiology of ADHD is unknown." Lastly, Dr. Joe Kosterich, Federal Chair of the Australian Medical Association states, " "The diagnosis of ADD is entirely subjective.... There is no test. It is just down to interpretation. Maybe a child blurts out in class or doesn’t sit still. The lines between an ADD sufferer and a healthy exuberant kid can be very blurred." A report completed by the Oregon State University Drug Effectiveness Review Project (2005) studied 2,287 studies and concluded the following: “No evidence on long-term safety of drugs used to treat ADHD in young children” or adolescents.” Good quality evidence … is lacking” that ADHD drugs improve “global academic performance, consequences of risky behaviors, social achievements” and other measures. Safety evidence is of “poor quality,” including research into the possibility that some ADHD drugs could stunt growth, one of the greatest concerns of parents. Evidence that ADHD drugs help adults “is not compelling,” nor is evidence that one drug “is more tolerable than another.” The way the drugs work is, in most cases, not well understood."

What we are experiencing are children in conflict. We cannot blame and denigrate the child and not respect his dignity. We cannot label and suppress behaviors. If a child is conflict, we must take responsibility to see why this child is in conflict and to use responsible and carefully planned interventions to aid this child in being successful. Some believe that they see enormous benefits from children on medication. I will give them this benefit, only if we see suppression of behavior, basically chemical restraint, as our concepts of 'what works', of 'progress' or 'success'. Because something 'works' does not imply it is good or ethical. I could probably scientifically validate that strapping a child to a chair would also aid with supposed hyperactivity, but this would be aversive and illegal. But once again, we are taking normal children and drugging them to suppress their behaviors. In order to achieve such a 'result', just what is going on in this child's body? Stanley I. Greenspan, a clinical professor of psychiatry at George Washington University states that, " The growing use of medication on their own is a worrisome trend while more and more people on Prozac or Ritalin are becoming bolder and less distractible, at the same time, more and more people are altering their moods without understanding what is happening to them or how it relates to their core personalities." He also states, "given appropriate nurturing, many affected children may not require medication." University of South Florida Professor of Psychology, Diane McGuiness comments, "The first factor of being put on drugs is to attribute your bad behavior to factors beyond your control. Drugs become a substitute for learning self-discipline. This problem is compounded when children are taken off medication and problem behavior initially rebounds to fantastic proportions. Second, longitudinal studies have confirmed that children on drugs actually deteriorate in academic performance over time. And we must consider the sense of worthlessness most of these young people experience.(McGuiness, 1985). Paul Wender, M.D. lists criteria when beginning medication, he states that a child must first understand why he is receiving medication, yet as Greenspan states above, this isn’t always happening. Wender states, "Most acknowledge problems in his own behavior that he himself does not like, so that -he will not feel that medicine is being given to him simply so that other people can tolerate him more." Now, Wender is one who began the first tests on the use of methylphenidate and is in support of its use in treatment. Greenspan comments, "working with the strengths of a child can create motivation." A child needs to be able to recognize and be motivated to change behaviors and work on strengths. Even Wender states that getting a child to 'label' behaviors is effective, that a child must recognize what is appropriate and what is not, and that parents should not encourage the idea that because the medication was wearing off or so forth that such excuses a level of knowledge and responsibility for certain behaviors. My concern lies too in that whereas some may feel medication to create some responsive in level of focus and so forth, it comes with a cost in side effects. Some may take the view that the potential for progress outweighs the potential side effects. This is where I disagree, and feel it better to avoid that which would cause any side effects, that psychotherapy alone can manage the difficulties. These are some of the things that bring alarm to me. Wender states, "Most common side effects of the stimulant medications are appetite loss...difficulty in falling asleep." He suggests the use of a small dose of sedative 'major tranquilizer' an hour before bedtime to solve this in some cases. So, here a see a cycle of drugs needing to be used and that’s worrisome. Wender states, "Research is being conducted to determine the -exact- effects of stimulant medication on growth." This tells me they are prescribing something, which they really do not know yet what the effects are on growth. He states as well that stimulant medication IS addictive in adults, but says, "The results suggest that there is no increased risk for drug abuse associated with treatment, although -more research is needed to rule this out conclusively.-" Here again, if it is addictive to adults, I ask, why not children too, and he says that research is yet conclusive. With effects on the cardiovascular system, Barkley states, "studies have -not- specifically addressed this important issue." So, they are prescribing something for which they are unsure of the effects on growth as well as the cardiovascular system. Barkley states as well, "The side effect that should receive serious attention from clinicians is the possible increase in motor or vocal tics produced by stimulant medication." He continues- "It still seems prudent to screen children with ADHD adequately for a personal or family history of tics or Tourette's Syndrome." I recall having a session with a child with the mother first and being informed that he was being treated with Ritalin, I later had subsequent time with the father, and he had visible tics, this really alarmed me in reading about the issue of tics and Tourette's and I had to question not to the family but within myself if this was really the best option for the child faced with this risk. Barkley also states, "Isolated cases may arise in which parents note that a child is no longer 'spontaneous' or childlike in his or her behavior and appears -controlled- or -socially aloof-. This is concerning, and it appears that stimulants do have an affect in gaining control and conformity. Many of the stated results of the stimulant medication are too subjective, and Barkley states clearly that, "an improved ability to master increasingly difficult or higher-level academic material, such as that assessed in achievement tests, has -not- been demonstrated. Here we have an example that it would not have been as a result of stimulant medication if we see academic progress. Barkley also says that 'low and moderate doses of methylphenidate do reduce the frequency of aggression and noncompliance in groups of children but have no appreciate effect on either direction on prosocial or nonsocial behaviors." So, I will acknowledge that stimulants can help with short-term behavioral inhibition, but what about long term? This is my main concern, with the side effects and without evidence of a long-term result and without knowledge of long-term results on growth and cardiovascular development, is this really the best option? Barkley states, " Few studies employing rigorous methodology have evaluated the long term efficacy of stimulant medication. Those that have examined the issue have generally found little advantage of medication over no medication when evaluated over extended periods (Pelham, 1985, Weiss &Hechtman, 1993) Children who had been on drugs but were off at the time of follow-up were not found to differ in any important respect from those who had never received pharmacotherapy." Another concern is the effects in mood, I worked with one child who was already experiencing social withdrawal and was going through the trauma of losing a loved one. After receiving stimulant medication, this intensified. Wender states, "Instead of becoming high or excited, these drugs in general calm down ADHD children and sometimes they may even become somewhat sad." Barkley states, "some children may evidence various mild negative moods or emotions in reaction to stimulants...Some children describe feeling 'funny', 'different' or dizzy as a function of medication." What about self-esteem and confidence, Greenspan acknowledges that creativity can be affected, and Barkley states, " some concern has been raised that diminished self-esteem could be a emanative effect of methylphenidate as children may attribute the source of their success while on medication to external rather than internal factors."

