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ADD drugs still
under scrutiny
(October
2007 Issue)
By Ami Albernaz
If past numbers in drug prescriptions for Attention Deficit Disorder
(ADD) hold true this year, nearly 18 million children will be placed
on these drugs before the current school year is over. And in New
England, which traditionally has led the nation in consumption rates
of these drugs, a few states have taken measures to try to safeguard
against their over prescription, a longstanding concern that has
perhaps gained urgency since a Food and Drug Administration advisory
committee last year approved warning labels for methylphenidates
including Ritalin.
In Connecticut, the legislature ruled in 2001 that schools could
not recommend drugs to students, establishing the country's first
so-called "anti-Ritalin" law. According to Michael Schwarzchild,
Ph.D., director of professional affairs at the Connecticut Psychological
Association and an advocate of the legislation, the law has so far
achieved its intentions.
"The law has been extremely effective," he says. "Schools can
make a statement along the lines of a psychiatric or psychological
evaluation being appropriate, but they cannot talk about what medications
might be helpful."
In 2004, New Hampshire passed a bill establishing a committee to
study the prevalence of psychotropic drugs in childcare centers,
preschools and public schools. The following year, the committee
noted in its report that while it did not find evidence of over
prescribing or of school staff urging parents to place their children
on medication, staff members needed to be mindful of not overstepping
their bounds in suggesting medication.
In Massachusetts, a 2003 bill that would have prohibited school
committees or school personnel from requiring a student be placed
on a psychotropic drug in order to attend or remain in school, and
from recommending children be placed on a psychotropic drug, appeared
to have stalled.
While a number of parents and child welfare advocates have long
argued that Attention Deficit Disorder drugs are sometimes recommended
for children who do not truly need them, health concerns around
the drugs were amplified early last year after the Food and Drug
Administration advisory committee's announcement that warning labels
were necessary because the drugs are known to raise heart rate and
blood pressure, increasing the risk of heart attacks or strokes.
A number of people have died while taking the drugs, although pre-existing
heart conditions might have played a role in at least some of the
cases. In addition, a study published earlier this year in the Journal
of Neuroscience suggested that Ritalin might affect brain chemistry
in young children.
Because medication has helped many people with Attention Deficit
Disorder, psychiatrists are more apt to monitor their usage carefully
than to stop prescribing them. In Vermont, for instance, several
programs have been designed to facilitate consultation between child
psychiatrists and pediatricians, and in one, child psychiatrists
are being stationed in pediatric practices, says David Fassler,
M.D., a clinical professor of psychiatry at the University of Vermont.
Schwarzchild adds that a good dosage of common sense goes a long
way when it comes to observing the drugs' effects. "Obviously, when
Ritalin or another ADD drug is prescribed appropriately and when
the situation is monitored, the issue is if the dosage is correct
and if the medication is correct," he says. "If it isn't working
and adjustments are made - and it still doesn't work - then the
medication needs to be stopped."
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