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Children are dying from ADHD Drugs
Info for Parents who are pressured to diagnose
and drug their children for ADD or ADHD. Story behind our Sons death caused
from ADHD drug, Ritalin.
Between 1990 and 2000 there were 186 deaths from methylphenidate reported
to the FDA MedWatch program, a voluntary reporting scheme, the numbers of
which represent no more than 10 to 20% of the actual incidence.
Our 14-year-old Son Died from
Ritalin Use
1. We have a National Directory of: ,
2. We have three stand alone categories for ADHD Help:
3. We also have the National Alliance, ADHD Help Pages with the above
Directories. , ,
April 15, 2001 this website was created in hopes of providing parents and guardians
with information about the truth behind ADHD and the drugs used to treat children
diagnosed with ADD or ADHD.
We built this website because we didn't want other children to die or suffer
side effects because of their parents lack of knowledge.
We did all we could to convince state and federal government about the methods
used in the miss-diagnosing of thousands of children with in ADD - Attention Deficit
Disorder and ADHD Attention hyperactivity disorder of ADHD and psychotropic drugging
of children with Ritalin and other drugs.
Since the death of our 14-year-old son Matthew caused from the use of Ritalin
prescribed for ADHD (Attention Deficit Hyperactivity Disorder) our family has been
informing others world wide via the internet about ADHD and the dangers of psychotropic
drugs in memory of our son and countless other children that have died over the
years as a direct result of using psychotropic drugs.
We wish to expose the health risks, dangers, deaths and suicides that are a direct
result of administering Ritalin and other psychiatric drugs to children.
We hope our story and information will in some way benefit your family and prevent
our tragedy from being your families' reality and nightmare.
Our fourteen year old son Matthew suddenly died on March 21, 2000. The cause
of death was determined to be from the long-term (age 7-14) use of Methylphenidate,
a drug commonly known as Ritalin.
According to Dr. Ljuba Dragovic, the Chief Pathologist of Oakland County, Michigan,
upon autopsy, Matthew's heart showed clear signs of small vessel damage caused from
the use of Methylphenidate (Ritalin).
*The certificate of death reads: &Death caused from Long Term
Use of Methylphenidate, Ritalin.&
I was told by one of the medical examiners that a full-grown man's heart weighs
about 350 grams and that Matthew's heart's weight was about 402 grams. Dr. Dragovic
said this type of heart damage is smoldering and not easily detected with the standard
test done for prescription refills. The standard test usually consists of blood
work, listening to the heart, and questions about school behaviors, sleeping and
eating habits.
*What is important to note here is that Matthew did not have
any pre-existing heart condition or defect.
Matthew's story started in a small town within Berkley, Michigan. While in first
grade Matthew was evaluated by the school, who believed he had ADHD. The school
social worker kept calling us in for meetings. One morning at one of these meetings
while waiting for the others to arrive, Monica told us that if we refused to take
Matthew to the doctor and get him on Ritalin, child protective services could charge
us for neglecting his educational and emotional needs. My wife and I were intimidated
and scared. We believed that there was a very real possibility of losing our children
if we did not comply with the schools threats.
Monica further explained ADHD to us, stating that it was a real brain disorder.
She also went on to tell us that the Methylphenidate (Ritalin) was a very mild medication
and would stimulate the brain stem and help Matthew focus.
We gave into the schools pressure and took our son to a pediatrician that they
recommended. His name was Dr. John Dorsey of Birmingham, Michigan. While visiting
Dr. Dorsey with the schools recommendation for Methylphenidate (Ritalin) in hand,
I noted that he seemed frustrated with the school. He asked us to remind the school
that he was not a pharmacy.
I can only conclude from his comment that we were not the first parents sent
to him by this school. Dr. John Dorsey officially diagnosed Matthew with ADHD. The
test used for the diagnosis was a five minute pencil twirling trick, resulting in
Matthew being diagnosed with ADHD.
*It is important to note that the schools insistence and role
in our son's drugging was documented in a letter written by Monica to the pediatrician
stating: &We would have hoped you would have started Matthew on a trial of medication
At no time were my wife and I ever told significant facts regarding the issue
of ADHD and the drugs used to &treat it&. These significant facts withheld from
us inevitably would have changed the road that we were headed down by ultimately
altering the decisions we would have made.