The Eli Lilly company has been marketing a new drug for those who are labeled as ADHD known as Strattera. This drug is purported to be a non-stimulant medication, however the side effects are similar. Rather than effecting the dopamine system as do the stimulants such as methylphenidate and dextroamphetamine, it works upon the norepinephrine neurotransmitter. Strattera is considered a Norepinephrine reuptake inhibitor. Norepinephrine is the brain's adrenalin. Norephinephrine is involved in the increased rate and force of the heart muscle, constriction of heart muscles, pulmonary function (Hedaya, 1999). If these functions are increased, it would be evident that Strattera could produce possible untoward effects on the cardiovascular system. It is interesting to note that in the safety information that Eli Lilly provides on its website, it refers to possible hazards to those who have heart disease or high blood pressure. Information provided by Eli Lilly accompanying prescriptions of this drug note the possibility of tachycardia, and increased blood pressure. Tourette's disorder, though the etiology is not fully known is being examined as difficulties arising in the metabolism of dopamine, serotonin, and norepinephrine. it is known that stimulant drugs can produce Tourette's like behavior in some children (Breggin, 1998). If Strattera affects the norepinephrine system, then it would seem evident that the possibility of such Tourette's like behavior could also become manifest in some children using Strattera. Therefore, though Strattera is being marketed in the fashion of being a non-stimulant drug, its ill effects are quite similar to that manifested by the stimulant medications. Eli Lilly's website notes that growth suppression is a common side effect and needs to be monitored in children making use of this drug. Loss of appetite and weight loss is also seen. The most common side effects as listed by Lilly are upset stomach, decreased appetite, nausea and vomiting, dizziness, tiredness, and mood swings. These are not unlike that associated with the stimulant medications. Lilly states in its press release in regards to Strattera's introduction: "It’s not known precisely how Strattera reduces ADHD symptoms. Scientists believe it works by blocking or slowing reabsorption of norepinephrine, a brain chemical considered important in regulating attention, impulsivity and activity levels. This keeps more norepinephrine at work in the tiny spaces between neurons in the brain.” If we examine this statement carefully, we see it states 'it is not precisely known', therefore once again a drug is being prescribed whose effects are not fully known for a'disorder' whose psychopathology is not yet delineated. Clinical trials for Strattera have been limited and any information on long term effects has only been studied by Lilly itself. It is interesting to note that before Strattera was actually placed on the market and had just received FDA approval that the stocks for Eli Lilly rose 6% at the announcement (CBS Marketwatch, November 27, 2002). Lilly is aware that it will profit highly by being able to market a drug as a non-stimulant (though its ill effects are similar), that is not a Schedule II drug thus less subject to scrutiny and regulation. Hemant K. Shah, an independent analyst quoted in an AP Health News Report (August 15, 2002) states that Strattera's market potential is large at a time when Eli Lilly is seeking to offset recent setbacks. , "Parents who have refused stimulant dangers because of their knowledge of the hazards involved will now be coerced to utilize Strattera being led to believe it is somehow safer because it does not fall into the category of a stimulant/ Schedule II drug.

