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American Morning

The Great Ritalin Debate

Aired August 28, 2001 - 11:15   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
LEON HARRIS, CNN ANCHOR: We're focusing on back to school this week at CNN. And a part of that for many children means Ritalin, a drug used to treat attention and hyperactivity problems. Now, inevitably, the debate comes down to this: Do so many children need so much medication? We'll talk with the experts about this in a moment.

But, first, CNN medical news correspondent Rhonda Rowland puts this issue into focus for us.

(BEGIN VIDEOTAPE)

RHONDA ROWLAND, CNN MEDICAL CORRESPONDENT (voice-over): Any school nurse will tell you, it's part of the routine: children topping up on Ritalin or other stimulants so they can pay attention in class.

DR. PETER JENSEN, ADHD RESEARCHER: We know they're effective. We know they're safe. And there has been some very large government- funded studies that have established this.

ROWLAND: Medications like Adderall, Concerta and Ritalin are used to treat attention hyperactivity disorder, ADHD, a brain disorder characterized inattention and impulsive behavior.

LENNY WINKLER (R), CONNECTICUT STATE REPRESENTATIVE: I believe we are overmedicating our children.

ROWLAND: Government studies suggest approximately four million school-aged children suffer from ADHD, yet about 20 million prescriptions are written each year for stimulant drugs. And the number keeps going up.

Now this month, for the first time, print and television ads are selling the drugs directly to the public.

WINKLER: I think it's a big mistake.

ROWLAND: Connecticut state Representative Lenny Winkler is an emergency room nurse by training.

WINKLER: I think we are aiming the information to the wrong people. They should be targeted to the physicians. The physician is the one that writes the prescription.

ROWLAND: Dr. Peter Jensen, a top ADHD researcher formerly with the National Institute of Mental Health, disagrees.

JENSEN: I am actually very pleased that there are responsible, carefully prepared, factually-based advertisements.

ROWLAND: Besides informing parents there are alternatives to Ritalin -- longer-acting to avoid embarrassing lunchtime trips to the nurse's office -- Dr. Jensen says the adds have there are other benefits.

JENSEN: They inform parents and others about the condition of ADHD, that it's a true medical disorder, that it has serious long-term consequences for children if they're not treated.

ROWLAND: In a normal brain, a chemical called dopamine passes from nerve cell to nerve cell. In ADHD cases, scientists believe dopamine does not stay in the nerve cells long enough. Ritalin keeps the dopamine in place, allowing normal brain function.

(on camera): There's no objective diagnostic tool for the disorder, so the diagnosis comes down to a judgment call. But are children being correctly diagnosed by the right professional? Last year, the American Academy of Pediatrics published guidelines recommending children suspected of ADHD have at least two to three visits with a physician and that the physician listen to family and teachers.

(voice-over): But Representative Winkler says, in reality, too often it's the teacher who's making the diagnosis.

WINKLER: And in some situations, even parents were told if they didn't place their child on a psychotropic drug, the child would not be able to attend school. And I just found this horrendous.

ROWLAND: Winkler is behind a Connecticut law that, starting October 1, prohibits schools and teachers from recommending psychotropic medications. The teacher could recommend a visit to the doctor. The president of the patient group CHADD, Children and Adults With ADHD, says the group supports such legislation, but says we shouldn't be too hard on schools.

UNIDENTIFIED FEMALE: Teachers are very much a part of the team, as well as the doctors and the parents. So they need to be able to relate information. But they certainly have no business making a recommendation for medication. ADHD is a medical diagnosis.

ROWLAND: While much of the public debate has focused on the overdiagnosis and overmedication of children, some doctors say a bigger problem is, children are being missed.

JENSEN: Here in the United States, there is a tendency to overprescribe in some instances. But it pales in comparison to the underprescription or the underrecognition of these problems in children.

ROWLAND: It's estimated that half the children with ADHD are not being treated at all. Much of the stigma associated with psychotropic drugs for treatment of ADHD come from their potential for abuse. The expected introduction of new, less addictive drugs over the next year could end the debate.

Rhonda Rowland, CNN, Atlanta.

(END VIDEOTAPE)

HARRIS: All right, now let's bring in the Ritalin experts.

Dr. Russell Barkley is a professor at the University of Massachusetts Medical School. He is the author of "Taking Charge of ADHD." Dr. Barkley joins us from Boston -- and from San Francisco, Dr. Lawrence Diller. He is a behavioral pediatrician. And he is also the author of "Running on Ritalin: A Physician Reflects on Children, Society, and Performance in a Pill."

Welcome to both of you.

I want to start with this idea -- the statistics that we saw on that report. And I must say, this is the first time I have seen this report. And I was shocked to see that the number of children on Ritalin has gone up 700 percent.

