105 Peavey Rd, Ste 116
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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. These other causes include illiteracy, nutritional deficiencies, 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 massive reform that will change these perverse incentives. The needed reforms must prevent a disability or disorder label by prioritizing other interventions. First, literacy of children must be targeted using intensive systematic phonics. Second, parents must not be coerced into placing their children onto medications whose efficacy and safety remain questionable. Third, appropriate attention must be paid in identifying and ameliorating the medical, psychological, and social causes of a child's behavioral and emotional symptoms. Finally, medications must be seen as one of many possible interventions, and their use must be accompanied by fully informed consent. Families must be adequately warned about all of the potential serious side effects of these medications; ultimately, the prescription of these drugs must be chosen by families, and not coerced by school systems.
BACKGROUND: This "special education" legislation was passed in 1975 to allow all children with disabilities access to public education. All children with disabilities are to receive a "free appropriate public education" in the "least restrictive environment." Congress promised to pay forty percent of the expenses to allow that access, but has never paid more than about seventeen percent. This has resulted in a huge un-funded mandate for the states.
IDEA started with payments to schools for children with physical disabilities, such as blindness, cerebral palsy, and orthopedic problems. In 1991, the criteria were changed to include children with mental and emotional disorders. The definition of a child with a disability in the law, particularly regarding mental and emotional problems is terribly vague: "a child with mental retardation...serious emotional disturbance...autism, traumatic brain injury, other health impairments or specific learning disabilities..."(1)
Attention Deficit Hyperactivity "Disorder," the most common mental or behavioral label given to children, is in the "other health impairment" category.
The criteria for emotional disturbance, while trying to maintain the aura of clinical credibility, are appallingly vague. These criteria are completely in the eye of the beholder, and with the states and schools having incentives to identify children; it is rather like a fox guarding the henhouse. These criteria also leave open the possibility that a child could be labeled for political reasons. For example, what standards are to be applied, and who is 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"?(2)
PROBLEMS WITH IDEA:
1) Skyrocketing diagnosis of children since 1991 - These mental and emotional "disorders" can be "treated" by the schools at very low cost to them. The parents have to purchase the medication while the schools receive the funding and expend few or no other funds to help the child in any other way. Here are some examples of this alarming trend from various reports:
2) Skyrocketing use of psychotropic drugs in children - Here are several disturbing reports:
3) No concrete tests or reproducible criteria for diagnosis - As ICSPP IDEA task force member, Bob Jacobs, Psy.D., has stated in his Australia-based report on ADHD for the Queensland Youth Affairs Network entitled Queensland's Children at Risk, "The undisputed clinical reality in July of 2002 is this: Physicians are identifying a "disease" based SOLELY on reports and observations of behavior. The only "tests" are questionnaires about the child's behavior, usually completed by the parents or teachers whose frustration with the child prompted the doctor visit in the first place. There is no confirmatory physical examination, EEG, CT-scan, X-ray, PET scan or any other diagnostic instrument because there is nothing to look for. By all standards of medicine these are healthy children whom we are arbitrarily declaring "sick" because people are not happy with their behavior." Here are several other reports and statements from around the world to confirm that clinical reality:
The 2001 World Health Report by the World Health Organization states, "Childhood and adolescence being developmental phases, it is difficult to draw clear boundaries between phenomena that are part of normal development and others that are abnormal."
The 1999 Surgeon General's Report on Mental Health says, "The diagnosis of mental disorders is often believed to be more difficult than diagnosis of somatic or general medical disorders since there is no definitive lesion, laboratory test or abnormality in brain tissue that can identify the illness"
"Finally, why must the APA (American Psychiatric Association) pretend to know more than it does? DSM IV (the fourth edition of the Diagnostic and Statistical Manual) is the fabrication upon which psychiatry seeks acceptance by medicine in general. Insiders know it is more of a political than scientific document."(9)
There has never been a single long-term study showing academic or social benefit of the stimulant medications. The 1999 Surgeon General's report said, "However, psychostimulants do not appear to achieve long-term changes in outcomes such as peer relationships, social or academic skills, or school achievement," and that is just one of many similar quotes. Obviously Ritalin and other members of its class are making learning more difficult, which is not what is wanted for special needs children served under IDEA.