Dr. Howard Gardner (1983) identified the concept of multiple intelligences. Gardner identified the following: Linguistic intelligence ("word smart"), Logical-mathematical intelligence ("number/reasoning smart"), Spatial intelligence ("picture smart"), Bodily-Kinesthetic intelligence ("body smart"), Musical intelligence ("music smart"),Interpersonal intelligence ("people smart"), Intrapersonal intelligence ("self smart"),Naturalist intelligence ("nature smart"). Gardner identified that most educational settings are geared towards the child who utilizes linguistic or logical-mathematical methods of learning. Therefore, those who utilize other learning styles and intelligences fall outside the mainstream educational system and thus are prone to be considered 'learning disabled' or to have "ADHD". Capturing children's interest in the learning process by adapting to their learning styles through creating a zeal for learning through such use of art, music exercises, role plays, reflection, and other means could provide an effective solution towards meeting the needs of our children.

Glasser has designed the concept of quality schools where children learn both independently and collaboratively, where mutual respect is a key concept and the method of instruction and management is completed through the use of choice theory rather than external control and punishing. Children are given a sense of responsibility and involvement. Critical thinking is encouraged and educators monitor themselves through student and team feedback. Student's learning is based on application and usefulness rather than rote learning. The building of meaningful, sustainable relationships are of utmost importance. Students are encouraged in demonstrating competency rather than rehashing material.

David Healy, former secretary of the British Psychopharmacological Society notes that vast influence of the pharmaceutical industry in skewing clinical trials. Recently, the FDA has issues serious warnings on a number of SSRI anti-depressant drugs in regards to increased suicidality in children and adolescents. Healy has argued that the pharmaceutical companies, such as Eli Lilly were very aware of the complications that these drugs caused but withheld information from being published. In May 25th, 1984, a communication from Eli Lilly US from Lilly Bad Homburg stated the following: "Considering the benefit and the risk, we think this preparation totally unsuitable for the treatment of depression.’ Lilly has recently settled a 0 million lawsuit in regards to increased diabetes risk with the use of its drug Zyprexa.

It is interesting to note that nearly all of the children involved in the situations of school situations were involved in the mental health system and undergoing treatment with one or more psychotropic agents: Shawn Cooper, a 15-year-old sophomore at Notus Junior-Senior High School in Notus, Idaho, fired a shotgun at his fellow students in April. Cooper was on Ritalin. Thomas Solomon, a 15-year-old at Heritage High School in Conyers, Georgia, shot and wounded six classmates in May. Solomon was on Ritalin. Kip Kinkel, a 15-year-old at Thurston High School in Springfield, Oregon, killed his parents and two classmates and wounded 22 other students last year. Kinkel was on Ritalin and Prozac, an anti-depressant. Eric Harris, one of the Columbine High School killers, was on the anti-depressant drug Luvox. Rod Matthews, 14, beat a classmate to death with a baseball bat in 1986 in Canton, Massachusetts. Matthews had been on Ritalin since the third grade. Yale researchers, as published in the March 1991 Journal of the American Academy of Child and Adolescent Psychology, found in their study of Prozac at least one 12-year-old who started having nightmares. The boy dreamed of killing his classmates at school until he himself was shot. The researchers took the boy off Prozac and he recovered. Then they put him back on the drug, apparently thinking that the anti-depressant could not have caused the nightmares. Once drugged again, the boy started to have acute suicidal thoughts and tendencies. Psychiatrist Peter Breggin has noted that a number of the SSRI's can be associated with triggering manic episodes and violence. In one clinical trial involving stimulants the rate of psychosis as an adverse drug reaction was 4%. This number may at first appear small, but when we examine that nearly 6,000,000 children are receiving stimulants in the US, this tells us that the possibility of 240,000 episodes of psychotic reaction could occur. In addition, as extended release drugs are being utilized, this makes the potential for adverse drug reactions more serious as the drug stays within the system for a longer period.

