November 25, 1999

Behavioral Drugs Focus of Debate in Colorado Schools


DENVER -- A resolution recently passed by the Colorado Board of Education to discourage teachers from recommending behavioral drugs like Ritalin and Luvox has intensified a national debate over the growing use of prescription drugs for children.

The resolution, the first of its kind in the country, carries no legal weight. But it urges teachers and other school personnel to use discipline and instruction to overcome problem behavior in the classroom, rather than to encourage parents to put their children on drugs that are commonly prescribed for attention deficit and hyperactive disorders.

Proponents of the resolution, which passed by a 6-to-1 vote on Nov. 11, said they were motivated, in part, by evidence that they said suggested that dozens of violent crimes, including the massacre last spring at Columbine High School in Littleton, Colo., had been committed by young people taking psychotropic drugs.

One of the teenage shooters at Columbine, Eric Harris, had been taking Luvox, an anti-depressant, although there is no evidence that the drug had anything to do with the shootings or that a teacher recommended the use of the medication.

Patti Johnson, the school board member who organized a hearing on the issue and proposed the resolution here, conceded that only a small number of teachers in Colorado had ever insisted on a child taking prescription drugs as a precondition to returning to class. But the resolution, she said, was largely intended for them.

No other states are considering a measure similar to the one in Colorado, where an unusual set of circumstances played a role in the passage of the resolution: an elected and fairly conservative school board responding, in part, to the outcry from one of the nation's worst school shootings. But the resolution reflected broader issues, as well, as parents, mental health professionals and school officials debate the use of behavioral drugs by more than 2.5 million children in the United States.

Experts in mental health issues point out that children who take the drugs do so because they were having difficulties to begin with. They acknowledge that impulsive or violent behavior is a side effect in a small percentage of people taking the drugs.

Arguing that a majority of the children who use the drugs are benefiting from them, these experts contend that the Colorado resolution is irresponsible and perhaps even dangerous in that it could lead school personnel to ignore signs of serious mental disorders in children and that it would discourage communication between teachers and parents.

"I hope what happened in Colorado is the exception and not the rule," said Michael M. Faenza, president of the National Mental Health Association, a consortium of advocacy groups for the mentally ill, conceding that he fears other states and school districts might replicate Colorado's efforts

"Holding up psychotropic medicines as the possible cause of violent behavior is absurd," Faenza said. "There's a wealth of information to show that they have helped dramatically."

The use of Ritalin and other psychotropic drugs has steadily increased among schoolchildren, according to Children and Adults with Attention Deficit/Hyperactivity Disorder, a national nonprofit organization known as CHADD, in Landover, Md.

In Colorado, increased usage has turned a new focus onto the role that teachers and administrators play in the lives of students. It has also pitted experts who say use of the drugs is growing because they are beneficial against those who contend parents and teachers are too quick to seek out prescription medicine as the simplest way to treat children with behavioral problems.

Ms. Johnson said in the five years that she has been on the board she has received "numerous complaints" from parents who claimed a teacher had insisted that their child go on Ritalin or another drug before returning to class.

Ms. Johnson recounted the case of one girl who was showing signs of attention deficit disorder through mood swings and napping in class. She said the girl was later diagnosed with hypoglycemia and needed to change her diet. According to the girl's parents, Ms. Johnson said, the teacher told them, "You need to get her a prescription for Ritalin."

As a result of the complaints, she said, a resolution was written to remove school personnel from any medical decisions. She said the board, which is comprised of six Republicans and one Democrat, passed the resolution along party lines with minimal debate.

The lone Democrat, Gully Stanford, did not return a telephone call, seeking comment.

"The resolution does not stop teachers from communicating with parents," Ms. Johnson said in an interview. "What it does do is stop teachers from giving parents an ultimatum: 'Put you kid on a drug or we're not going to teach them.' That can't happen any more. It's wrong."

Brenda Welburn, executive director of the National Association of State Boards of Education, said Colorado is one of only seven states that elect a board of education. Those boards, she said, tend to be more pragmatic.

Ms. Welburn added, however, "I agree that too often the first answer for children with some behavior problem is to reach for medication. Some of the numbers we are seeing for medication of children are staggering."

Julie Underwood, general counsel of the National School Boards Association, said she knew of no other school board examining the question. Ms. Underwood added that while many are concerned about overmedication, "We would be reluctant to support such a resolution because there are children who may need such services, who may benefit from the medication."

Dr. Stephen M. Stahl, a professor of psychiatry at the University of California in San Diego, said that because of the complexities of mental disorders and the rapidly changing personalities of children as they grow older, both sides of the psychotropic debate may be right.

"There's no blood test for this," Dr. Stahl said. "It's not objective. If a kid is acting out in class and a stimulant like Ritalin calms him down, it would be immoral not to give him the medicine."

"But the problem comes," he added, "when the stimulants don't work and parents give them anyway as an excuse to avoid tough decisions or talking with teachers and doctors to learn what's going on."

Another problem complicating the issue, Dr. Stahl said, is the location of the school. Typically, he said, in poor areas, mental disorders are underdiagnosed, and often in more affluent school districts, children are overdiagnosed, sometimes making a bad situation worse.

Besides complaints from parents about insistent teachers, Ms. Johnson said she was also motivated to propose the resolution by the violent crimes involving young people, in which investigators said the perpetrators were using psychotropic drugs.

Accounts of those incidents also persuaded a Colorado state lawmaker, Penn Pfiffner of Lakeland, to hold a separate hearing on the prescription drugs issue, which, by coincidence, came two days before the school board voted on Ms. Johnson's measure.

Dr. Peter R. Breggin, director of the International Center for the Study of Psychiatry and Psychology, a nonprofit research organization in Bethesda, Md., testified at both hearings and said doctors have become too eager to prescribe psychotropic drugs at the expense of conversations among parents, teachers and children to learn why children are acting in antisocial ways.

"It's a tremendous mistake to subdue the behavior of children instead of tending to their needs," Dr. Breggin said in an interview.

"We're drugging them into submission rather than identifying and meeting the genuine needs of the family, the school and the community," Dr. Breggin said. "It's wrong in principle."

Citing Harris and other young killers who were found to be taking Ritalin and other drugs, Dr. Breggin said he was convinced there was a direct link between the drugs and violent acts.

Cohen of CHADD and others said the resolution might inhibit teachers from applying common sense and experience in the case of a troublesome child by merely telling parents something is wrong without offering a full range of possible solutions.

"If a child has hearing or vision problems that the teacher identifies, we would expect the teacher to talk to the parents," said Jeanne Mueller Rohner, executive director of the Mental Health Association of Colorado, which opposed the resolution. "It should be the same thing for mental health."

Opponents of the measure also said they were uncomfortable with the ardent support offered the measure by the Church of Scientology through an affiliate organization, the Citizens Commission on Human Rights.

The president of its American branch, Bruce Wiseman, who described the commission as a "psychiatric watchdog group," testified at both hearings and urged rejection of Ritalin and other drugs as a solution to troublesome behavior.

But Ms. Johnson, as well as Pfiffner, said the organization's support was not a critical factor in any of their actions.

But in the end, said Andrea Giunta, president of the largest teachers' union in Denver, it might not matter.

By the time most children are diagnosed with an attention deficit or hyperactive disorder, Ms. Giunta said they have been observed and analyzed by a team of experts, including teachers, nurses, counselors and school psychologists.

"A teacher shouldn't recommend a specific course of action," Ms. Giunta said. "But what she can do is say, this has been my experience with other children when they have displayed this kind of behavior. What you do is up to you."

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