We were not told that The Drug Enforcement Administration had classified Methylphenidate
(Ritalin) as a Schedule II drug, comparable to Cocaine.
We were not told that Methylphenidate is also one of the top ten abused prescription
At no time were we informed of the unscientific nature of the disorder.
We were not told that there was widespread controversy among the medical establishment
in regards to the validity of the disorder.
Furthermore, we were not provided with information involving the dangers of using
Methylphenidate (Ritalin) as &treatment& for Attention Deficit Hyperactivity Disorder.
One of these dangers includes the fact that Methylphenidate, Ritalin causes constriction
of veins and arteries, causing the heart to work overtime and inevitably leading
to damage to the organ itself.
We were not made aware of the large number of children's deaths, that have been
linked with these types of drugs used as &treatment&.
While Matthew was taking Methylphenidate (Ritalin), at no time, were we informed
of any test: echo-cardiogram, MRI. These types of tests could have detected the
damage done to his heart. These test are not considered &standard& in monitoring
&treatment& of ADHD they are usually never administered to children. Sadly death
is inevitable without the possibility of detection.
*I want to ask every parent to ask themselves these important questions:
How different would your decisions be if information was withheld from you? How
different would your decisions be if you receive only distorted data?
I, myself, know that our families and Matthews outcome would have been quite
different had we received all information. If I had known certain facts I would
have acted differently and my son would be alive today. This I am sure of.
Informed Consent&, which states in part A person's agreement to allow something
to happen (such as surgery) that is based on a full disclosure of the facts needed
to make the de i.e. knowledge of risks involved, alternatives
etc& and &the probable risks against the probable benefits&
The violation of parent's rights is when they are not told of the unscientific
nature of so-called disorders such as ADHD or the risks of the treatments involving
drugs like Ritalin, and they certainly are not told of alternatives to their child's
behavior such as undiagnosed allergies or food sensitivities, which could manifest
with the symptoms of what psychiatry calls ADHD.
*Here are some facts that are being withheld from parents that could
possibly alter their life decisions and outcomes.
Did you know that schools receive additional money from state and federal government
for every child labeled and drugged? This clearly demonstrates a possible &financial
incentive& for schools to label and drug children. It also backs up the alarming
rise/increase in the labeling and drugging that has taken place in the last decade
within our schools.
Did you know that parents receiving welfare money from the government can get
additional funds for every child that they have labeled and drugged? In this way,
many lower socio-economic parents (many times single mothers) are reeled into the
drugging by these financial incentives waved in front of them in hard times, making
lifestyle changes possible.
Did you know that by labeling your child with ADHD, you are actually labeling
them with a mental illness listed in the DSM-IV, the unscientific billing bible
for psychiatry?
Did you know that a child taking a psycho-tropic, psycho-stimulant drugs like
Ritalin after the age of 12 is ineligible for military service?
Did you know that the subjective checklists that are being used as criteria for
diagnosis are very similar to the checklists used to determine Gifted and Talented
Children? These two checklists are almost identical.
The Drug Enforcement Administration clearly states in their report on Methylphenidate:
&However, contrary to popular belief, stimulants like methylphenidate will affect
normal children and adults in the same manner that they affect ADHD children. Behavioral
or attentional improvements with methylphenidate treatment therefore is not diagnostic
of ADHD.& (p.11) This statement thoroughly contradicts what is being told to many
parents by the many &professionals& that have a vested stake in the diagnosis itself.
The DEA further states that: &Of particular concern is that most of the ADHD
literature prepared for public consumption by CHADD and other groups and available
to parents, does not address the abuse potential or actual abuse of methylphenidate.
Instead, methylphenidate (usually referred to as Ritalin by these groups) is routinely
portrayed as a benign, mild substance that is not associated with abuse or serious
side effects. In reality, however, there is an abundance of scientific literature
which indicates that methylphenidate shares the same abuse potential as other Schedule
II stimulants.& (p.4)
Did you know that groups like CHADD and others available to parents are being
supported financially by pharmaceutical companies? This is a red flag and demonstrates
a conflict of interest in the role that these groups have regarding our children's
health and well-being.