Two organizations that claim to be support groups for families can actually be considered front groups for the pharmaceutical industry. One such group is CHADD and the other NAMI. CHADD's events have been frequently sponsored by grants from Ciba Pharmaceuticals who makes Ritalin and in the first year, the majority of the funding for this non-profit organization came directly from the pharmaceutical companies including grants from Ciba, Pfizer, and Alza Pharmaceuticals among others. NAMI also receives large grants from the pharmaceutical industry and promotes the use of psychotropic drugs and the theory of 'chemical imbalances."

How do we deal with our seriously distressed children and adolescents? Adolescents are in a period of seeking autonomy and self-determination. These qualities can aid them in becoming agents of active transformation in their own lives. For one to recover from distress they are in need of being able to regain hope and to have an effective exercise of their free will. (Breggin, 1996). Adolescents based on their experiences formulate thoughts and feelings and begin to create values and meanings for themselves. Those adolescents who are suffering from serious emotional distress have become lost on this path to finding meaning in their lives. Once this occurs, they begin to develop anguish and self-defeating responses to life. This creates in them anxiety and despair leading towards what some would call ‘madness’ (Breggin, 1991). These adolescents must learn to feel empowered once again, and not to feel labeled as an ‘it’, not to be viewed through the lens of their particular diagnosis and categorization they have been ascribed. These adolescents need coaches and individuals who will aid them compassionately and empathetically in navigating and negotiating through life’s stresses. The therapist and others must look upon the distressed adolescent with dignity. To look upon the adolescent through ‘scientific’ or ‘objective’ means leads us to the tendency to diagnosis and control the person, to impose our own abstract and potentially oppressive category upon them and to manipulate the outcome. Physical interventions, such as psychotropic drugs, restraints, and enforced confinement to mental hospitals or residential treatment facilities are a part of this desire to control rather than truly aid and come to an understanding of the distress the adolescent is experiencing (Breggin and Breggin, 1993, a&b). Psychotropic medications with these seriously distressed individuals only deal with symptoms, they blunt certain functions to make the person more tolerable and amenable to societal expectations. Psychotherapy, on the other hand, focuses on the subjective changes in patient’s feelings and on actual changes in lifestyle or conduct of life (Fisher & Greenberg, 1989). Based on the viewpoints of biopsychiatry, adolescents who are medicated and placed in mental hospitals are labeled as improved when they conform to hospital demands or receive discharge. However, what is not examined is, how do the patients themselves actually feel? An estimated 180,000 to 300,000 young people a year are placed in private psychiatric facilities. These children and adolescents often feel powerless in these placements. But as mentioned above, it is the need for feelings of empowerment and hope that will lead to a genuine recovery from distress. Psychologist D.L. Rosenhan lead a study where ‘pseudopatients’ had themselves admitted to psychiatric hospitals to experience them first hand and report on this experience. Rosenhan reported in an article appearing in the January 19, 1973 issue of Science, “Powerlessness was evident everywhere…He is shorn of credibility by virtue of his psychiatric label. His freedom of movement is restricted. He cannot initiate contact with staff, but may only respond to overtures as they make. Personal privacy is minimal…” With children and adolescents it is easier to rationalize away their rights and control becomes more arbitrary and complete (Breggin, 1991). Psychiatrist Peter Breggin states that in such an environment ‘it is hard for a child to resist feeling spiritually crushed, abandoned, and worthless under such conditions. With a less formed sense of self than an adult has, a child is less able to resist the shame attached to being diagnosed and labeled a ‘mental patient’. Children may also find it much harder to conform to institutional life. They are naturally energetic, rambunctious, at times strident, often noisy, and resistant to control. If a boy doesn’t conform, he is considered ‘ill’ and can be subjected to physical restraints, solitary confinement, and toxic drugs. (Breggin, 1991). It