Dr. Barkley, you say that that is justifiable?

DR. RUSSELL BARKLEY, AUTHOR, "TAKING CHARGE OF ADHD": Yes, I do.

I think that you can always lie with statistics by converting them to percentage increases. Basically, what you have is about a half a percent of all school children about 20 years ago were taking medication. That has risen to be about 2 to 2.5 percent, still a far cry below what the actual prevalence of this disorder is in our population.

HARRIS: Do you have a problem with that at all Dr. Diller -- at all?

DR. LAWRENCE DILLER, AUTHOR, "RUNNING ON RITALIN": Well, I think that the percentages belie the fact some communities, one in five boys in the fifth grade are take Ritalin, and other communities, they're not using it at all, and that the use of Ritalin is loosely tied, at best, to the diagnosis it is meant to treat, which is ADHD. Ritalin is given out for a whole host of problems.

HARRIS: OK. Now, you say that the diagnosis doesn't necessarily match the treatment when it comes down to Ritalin. What do you mean by that?

DILLER: Well, Ritalin helps anyone, child or adult, or ADHD or not, improve their performance. And what's happening is that the children are underperforming or misbehaving in school. And very often with very inadequate evaluations, the doctor, pressed for time, the teacher, pressed to keep the class in order, make the recommendation that the child take Ritalin.

HARRIS: Well, let's talk about, because I think some people may have a problem with the idea of teachers actually playing such a role in the process of putting a child on any kind of medication whatsoever.

Dr. Barkley, what do you think a teacher's role should be in this?

BARKLEY: I think the teacher's role is absolutely crucial. She or he has access to information that a physician or a parent is not going to have. And that needs to be communicated directly to physicians. And the idea that we're going to start gagging teachers in Connecticut and telling them that they can't discuss a range of treatment options for a child is absolutely ridiculous.

And you'll see that it is actually something that has been motivated by a fringe religious group in this country that is trying to stop the use of medication in schools. I think teachers have the ability and should have the right to explain treatment options. After all, the final decision is going to be made between the physician and the parent.

HARRIS: But a teacher isn't necessarily a behavioral psychology expert or anything. Why should a teacher, then, be allowed to do this?

BARKLEY: Teachers are gatekeepers. And that is to say that teachers are the first-line recognition of when there is going to be a problem with a child in school in their academic performance or social adjustment.

And as gatekeepers, it is a teacher's responsibility to recognize if a child is at risk. That is all their responsibility happens to be. But it's an important responsibility.

HARRIS: OK.

DILLER: Can I say something? Can I say something?

HARRIS: Go ahead, Dr. Diller. I was going to get to you next.

DILLER: I mean, I don't want to blame teachers. They have a very hard job. But too often in my practice, I get a child referred to see me who has never had a decent education evaluation as part of the referral process.

And I think many of these laws are simply saying: Exhaust your educational techniques. Exhaust your disciplinary techniques before you refer them to me to medicate.

And I think that is reasonable.

HARRIS: All right, on the way, one last final question: Quickly, if you both can give me your views on whether or not managed care -- which -- so many kids nowadays are on HMO plans right now -- does that play a role in this at all?

BARKLEY: Managed care is a big problem for us because it's a major obstacle to access to services for many children. And it also limits the amount of time that physicians can spend with an individual getting a proper evaluation.

HARRIS: All right, Dr. Diller, final word?

DILLER: You know, I want to bring up the advertising that has come up in the last couple of months directly to the parents, and its use of the superhero for one of the ads that looks so much to me like Joe Camel. What I'm afraid is that the drug companies are pushing one particular view of children's problematic behavior: that it's the children's brain.

And it's a much more complex issue than that. And there's no stock dividends, no equity for special education teachers and family therapists. And I think we're going to have one point of view promoted only. And that's what the parents are going to hear. And that worries me deeply.

HARRIS: Proof that there is no easy answer here.

Dr. Russell Barkley and Dr. Lawrence Diller, thank you very much for your time with us.

DILLER: Thanks for very much having us.

HARRIS: We appreciate that.

BARKLEY: Thank you.

HARRIS: Take care -- Daryn, over to you.

DARYN KAGAN, CNN ANCHOR: Leon, thank you. Thank you to both doctors as well.

After this short break, we're going to get a personal perspective and talk with one parent and her child for a detailed account of their personal experiences with Ritalin.

(COMMERCIAL BREAK)

KAGAN: Let's pick up our discussion of Ritalin and get a personal story. Jan Heininger is a parent of a child on Ritalin, she is also the co-author of the book "From Chaos To Calm." Her son, Theo, also joins us from Washington, D.C., this mornings. Theo is 13 years old and starting the eighth grade. He has been taking Ritalin or a similar drug for five years.