Other very worrisome side effects include sleeplessness, weight loss, growth retardation including decreased brain growth, heart damage including cardiac arrest, atrophy (shrinkage) of the brain, psychosis, and violence.(12) Particularly concerning is a 1986 study that showed cortical atrophy in 50% of a group of 24 young adults who had been on Ritalin for several years in their childhood.(13) Neither the Food and Drug Administration nor the pharmaceutical manufacturers have ever followed up this study. Dr. Breggin reiterates this concern by saying, "Brain structural abnormalities found in children diagnosed with ADHD and treated with stimulants - to the extent that they are valid findings - are almost certainly due to the stimulants and other psychiatric medication to which they have been exposed. These studies add to the accumulating evidence that psychostimulants cause irreversible brain damage."(14)
Psychosis is one manifestation of the kind of brain damage that can occur from use of the stimulants. The risk of psychosis is listed in the package insert, but receives little attention from physicians and is rarely discussed with parents. Psychosis may happen as a toxic reaction to the stimulant medications or as they are withdrawn after long-term use. Previously thought to occur in 1% of patients on the stimulants, a 1999 study from the Canadian Journal of Psychiatry showed that the incidence of drug-induced psychosis is closer to 9% and that is probably an underestimate.(15) A 1993 study by Koek and Colpaert states that Ritalin "induces a psychopathology that seems to mimic schizophrenic psychosis more closely than amphetamines and cocaine."(16) These schizophrenic-like and manic-like reactions to stimulants are thought to lead to violence as well as depression and suicide.(17) All four of the perpetrators of the major school shootings were taking psychiatric drugs, some including Ritalin, at the time of their crimes.(18)
5) Invalid screening process for behavioral and emotional disorders with resulting labels having profound, long-lasting negative effects on a child - Early intervention programs within the field of mental health engender serious dilemmas. The contemporary example of pre-psychotic treatment programs was analyzed by ICSPP IDEA Task Force member Grace Jackson, M.D. and may be used to illustrate a variety of methodological flaws associated with premature screening and preventive pharmacology for attention deficit disorder, which in some studies has been used as a marker for schizophrenic psychosis:(19)
Specificity: Problems with specificity arise from the use of screening instruments that incorrectly identify healthy individuals as abnormal. In many investigations, the use of ambiguous features to identify patients (or pre-patients) has led to inappropriate labeling and treatment.
7) Coercion of parents to drug their children - ICSPP IDEA task force member, Doretta Hegg, M.A., founder of C.H.I.L.D., sees repetitive intimidation and suggestive coercion employed by schools that panic parents into putting their child on a psychotropic medication. Here are a few examples from around the country:
Neil Bush, brother of President George W. Bush, stated that he endured pressure from a private school in Houston to medicate his son Pierce with Ritalin for ADHD incorrectly diagnosed by the school. "There is a systemic problem in this country, where schools are often forcing parents to turn to Ritalin," said Bush, 47, who spent years researching the issue. "It's obvious to me that we have a crisis in this country." Neil Bush also said, "The problem is, it isn't the kids that are broken. It's the system that is failing to engage children in the classroom," and "My heart goes out to any parents who are being led to believe their kids have a disorder or are disabled."(23)
8) Ignorance or neglect of the numerous other reasons children might have behavior or emotional problems before medications are recommended - Here are some examples in the main categories:
2) Limit acceptable emotional disorders under IDEA to those with demonstrable organic etiology - To prevent the harm of an emotional, behavioral, or psychiatric label and the potential for treatment with powerful, dangerous psychiatric drugs, the disorder must be verifiable.
3) Investigate dangers of psychiatric medications, such as cortical atrophy, psychosis, violence, suicide, and cardiac arrest - Congress should exercise its legitimate oversight authority of the Food and Drug Administration and call for thorough investigations into the role of these drugs in the problems listed.
4) Prohibit and penalize coercion of parents to drug their children - Withholding federal IDEA funds or making schools financially responsible for the costs of withdrawing children from psychotropic medication and any adverse effects of those drugs are penalties that are being discussed. Although some physicians are too eager to prescribe these medications, at least the decision should be removed from unqualified school personnel to parents and their family physician without threat of child abuse charges or losing their children for the parents or removal from the home, expulsion, or inappropriate educational placement for the child.
5) Safeguard the rights of parents and children, by emphasizing the need for fully informed consent and by demanding that prescribers disclose the risks and potential adverse effects associated with the use of psychoactive medications - No parent should have to find out about the potential for cardiac arrest, growth retardation, cortical atrophy, psychosis, violence, or suicide because it happens to their child.
6) Ensure that other reasons for behavior or academic problems are discussed before psychotropic drugs are suggested - The list above, though incomplete, is quite long. No child has emotional or behavioral problems due to a low blood level of any psychotropic drug. Making sure that other causes are ruled out will allow scarce funds to go to children who truly need them.
7) Focus on academic issues instead of expanded behavioral screening - According to special education teacher, Mary Sue Laing, "EARLY [ACADEMIC SCREENING and] INTERVENTION is of the utmost importance in assisting students, especially young students. A month is a long time in the life of a little child. Intervention should consist of using highly structured methods that teach the student how to read, write, and do math correctly from the beginning. In reading, only methods that teach the sound-symbol relationship should be used. Visual guessing in reading, invented spelling, and free play with math manipulatives are inadequate methods for students who experience learning difficulties." It is these activities upon which schools must concentrate. Given the inaccuracy of the process and the invalidity of the diagnoses, especially ADHD, expanded behavioral screening will result in more children receiving labels with the harm described above and treated with psychotropic drugs with all of the dangerous side effects also described above.