should be mentioned that the drugs commonly used for severely distressed adolescents are the same as those used for adults, most frequently the neuroleptics. These medications are reported to cause lack of energy, painful emotions, motor impairment, cognitive dysfunction and tend to ‘blunt; the personality of the treated patients as well as having a risk for the development of tardive dyskinesia, a permanent and debilitating neurological problem (Gualteri and Barnhill, 1988). These drugs subdue the adolescent into conformity by blunting the brain, but never do they teach the child how to develop meaning, how to cope, nor do they allow the adolescent to express his pain and emotional distress that is within. The adolescent is merely sedated to make his behaviors more manageable to adults. The adolescent learns nothing. The adolescents who are suffering from severe emotional distress are in conflict. They have internalized feelings of guilt, shame, anger, anxiety, and numbing. These adolescents instead of coercive and intrusive ‘treatments’ need the ability to find a safe place where coercive power is replaced by reason, love, and mutual attempts to satisfy their basic needs. These adolescents because of their distress have broken away from the accepted realities, they have sought to recreate their existence, for some a more primitive existence (Schilder, 1952). The feelings of anxiety that an adolescent may experience are linked to a fear of being and belonging (Stern, 1996, pg. 12) Depression, mania, and anxiety are all linked together and are indicative of trauma. The adolescent being a shattered person seeks an escape by altered perception. We must begin to realize that all behaviors and experiences have meaning, even those things that may appear the most ‘odd’ to us. The symptoms labeled to be schizophrenic exhibited by certain adolescents in distress ‘may be understood as manifestations of chronic terror or defense against the terror (Karon, 1996). This is often expressed as anger, loneliness, and humiliation. The therapist and others must convey to the adolescent that he wants to understand, that the client is helpable, but it will take hard work (Karon, 1996). The therapist must forge an alliance with the adolescent, aiding them to understand the real dangers and to be able to develop appropriate coping mechanisms. These adolescents are often viewed as dangerous themselves but the majority are not. They need to be hard, and forging this alliance will give them the needed voice leading to their recovery. Hallucinations that are experienced by the seriously distressed adolescent are actually repressed thoughts and feelings coming outward, the unconscious into the conscious. Delusions are the adolescent transferring experiences from their past without having the awareness that it is past (Karon, 1996, pg. 36). The therapist can guide in interpreting the meaning of these hallucinations and delusions and once the adolescent is gently approached with their underlying meaning, these events can dissipate. Delusions are also connected with an attempt to find a systematic explanation of our world, to find meaning. A person who has experienced severe distress has lost this meaning and thus develops unusual ways of seeking to make sense of their experiences and the world around them (Karon, 1996, pg. 38). The therapist can gently call the adolescent’s attention to inconsistencies but at the same time respect their vision. The results of a psychosocial approach to those with severe emotional distress has been proven to be more effective than the current biopsychiatric methods as evidenced by a study by Loren Mosher, MD where he took schizophrenic adults who were on either very low doses or no medication, and offered them a ‘safe place’ with non professional staff residing with them and sharing in their daily experiences. A 2 year follow up of these patients noted higher levels of success and progress than their counterparts who were subjected to neuroleptics and psychiatric hospitalization (Mosher, 1996, pg. 53) The model known as the Soteria project was based on principles of growth, development, and learning. All facets of the distressed person’s experience were treated by the staff as ‘real’ (Mosher, 1996, pg. 49) Limits were set and mutual agreements made with the patients if they presented as a danger to themselves or others. Such a model could be adapted to use with adolescents, offering them the need for compassion, empathy, and finding that ‘safe’ place, restoring within themselves a feeling of worth and dignity, that will lead to their ability to address the issues of their distress and traverse towards recovery.