Did you know that there are studies such as the Berkeley Study that contends
that Ritalin and other stimulants further raise the risk of drug abuse? From the
Wall Street Journal, Monday, May 17, 1999 by Marilyn Chase: &Nadine Lambert, a professor
of education, followed almost 500 children for 26 years. She argues that exposure
to Ritalin makes the brain more susceptible to the addictive power of cocaine and
doubles the risk of abuse.&
This study seems to never make it into the hands of parents because it doesn't
support the theories of those using the diagnosis to profit off of our children.
What does seem to make it into many parents' hands is research indicating that if
children go &untreated&, which corresponds with &unmedicated& they will &self-medicate&
or end up as juvenile delinquents. Sadly many of these parents are not aware that
many of this biased and unproven research (one such is the Beiderman study) infiltrating
our schools are actually being distributed by pharmaceutical companies, such as
Novartis. This in itself is another red flag and conflict of interest surrounding
our children's health.
I leave you with this question: How many more 11 year old Stephanie Hall's, 14
year old Matthew Smith's and 10 year old Shaina Dunkle's need to die before we realize
what is happening and speak out and act to put an end to it?
One toy might be recalled if 1 or 2 children die from it. How many children have
to die from these drugs before we realize and put an end to this horror. Why should
hundreds or thousands have to die before we are outraged and act?
Is the profit of so many, worth more than our children's safety and lives? Sadly
the deaths of these children have remained unexposed and suppressed for so long
because there is a tremendous amount of money and profit at stake for so many. My
son's voice will not be one of those suppressed and quieted.
*Below is a copy of a letter sent to the doctor by our sons school social
worker and psychologist asking the doctor for our six-year-old to be put on Ritalin.
IEP will be on December 6. We have recognized his learning difficulties. We'll
likely give him maximum time in a resource room (3 hours/day).
Our concern is that his psychological testing has shown strong average intelligence.
Sub-scores are weakest in the areas of attention and memory (which our psychologist
believes are indications of ADHD)
He has had a long history of impulsive over-activity. We (social worker-psychologist
witnessed this in Matt's pre-school at Miss Molly's, That's why we certified him
eligible for PPI - pre- primary-impaired. He had his PPI year, then kindergarten
year and now 1st grade.
Many environmental changes have been tried to help Matt concentrate and focus,
yet he is still at a beginning kindergarten readiness. We believe his high level
of distraction is even more of a handicap than his learning deficits.
We had hoped by September you and Matt's parents would have begun a trial of
medication so that we could assess whether his learning would have benefited by
increased focus and concentration.
Would you consider simultaneously having Matt begin his 3 hours in a resource
room with a prescribed medical therapy? Parents indicate they would feel comfortable
with this decision if you do.
We are so concerned that Matt has begun to see himself as &bad& and doing &bad
things& I, as the school social worker, will continue to work with Matt on self-esteem
and social skills.
Matthew supposedly needed this drug Ritalin because of a subjective diagnosis
called ADHD until it silenced him forever on March 21, 2000, even sadder I have
learned that thousands of children have died as a direct result of using psychotropic
medications over the years.
*Matthew's Voice in Death Will be Heard by All 9/1/1985 - 3/21/2000
In closing we would hope this website about Attention Deficit Hyperactivity disorder,
&ADHD& or Attention Deficit Disorder &ADD&. and just how lethal these psychotropic
can be. Sincerely, &The Smith family
Ritalin: Child Abuse on Prescription?
Study's failure to report on the crucial comparison between unmedicated and medicated
ADHD subjects.
Family doctors are these days frequently under pressure (usually from teachers
and social workers who know nothing about drug therapy and probably understand nothing
about the way the international drug industry operates) to prescribe the drug called
Ritalin for children who are accused of behaving badly, reported as not doing well
at school and `diagnosed' as suffering from something called Attention Deficit Hyperactivity
Disorder (known as ADHD).
For several decades now Ritalin, and other amphetamine type drugs, have been
prescribed for children dysfunction and diagnosed as suffering from various types
of brain hyperactivity. (Other psycho-stimulants which have, at one time or another,
been regarded as competitors to Ritalin have included Dexedrine).