8) Strictly enforce the 2001 Protection of Pupil Rights Amendments in the ESEA that that require notice and right of parental inspection of curriculum and physical or psychological evaluations, including surveys, of students in school , as well as opting their children out of these procedures and related curriculum.(41)
9) Strictly enforce the 2001 amendments to the ESEA that prohibit assessments based on attitudes, values, and beliefs of students and their families.(42)********
1. Public Law 105-17, Section 602(3)(A)(i)
2. IDEA regulations as quoted in Hannah, Pediatric Annals, vol.31, no. 8, 8/02, p. 508
3. Presidential Commission Report - A NEW ERA: Revitalizing Special Education for Children and their Families7/02, p. 21
4. Ibid., p.23
5. MN Dept of Children Families and Learning data from annual reports on students receiving IDEA funds
6. Zito, JAMA, Vol. 283, No, 8, 2/23/00
7. See Pills or Patience? Sacramento Bee, 6/23/02
8. A NEW ERA, p.21
9. Mosher, Loren, M.D., Psychiatrist, former Chief of the National Institute of Mental Health's Center for the Study of Schizophrenia, quoted in Death from Ritalin: The Truth Behind ADHD, last visited 08/20/02
10. Breggin, P. (2001). Talking Back to Ritalin, revised edition. Cambridge, MA: Perseus Publishing, p. 32
11. Ibid., pp. 49-50
12. Ibid., p. 32
13. Nasrallah, H., et.al., Psychiatry Research 17:241-246, 1986 as quoted in ibid., p.67
14. Ibid., p. 69
15. Cherland and Fitzpatrick, Canadian Journal of Psychiatry, October, 1998, as quoted in ibid., p. 45
16. Koek, W., and Colpaert, F.C., Journal of Pharmacology and Experimental Therapeutics, Vol. 267, p. 181-191, 1993 as quoted in ibid, p. 46
17. Ibid., p. 47
18. See Farber, B., The Link Between Anti-depressants and Mayhem, Newsmax.com, July 2, 2001
19. NIMH document PKT 00-0016, October 1995, "Multimodal Treatment Study of Children with ADHD," entitled "Cooperative Agreement for Multi-Site Multimodal Treatment Study of Children With ADHD (MTA): Investigator William E. Pelhan, Ph.D., Western Psychiatric Institute & Clinic, University of Pittsburgh. Grant Title: Pharmacologic and Psychosocial Treatment for ADHD (Uo1MH50467-01) as quoted from Eakman, B., (1998) Cloning of the American Mind - Eradicating Morality Through Education, Lafayette, LA, Huntington House, p. 103 and discussed on pp. 98-100 and 173-175
20. Montero, D., I was forced to dope my kid, New York Post, 8/7/02
21. Karlin, R., Court orders couple to give son drug (Ritalin) after school turns parents in, Albany Times Union, 7/19/00
22. Montero, D., Bush's Bro: My Son was a Victim of School Rx, New York Post, 8/14/02
24. A Parent's Nightmare: Losing a Child to Drug-Induced Psychosis, Education Reporter, June, 2002
25. See any pediatric or internal medicine text book
26. See any edition of the Physician's Desk Reference or pharmacology textbook
27. See, for example, Murray, M. and Pizzorno, J., (1998) Encyclopedia of Natural Medicine, Revised 2nd Edition, Rocklin, CA, Prima Publishing pp. 273-281
28. See, for example, Rapp, D., (1996) Is This Your Child's World? - How You Can Fix the Schools and Homes That Are Making Your Children Sick, New York, Bantam
29. Cave, S., (2001) What Your Doctor May NOT Tell You About Children's Vaccinations, New York, Warner Books, p. 39-56
30.Ibid., pp. 57-78
31. Crook, W., (1991) Help for the Hyperactive Child, Jackson, TN, Professional Books
32. A New Era, p. 22
33. See The No Child Left Behind Act of 2001, Section 1111, (b)(2)(C)
34. See (2002) Minority Students in Special and Gifted Education, Washington D.C., National Academy Press, especially Chapter 2
35. See the Goals 2000 chapter of Quist, A. The Seamless Web,g 1999 Mankato, MN Maple River Education Coalition
36. Eakman, B., Bushwhacking Johnny, Chronicles Magazine, September 2002, pp. 41-43
37. Brunner, M., (1993) Retarding America, Imprisoning Potential, Halcyon House as quoted in Eakman p. 385
38. See Effrem, K. Data Privacy Chapter of Quist, A., (1999) The Seamless Web, Mankato, MN Maple River Education Coalition at http://www.edwatch.org/seamless_web.htm
39. See Chapman, M., and Bachmann, M., US Policy embraces State-Planned economy, Maple River Education Coalition at http://mredcopac.org/upda0219.htm
40. See Sommers, C. (2001) The War Against Boys: How Misguided Feminism is Harming Our Young Men, Touchstone
41. See The No Child Left Behind Act of 2001, Section 1061
42. Ibid., Sections 1111(b)(3)(C)(xiv) and 411(b)(5)(A), which say, "...objectively measure academic achievement, knowledge, and skills, and be tests that do not evaluate or assess personal or family beliefs and attitudes, or publicly disclose personally identifiable information
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