Curbing Psychiatric Drug Use

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Two new studies should end all doubt, if any remained, that U.S. children are going on psychiatric drugs at a frightful rate of increase, and in far higher proportions in some parts of the country than in others. As Congress begins to consider the Individuals with Disabilities Education Act, a crucial question will be what people in authority in the public and private sectors are going to do about it.

Researchers at the University of Maryland studied data for 900,000 children and found a 200 percent to 300 percent increase in the use of behavior-altering drugs between 1987 and 1996. By far the largest increases occurred after 1991 — and therein may lie a valuable lesson for policymakers who are concerned about the widespread drugging of American kids.


It was in 1991 that federal funds first were made available to treat attention deficit hyperactivity disorder (ADHD). Before a child gets the psychiatric drug, he gets a label — often a preliminary one of learning disabled from school authorities, and then ADHD or simply ADD from a physician. The prescription commonly given is Ritalin, a powerful stimulant that is supposed to help its users focus their mental energies, although researchers have also noted an increase in pediatric prescriptions for amphetamines.

Last year, a Presidential commission on special education concluded that there are often serious problems and discrepancies with the process by which children are diagnosed with ADHD. Further evidence of this may be found in a new study published in the February issue of the journal of the American Academy of Pediatrics that reveals dramatic regional variations in prescription rates for Ritalin and amphetamines.

The study of 178,000 children between the ages of 5 and 14 found that in 1999, Southern and Midwestern states had the highest rates of Ritalin and amphetamine use for children. Louisiana had the highest rate, with ADHD drugs constituting 6.5 percent of children’s prescriptions, followed by North Carolina, Missouri, Alabama and South Carolina. Virginia’s rate of 4.9 percent was well above levels for Maryland and West Virginia.

The states with the lowest Ritalin and amphetamine rates, after the District of Columbia, were Nevada, Colorado, California and New Jersey.

The study’s authors were careful to say their paper did not attempt to establish “if the higher rates of use represent overuse or the lower rates represent underuse,” although “both may be occurring.” Nevertheless, the explosive increases raise reasonable questions about what this trend is doing to U.S. children.

Authorities including the National Institutes of Health recognize that the long-term (defined as two years or longer) effects of psychiatric drugs on children have not yet been proven. Ritalin’s manufacturer warns that it should not be administered to children under the age of 6, when the developing brain is continuing to undergo major changes. But the University of Maryland researchers confirm that the number of children under the age of 5 being placed on Ritalin and other powerful stimulants has risen drastically since 1991.

There are other long-term risks for children who are wrongly identified as disabled. They become part of a second-tier of education, less likely to graduate high school. Often the only reason these children become labeled in the first place is that their schools did an inadequate job teaching them to read. And when state and federal funding gives schools financial incentives to over-identify children as disabled, these problems only get worse.

With the president’s budget proposing major increases in federal spending for special education, policymakers must consider whether the system itself has become so problematic that until it receives major changes, this situation is likely to continue to get worse. If current special education law played a role in encouraging these dramatic increases in labeling and drugging of kids, what effect would funding increases have on the process? Washington can change the incentives, but it can’t solve the problem by itself. A large part of the answer must come from parents, the medical community, and teachers and principals. Some critics believe schools pressure parents into putting their children on Ritalin so that they are more docile and teachable. Others contend some parents push to have their children labeled and medicated to achieve an edge in academic competition.

All who are concerned for the health and safety of children ought to consider whether there are creative and constructive ways to alter hyperactive behavior — through incentives, discipline, alternative instruction, tough love, or even nutrition — without resort to powerful drugs that may be exacting a terrible toll.

”’Robert Holland is Senior Fellow and Don Soifer is Executive Vice President at the Lexington Institute in Arlington, Va. They can be reached at:”’