In my view the first problem is that Attention Deficit Hyperactivity Disorder
(and other variations on the hyperactivity theme) is a rather vague diagnosis which
is often leapt upon by teachers, social workers and parents to excuse and explain
any unacceptable or uncontrollable behaviour.
Parents of children whose behaviour is in any way regarded as different or unusual
are often encouraged to believe that their child is suffering from a disease for
two simple reasons. First, it is more socially acceptable to give a child a pseudoscientific
label than to have to admit that he or she may simply be badly behaved.
Second, when a child has been given a label it is possible to offer a treatment.
Commonly it will be one, such as a drug, which offers someone a profit. ADHD, which
is also known as Attention Deficit Disorder (or ADD), hyperkinetic child syndrome,
minimal brain damage, minimal brain dysfunction in children, minimal cerebral dysfunction
and psycho-organic syndrome in children, is a remarkably non specific disorder.
The symptoms which characterize the disorder may include: a chronic history of a
short attention span, distractibility, emotional lability, impulsivity, moderate
to severe hyperactivity, minor neurological signs and abnormal EEG. Learning may
or may not be impaired.
Read that rather nonsensical list of symptoms carefully and you'll find that
just about any child alive could probably be described as suffering from ADHD.
What child isn't impulsive occasionally? What child doesn't cry and laugh (that's
what emotional lability means)? What child cannot be distracted?
One big worry I have is that Ritalin could be recommended for any child who seemed
bored and restless or who exhibited unusual signs of intelligence or skill. Read
the biographies of geniuses and you may wonder what we are doing to our current
generation of most talented individuals.
`Is Ritalin a drug in search of a disease?' wrote one author, and it isn't difficult
to see why.
First Used In The 1960s
Ritalin has been recommended as a treatment for functional behaviour problems
since the 1960s. When CIBA first suggested this in 1961 they were turned down by
the FDA but in 1963 approval was given for this use of the drug.
By 1966 the `experts' had come up with a definition of the sort of child for
whom Ritalin could useful be prescribed. Children suffering from Minimal Brain Dysfunction
(MBD), the first syndrome for which Ritalin was recommended, were defined as `children
of near average, average or above average general intelligence with certain learning
or behavioral disabilities ranging from mild to severe, which are associated with
deviations of function of the central nervous system. These deviations may manifest
themselves by various combinations of impairment in perception, conceptualization,
language, memory and control of attention, impulse or motor function'.
Other symptoms which children might exhibit and which could be ascribed to MBD
included: being sweet and even tempered, being cooperative and friendly, being gullible
and easily led, being a light sleeper, being a heavy sleeper and so on and on.
Given that sort of list to work with it is difficult to think of a child who
wouldn't benefit from Ritalin - though the official estimate seemed to be that only
around 1 in 20 children were real MBD sufferers.
A Convenient Diagnosis
The bottom line is that it has become easy for social workers and teachers to
define any children who misbehaves or doesn't learn `properly' as suffering from
MBD or ADHD. Its a convenient diagnosis which excuses parents, teachers and social
workers from responsibility or any sense of guilt. How can the parents or the teacher
be accused of failing when the child is ill?
The head of the task force which identified and labeled MBD allegedly subsequently
joined the company making Ritalin and produced their hand book for doctors on the
condition. Commercially Ritalin and MBD became a huge success. By 1975 around a
million children in the U.S. were diagnosed as suffering from MBD. Half of these
were being given drugs and half of those on drugs were on Ritalin.
For the sake of completeness I should point out that Ritalin has not always been
used exclusively in the treatment of badly behaved children.
When Dr Andrew Malleson wrote his book `Need Your Doctor Be So Useless' in 1973
he reported that the CIBA Pharmaceutical Company had suggested `to doctors the use
of their habit forming drug Ritalin for `environmental depression' caused by `NOISE:
a new social problem'.
Does Ritalin Work?
The next question which has to be asked is: `Does Ritalin work?'
Well, I'm afraid that I can't answer that question. And I honestly don't think
anyone else can either. Novartis, the drug company which is now responsible for
Ritalin in the UK, admits that `data on...efficacy of long term use of Ritalin are
not complete'.