In today's mental health system there is a pattern of fraud and coercion that takes way the freedoms and dignity of children and their families. Children are receiving stigmatizing labels and being prescribed psychotropic drugs with many untoward effects. Psychiatrist Thomas Szasz, MD made the comment that if an individual hit us with a blackjack and robbed us of our dignity we would call them thugs, yet psychiatrists label and drug children and rob them of their dignity and nothing is said. All in the name of profit. Rarely, if never are the families given informed consent. Szasz has also stated, "From a sociological point of view, psychiatry is a secular institution to regulate domestic relations. From my point of view, it is child abuse." Families are provided with literature that appears so matter of fact but is funded by the pharmaceutical companies and tainted with their bias. According to the Poughkeepsie Journal, the 'support' or should it be said front group for Children diagnosed with Attention Deficit Hyperactivity Disorder received substantial funds from the pharmaceutical companies: "CHADD received 5,000 from drug companies in the year ending June 2000, about 12 percent of its budget."

Children are being beaten, improperly restrained, physically and sexually abused, and emotionally scarred in residential treatment programs. Juvenile probation officials are failing to understand the emotional distress of our children, they are submitting to this "psychiatric Gestapo". Educators rather than finding new methods of shaping our children's learning are falling into the trap of psychiatric 'solutions' as well. Never could it be that a school has simply failed to help a child learn, rather it is always the child denigrated and labeled as 'disordered'. There are loving and concerned parents, and there are others who lack love and compassion towards their children. There are loving and concerned parents who become duped by the 'professionals'.

Some of tried to utilize the analogy of real, demonstrable physical diseases such as diabetes to compare with ADHD. As prior mentioned, there is no demonstratable physical abnormality with ADHD, thus it is not a disease. Insulin is a naturally occurring substance in the body by which one with diabetes either produces too much or too little. Who has ever heard of a person having a Ritalin deficiency? In addition, if I were to walk in to my physician and he tests my heart rate as normal, the nurse enters and startles me, and my heart rate is measured again, and my physician thus says I have heart disease, none would probably ever visit this physician again. But this is what is happening with psychiatrists. They fail to recognize the experience behind behaviors, and just seeing the behavior conclude a so-called disease is present .

I share this scenario because sadly it is becoming a frightening reality: A child is considered overly active and has behavioral issues at school. The school staff may recommend psychiatric intervention and even go as far as to say that medication is necessary, even designating which one. This now illegal after the passage of the Child Medication Safety Act, however it has and still continues to occur. The child sees the psychiatrist for a brief session- it is not thoroughly examined if the child has any physical conditions, allergies, etc. Immediately the child is labeled and given a dose of psychostimulant. The child develops side effects such as weight loss, insomnia, and possible tics. In order to counteract the insomnia, a new drug such as Klonidine is added. The child develops emotional lability and has crying episodes and manic behaviors. The psychiatrist is seen again for a brief time, and on this visit its determined that 'bipolar is emerging'. The child is then given Depakote or some other mood stabilizer. The child now must receive regular blood tests to insure that liver toxicity does not arise. The child is not overly active, he is quite docile, so it is reported that improvement has occurred. However, with the combination of drugs, he develops some psychotic like symptoms where he feels something is crawling on him and has some hallucinations. The psychiatrist is consulted again, and its determined that bipolar with psychotic features exists or maybe even the possibility of childhood schizophrenia. The child is then given Risperdal or another neuroleptic. Strangely, the child begins developing unusual jaw movements and muscle rigidity. The parents are concerned and ask the psychiatrist if this is medication related and if the child is overmedicated. The psychiatrist brushes off the question and prescribes Cogentin (used for Parkinson's) to alleviate the neurological problems caused by the development of tardive dyskinesia but fails to remove the offending agent. The child's behavior becomes more unusual and bizarre leading to hospitalization where medications are raised and adjusted and new ones added. Then the recommendation comes from the psychiatrist that it would be better for the child to be moved to a residential treatment facility. While in the residential facility, the child is frequently restrained and is injured, he is placed with other children with serious emotional and behavioral distress. He is discharged home having absorbed a lot of new negative behaviors from peers, lacking knowledge of the outside world, and with few skills. So, once the child nears adulthood, it is recommended that he live in a group home where he can be cared for and the psychiatric regiment can be maintained. The child has been 'treated.'

What is the solution to resolving the insanity of the mental health system? First, we must stop looking through the eyes of a medical model, where we see children as broken and disordered and attempts are made to attributing their behaviors and emotions solely to a malfunctioning brain. There is no evidence supporting the psychopathology of a number of disorders. The linkage between the pharmaceutical companies and psychiatry needs to be evaluated as well as the information that is disseminated via the research and materials provided by pharmaceutical company money. One such example is CHADD, the 'support' group for parents of children diagnosed with ADHD that has received a great de

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