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The Reauthorization of the Individuals with Disabilities Act:
Its Impact on the Diagnosis and Treatment of Children with Mental and Emotional Disorders

October 29, 2002

By Karen R. Effrem, M.D. - National Physicians Center Executive Board

SUMMARY: Although well intentioned, the Individuals with Disabilities Education Act has resulted in perverse financial and policy incentives for too many children to be labeled with mental and emotional disorders and learning disabilities whose criteria are extremely vague, controversial, and too easily misinterpreted. Besides burdening a child with a label that will stay for the rest of one's academic and employment career, far too many children are placed on powerful medications. These drugs have dangerous side effects with no long-term research to expose potential harm from chronic/acute use when there are many other reasons for that child's difficulties in school, such as illiteracy, nutritional deficiencies and other medical problems, and social issues. Instead of reducing the number of children placed in special education, more and earlier behavioral screening will only result in more children being labeled and drugged, because the criteria are vague and the process is inaccurate. Before full funding is attained, IDEA needs reform that will change these perverse incentives. Suggestions for change are offered at the end.

PROBLEMS WITH IDEA:
1) Skyrocketing diagnosis of children since 1991

2) Soaring use of psychotropic drugs in children:

3) No concrete tests or reproducible criteria for diagnosis - The criteria for emotional disturbance, while trying to maintain the aura of clinical credibility, are vague. The criteria for emotional disturbance, while attempting to maintain the aura of clinical credibility, are vague. These criteria are subjective, and with the states and schools having incentives to identify children, there is a tendency to over-diagnose children. These criteria also leave open the possibility that a child could be labeled for political reasons. For example, the standards to be applied, and the persons authorized to determine whether or not a child displays "inappropriate types of behavior or feelings under normal circumstances," a "pervasive mood of unhappiness or depression," or an "inability to build or maintain satisfactory interpersonal relationships with peers and teachers" need to be clearly defined.(2) We believe this will very difficult.

4) Harmful side effects of psychotropic drugs used in children without long term safety studies - The stimulant class of medication, which includes Ritalin, can cause a whole host of extremely serious side effects. Dr. Peter Breggin has highlighted in his book Talking Back to Ritalin(3) and many other researchers; even those who support using these drugs, have found many disturbing problems with them.

5) Invalid screening process for behavioral and emotional disorders with resulting labels having profound, long-lasting negative effects on a child -

6) Coercion of parents to drug their children - Here are a few examples:

7) Ignorance or neglect of the numerous other reasons children might have behavior or emotional problems before medications are recommended - The main categories of other reasons for behavioral and emotional problems are medical/nutritional, environmental, vaccine reactions, educational including federal education mandates, and societal, including the temptation for people to want to receive Social Security disability income.

RECOMMENDATIONS:
1) Change the financial and policy incentives for schools to label children with mental and emotional disorders or learning disabilities that have vague criteria
2) Limit acceptable emotional disorders under IDEA to those with demonstrable organic etiology
3) Further investigate dangers of psychiatric medications, such as cortical atrophy, psychosis, violence, suicide, and cardiac arrest
4) Make sure that other reasons for behavior or academic problems are discussed before psychotropic drugs are suggested 5) Prohibit and penalize coercion of parents to drug their children
6) If medications are discussed at all within the context of special education, the potential side effects must be fully explained to parents, who must maintain the right to refuse them
7) Focus early on academic issues instead of expanded behavioral screening
8) Strictly enforce the 2001 amendments to the ESEA that require notice and right of inspection of curriculum physical or psychological evaluations, including surveys, of students in school.
9) Strictly enforce the 2001 amendments to the ESEA that prohibit assessments based on attitudes, values, beliefs, and behaviors of students and their families.

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Footnotes

1. A NEW ERA: Revitalizing Special Education for Children and their Families, p.23
2. IDEA regulations as quoted in Hannah, Pediatric Annals, vol.31, no. 8, 8/02, p. 508
3. Breggin, P. (2001). Talking Back to Ritalin, revised edition. Cambridge, MA: Perseus Publishing, p. 32
4. Ibid., pp. 49-50
5. Cherland and Fitzpatrick, Canadian Journal of Psychiatry, October, 1998, as quoted in ibid., p. 45
6. Breggin, p. 47
7. See Farber, B., The Link Between Anti-depressants and Mayhem, Newsmax.com, July 2, 2001 at http://www.newsmax.com/archives/articles/2001/7/2/181622.shtml
8. Montero, D., I was forced to dope my kid, New York Post, 8/7/02 at http://www.nypost.com/news/regionalnews/54243.htm
9. Karlin, R., Court orders couple to give son drug (Ritalin) after school turns parents in, Albany Times Union,