With one in twenty children said to be suffering from MBD (or ADHD or ADD or
whatever else anyone wants to call it), with Ritalin having been on the market and
used for this condition for over three decades, and with some experts saying that
a million children a year are given Ritalin in the U.S. alone you might find this
a trifle disappointing.
Just how long does it take to find out whether or not a drug works? Am I being
horribly cynical in suggesting that it might be against the drug company's interests
to find out whether or not Ritalin really works? After all, if long term studies
found that Ritalin didn't work a very profitable drug would, presumably, lose some
of its appeal. Some research has been done. One five year study of hyperactive children
who were given Ritalin at Montreal Children's Hospital found that the children did
not differ in the long term from hyperactive children who were not given the drug.
At least one investigator has reported that drugs like Ritalin may produce a deterioration
in learning new skills at school and parents have reported that the symptoms of
MBD have miraculously disappeared during school holidays.
The picture is confused by the fact that there may be a short term improvement
in behaviour among children given Ritalin. But is this a real improvement? Or is
the child simply drugged? Amphetamine type drugs reduce the variety of behaviour
exhibited by children. A child taking Ritalin might have more focused behaviour.
But although that might mean less disruption in the classroom does it really help
the child? And should we give a child a powerful and potentially hazardous drug
because they it keeps him quiet?
There is evidence suggesting that children who are genuinely hyperactive may
have been poisoned by food additives or by lead breathed in from air polluted by
petrol fumes. If this is so then is giving another potentially toxic drug really
the answer to this problem?
Potentially Toxic
The next problem is that I believe that Ritalin can reasonably be described as
potentially toxic. Ritalin has been described as `very safe' but for the record
here is a list of some of the possible side effects which may be associated with
Ritalin: nervousness, insomnia, decreased appetite, headache, drowsiness, dizziness,
dyskinesia, blurring of vision, convulsions, muscle cramps, tics, Tourette's syndrome,
toxic psychosis (some with visual and tactile hallucinations), transient depressed
mood, abdominal pain, nausea, vomiting, dry mouth, tachycardia, palpitations, arrhythmias,
changes in blood pressure and heart rate, angina pectoris, rash, pruritus, urticaria,
fever, arthralgia, alopecia, thrombocytopenia purpura, exfoliative dermatitis, erythema
multiforme, leucopenia, anaemia and minor retardation of growth during prolonged
therapy in children.
Doctors who prescribe Ritalin, and who have the time and the inclination to read
the warnings issued with the drug, will discover that Ritalin should not be given
to patients suffering from marked anxiety, agitation or tension since it may aggravate
these symptoms.
Ritalin is contraindicated in patients with tics, tics in siblings or a family
history or diagnosis of Tourette's syndrome. It is also contraindicated in patients
with severe angina pectoris, cardiac arrhythmias, glaucoma, thyrotoxicosis, or known
sensitivity to methylphenidate and it should be used cautiously in patients with
hypertension (blood pressure should be monitored at appropriate intervals). Ritalin
should not be used in children under six years of age, should not be used as treatment
for severe depression of either exogenous or endogenous origin and may exacerbate
symptoms of behavioural disturbance and thought disorder if given to psychotic children.
The company selling it claims that although available clinical evidence indicates
that treatment with Ritalin during childhood does not increase the likelihood of
addiction chronic abuse of Ritalin can lead to marked tolerance and psychic dependence
with varying degrees of abnormal behaviour.
Ritalin, it is warned, should be employed with caution in emotionally unstable
patients, such as those with a history of drug dependence or alcoholism, because
such patients may increase the dosage on their own initiative.
Ritalin should also be used with caution in patients with epilepsy since there
may be an increase in seizure frequency.
And height and weight should be carefully monitored in children as prolonged
therapy may result in growth retardation. (A child might lose several inches in
possible height - though if treatment is stopped there is a generally a growth spurt).
It is perhaps worth mentioning here my view that if a drug is powerful enough to
retard growth it does not seem entirely unreasonable to suspect that the chances
are high that it may be having other powerful effects upon and within the body.
Doctors are also warned that careful supervision is required during drug withdrawal,
since depression as well as renewed overactivity can be unmasked. Long term follow
up may be needed for some patients.