Good morning to both of you.

JAN HEININGER, CO-AUTHOR, "FROM CHAOS TO CALM": Good morning.

THEODORE REUTER, RITALIN PATIENT: Good morning.

KAGAN: Theo, you're starting eighth grade?

REUTER: Yes. KAGAN: Are you missing school today?

REUTER: Not really. No, not at all.

KAGAN: OK. Just wanted to check on that one. All right, let's bring your mom in here. Mom, so Theo has been on Ritalin or some form of a drug like that for about five years. What were some of the first signs that he could use some additional help?

HEININGER: Well, it was interesting, the discussion about teachers, because in fact it was his third grade teacher who first suggested that Theo might have Attention Deficit Disorder. Said nothing about medication at that point, but that did cause us to go and seek a diagnosis and evaluation.

And it was after a very extensive diagnostic process that he was referred for medication, and went through another evaluation by a physician who was a specialist in ADHD. And the conclusion was that he might do quite well on medication, and that's been the case.

KAGAN: What were some of the signs and some of the challenges that Theo was having at that time in third grade, that caused the attention in the first place?

HEININGER: Well, one thing that was picked up was he -- his spelling ability was not as strong as his reading ability. And that was the first thing that tipped off the teacher.

He was having difficulty in class focusing, some restlessness, difficulty keeping his mind on what he was supposed to be doing, because his mind was racing ahead to other things that were more interesting to him.

KAGAN: That's a big decision for a parent though, to make that leap to go to medication. What was it that finally convinced you that was the right thing for your child?

HEININGER: Well, my reaction when the teacher suggested that Theo might have Attention Deficit Disorder, was what you see in the media: Oh no, not my child.

But when we went through the diagnostic process and I felt confident that I could trust the results, and that I could trust the evaluation that his physician did for whether medication would be helpful; my conclusion was, well, let's give it a try and see how it work.

And, in fact, the results were almost instantaneous. His performance in school skyrocketed right away.

KAGAN: Theo, let's bring you in here. We've been talking to all of these adults. Let's really talk to a kid that who actually takes Ritalin.

Do you remember back in third grade when the teacher called your parents, and maybe some of the challenges you were having back then? REUTER: Yes. I remember a lot of it, and I used to quite often just retreat into the books that were in the back of the classroom. And I was kind of having trouble spelling. Everything we tried wasn't working.

Also they had to tell me to pay attention a lot.

KAGAN: That gets kind of frustrating when you are a third grader?

REUTER: Yes.

KAGAN: So, you started taking Ritalin. And then do you remember having a big difference as well?

REUTER: That's one of the big things I've discovered about medication for ADHD and ADD, is that I didn't feel any difference myself. Everyone else seemed to notice it. It just goes into my system, and I don't really notice anything.

KAGAN: So, when you take this pill it's not like you even feel anything, you're just noticing people around you saying that your behavior is so much better?

REUTER: Correct.

KAGAN: Got it. Mom, a lot of criticism, and you heard in this last segment, in the debate. A lot of people saying, you know what, this is just America not dealing with difficult kids, and we're just overmedicating our children.

What would you say to those critics?

HEININGER: I think there are probably some children who are not properly diagnosed and given Ritalin when they shouldn't be. But for those who are properly diagnosed and carefully evaluated, medication can be a godsend. It -- it's changed our lives in terms of making it much easier to live with Theodore. And also, much easier for him to keep his mind focused on his school work and on his homework when he comes home.

KAGAN: And one quick note, I had a chance to read your story, I just want to make sure you get your point across.

It's not as simple as just giving your kid a pill. You have been very diligent in watching his progress and his dosage, and that changes as the years go by and Theo grows up.

HEININGER: Well, that's the critical thing is that when a child is placed on medication, you really have to monitor it very carefully. And the physician has to, but as a parent I have to be very alert to any signs that I see that the dose might not be working. And in Theodore's case, he went through a period where Ritalin stopped working, and we switched him to another medication, Adderall. And we've recently switched him back to long acting Ritalin, which is the drug Concerta, so that he doesn't have to take a lunchtime dose at school.

But, if you don't monitor it carefully, then it's almost as bad as not taking anything at all.

KAGAN: Yes. Parent involvement is the key. There's no magical pill for that. You've got to put in the time and the effort. Jan Heininger, thank you. Theo Reuter. Hey, Theo?

REUTER: Yes?

KAGAN: Good luck in eighth grade.

REUTER: Thank you.

KAGAN: Thanks for stopping by and seeing us today, we appreciate it.

REUTER: Sure.

HEININGER: Thank you, Daryn.

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