There have also been reports that children have committed suicide after drug
withdrawal. And one study has shown that children who are treated with stimulants
alone had higher arrest records and were more likely to be institutionalized. Long
term use of Ritalin has been said to cause irritability and hyperactivity (these
are, you may remember, the problems for which the drug is often prescribed). In
a study published in Psychiatric Research and entitled Cortical Atrophy in Young
Adults With A History of Hyperactivity brain atrophy was reported in more than half
of 24 adults treated with psychostimulants (though I don't think anyone can say
for sure whether or not the psychostimulants caused the brain atrophy the possible
link should make prescribers, teachers and parents who are fans of Ritalin stop
and think for a moment).
In Johannesburg a study of 14 children is said to have produced a response in
only 2 children. One child showed some deterioration and another showed marked deterioration.
The final insult is, surely, the fact that the company selling Ritalin tells
doctors that `Data on safety and efficacy of long term use of Ritalin are not complete.'
For this reason they recommend that patients requiring long term therapy should
be monitored carefully with periodic complete and differential blood counts, and
platelet counts.
I regard this as an insult because Ritalin is not a new drug.
I have not, at the time of writing this, been able to find out exactly when it
was first introduced but I have been able to trace it back to 1961.
Now, maybe I'm being rather demanding but it does seem to me that when a drug
has been on the market for well over a quarter of a century it isn't entirely unreasonable
for the drug company involved to have completed studying the data on whether or
not it works and is safe.
Cancer In Mice
When early safety tests were done on mice researchers found that the drug caused
an increased in hepatocellular adenomas and, in male mice only, an increase in hepatoblastomas
(described as `a relatively rare rodent malignant tumor type'). The significance
of these results to humans is unknown' say Novartis, the company selling Ritalin.
Here, once again, is yet more proof of the total worthlessness of animal experiments
and the ruthless and cynical attitude shown by drug companies and those government
departments which allegedly exist to protect the public from unsafe drugs.
I have frequently argued that when drug companies perform pre clinical tests
on animals they do so knowing that if the tests show that a drug doesn't cause any
problems when given to animals they can use the results to help convince the authorities
that the drug is safe.
On the other hand when a drug does cause a problem when given to animals the
results can be ignored on the grounds that `the significance of these results to
humans is unknown'.
The question here is a very simple one: if the experiments on mice which showed
that Ritalin causes cancer were of value why is the drug still available on prescription
for children? And if the experiments can safely be ignored (on the grounds that
animals are so different to human beings that the results are irrelevant) why the
hell were the tests done in the first place?
Ignorance And Misplaced Trust
My own feeling is that the people who told you that Ritalin is 'very safe' are
either unable to read or too lazy to do any research into the safety of a product
which they are recommending with such enthusiasm.
Years of experience mean that I am not in the slightest bit surprised to find
such crass stupidity exhibited by social workers. I am, however, more surprised
to find school teachers showing such a potent mixture of ignorance and misplaced
trust. Some observers claim that Ritalin can be considered for a children when tests
and clinical examinations have shown the existence of a clear neurological disorder
- with abnormal brain wave patterns.
Psychiatrist, psychologist, health visitor, teachers, GP and parents should,
it is said, all be considered before considering treatment.
Even the company selling Ritalin says that `Ritalin treatment is not indicated
in all children with this syndrome and the decision to use the drug must be based
on the physician's evaluation of the child's history and the duration and severity
of symptoms'.
However, despite this, when a team of researchers from the United Nationals International
Narcotics Control Board examined the records of nearly 400 pediatricians who had
prescribed Ritalin they found that half the children who had been diagnosed as suffering
from MBD (or ADD or whatever) had not been given psychological or educational testing
before being given the drug. The United Nations concluded that frustrated parents,
teachers and doctors were too quick to stick a label of ADD onto children with behavioral
problems (or, to be more accurate, to children whose behavioral was annoying the
parents, teachers and doctors).
Less Than Enthusiastic
I am less than enthusiastic about this drug. In my view, the world would be a
healthier place if all supplies of this wretched drug were wrapped in concrete and
buried in the rubble of the headquarters of the company making the damned stuff.
You might have guessed by now that I wouldn't prescribe Ritalin for anyone -
for anything.
But other doctors clearly don't agree with me. Some observers have described
Ritalin as a drug that can unlock a child's potential. And although estimates about
the number of children taking Ritalin vary in the U.S. alone it has been claimed
that up to 12 % of all American boys aged between 6 and 14 are being prescribed
Ritalin to treat various behavioral disorders. In 1990 the world wide production
of the drug was less than three tones. By 1994 production of the drug had virtually
trebled. It is now not unknown for schools to arrange for children to be treated
with Ritalin without obtaining parental permission.
It is worth remembering that although doctors, parents and teachers have for
over thirty years now been enthusiastically recommending the use of Ritalin (and
similar drugs) in the treatment of MBD there are still a number of unanswered questions.
We still do not know whether the drug works and nor do we know whether it causes
any permanent long term damage. We do not know whether the listed potential side
effects do more damage than any possible good the drug might do. And, perhaps most
astonishing of all, despite the fact that millions of children have been diagnosed
as suffering from ADHD, ADD or MBD, and treated with powerful drugs, we do not even
know whether any of these conditions - or hyperactivity - really exist.
Back in 1970 the Committee on Government Operations of the U.S. House of Representatives
studied the use of behaviour modification drugs on children. At that time around
200,000 to 300,000 children a year in the U.S. were being given these drugs and
the point was then made that hyperactivity is considered a disease because it makes
it difficult for schools to be run `like maximum security prisons, for the comfort
and the convenience of the teachers and administrators who work in them...'.
Since then the only thing that has changed is that the popularity of Ritalin
has continued to rise and rise and rise inexorably.
Prescribing Ritalin is, in my view, authorized child abuse on a massive, global
But it is clear that the prescribing of powerful mind altering drugs for small
children is big business.
In the US the use of antidepressants and stimulants among toddlers aged between
two and four tripled between 1991 and 1995. The period between birth and four years
of age is a time of great change in the human body. Most importantly it is a time
when the brain is maturing. Heaven knows what effect these drugs have on those tiny
developing brains.
Ritalin is now widely prescribed for toddlers. So are many other antidepressants,
stimulants and other powerful drugs. Remember: typical symptoms of this alleged
disease include `restlessness' and `inattentiveness'.
I am delighted that my protests and complaints about these absurd and obscene
prescribing habits have drawn a number of vicious complaints from doctors.
In my view every doctor who prescribes such drugs for children with alleged ADHD
should be defrocked, given a good thrashing with genetically engineered stinging
nettles and forced to emigrate to the USA.
The Truth Behind Brain Scans
Study's failure to report on the crucial comparison between unmedicated and medicated
ADHD subjects.
2004 The Institute of Mind and Behavior, Inc.
The Journal of Mind and Behavior Spring 2004, Volume 25, Number 2
Pages 161-166
An Update on ADHD Neuroimaging Research
David Cohen Florida International University and Jonathan Leo Lake Erie College
of Osteopathic Medicine Bradenton
Since the publication of a critical review on ADHD neuroimaging in a past issue
of this journal (Leo and Cohen, 2003), several relevant studies have appeared, including
one study that had a subgroup of unmedicated ADHD children (Sowell, Thompson, Welcome,
Henkenius, Toga, and Peterson, 2003). In this update to our earlier review we comment
on this last study's failure to report on the crucial comparison between unmedicated
and medicated ADHD subjects. The issue of prior medication exposure in ADHD subjects
constitutes a serious confound in this body of research, and still continues to
be dismissed and willfully obscured by researchers in this field.
In a previous issue of this journal, we reviewed the attention-deficit/hyperactivity
disorder (ADHD) neuroimaging research (Leo and Cohen, 2003). We pointed out the
difficulty in drawing meaningful conclusions from this body of research because
of a significant confounding variable: prior or current medication use by the ADHD
patients. As we documented, in the large majority of ADHD neuroimaging studies,
researchers have compared brain scans from normal control subjects to brain scans
from medicated ADHD subjects. This makes it difficult to know if between-group differences
reported by researchers might result from an idiopathic organic brain defect - as
implied or stated in most studies - or from brain changes resulting from prior drug
use by the subjects diagnosed with ADHD. Critics over the past decade pointed out
that prior medication use constitutes an important potential confounding variable
that limits the validity of these studies, but most researchers have continued to
use medicated patients in their studies, sometimes without acknowledgement of the
Despite the dismissal of the issue of prior medication use in published reports,
the issue must have been quite sensitive in the minds of researchers nonetheless.
Indeed, immediately upon the publication of a large study (n=291) by Castellanos,
Lee, Sharp, Jeffries, Greenstein and Clasen (2002), that included a subset of ADHD
patients who had never taken medication, the sponsor of that study, the National
Institute of Mental Health (NIMH), released a press briefing declaring: &Brain Shrinkage
in ADHD Not Caused by Medications& (NIMH, 2002). This announcement rested on results
of a subgroup comparison between 103 medicated and 49 unmedicated ADHD subjects,
which found that, just like their medicated peers, unmedicated youths also demonstrated
statistically significant smaller brain volumes than normal control subjects. There
was no mention in this study about the specifics of the medication history of the
medicated children. In our earlier review (Leo and Cohen, 2003) we discussed several
problems with the Castellanos et al. study. The following is a brief summary of
that discussion:
On average the unmedicated ADHD subjects were two years younger than the medicated
ADHD subjects.
The unmedicated ADHD subjects were stated to be shorter and lighter than the
normal controls but precise figures on height and weight were not provided.
No details were given about previous treatment histories of the medicated ADHD
subjects, such as duration, dose, or even what drug or drugs were prescribed.
Since our review appeared, several ADHD neuroimaging studies have been published.
Unfortunately, by failing to exercise appropriate control over the variable of prior
medication, these studies perpetuate the confusion and uncertainty that, we argued,
characterizes findings in this body of research. For example, Mostofsky, Cooper,
Kates, Denckla, and Kaufmann (2002) had 12 ADHD subjects in their study, ten of
whom had a prior history of medication.
MacMaster, Carrey, Sparkes, and Kusumakar (2003) entitled their study &Proton
Spectroscopy in Medication-Free Pediatric Attention-Deficit/Hyperactivity Disorder,&
yet eight of their 9 ADHD subjects had a prior history of medication: three stopped
taking their medication 48 hours before the scan, and five stopped taking it one
to 3 weeks before the scan. Taking medicated ADHD subjects off their medication
before the imaging and then classifying them as &medication-free& is unsound. We
cannot emphasize enough that a study wishing to reach conclusions about the neuropathology
of ADHD needs to recruit a control group of medication-na ve subjects, especially
given the well-documented neuropathological effects of psychotropic medication (Leo
and Cohen, 2003).
In our view, the most significant recent report was of a relatively large study
involving 27 ADHD and 46 normal control subjects, conducted by the Laboratory of
Neuroimaging at the University of California, Los Angeles (LONI). Sowell, Thompson,
Welcome, Henkenius, Toga, and Peterson (2003) reported that the ADHD children had
smaller frontal lobes compared to normal controls subjects, but overall the ADHD
subjects had more cortical grey matter. In our view, this study's significance derives
not necessarily from this result, but - as with several previous ADHD neuroimaging
studies - from important comparisons that researchers could have made, but did not.
As in the Castellanos et al. (2002) study, some of the ADHD subjects in the Sowell
et al. (2003) study were apparently medication-na ve. We say &apparently& because
specific descriptions were not provided: &15 of the 27 patients were taking stimulant
medication at the time of imaging& (p. 1705). It is unclear how to categorize the
remaining 12 patients. Did they have a history of medication and then stop taking
it for 48 hours, or some other arbitrary time period, before imaging? It surprises
us that a study published in Lancet could be so vague about one of the most important
variables in the study.
Conclusions based on a comparison of normal control subjects to medication- na
ve ADHD subjects would be very different than conclusions based on a comparison
of control subjects to ADHD subjects with varying durations of medication exposure
and with some patients undergoing abrupt withdrawal.
The issue becomes considerably more muddled and confusing due to a brief discussion
of the potential role of stimulant medication on their findings at the end of Sowell
et al.'s (2003) paper. The authors first appropriately acknowledged that, since
55% of their ADHD children were taking stimulants, &the effects of stimulant drugs
could have confounded our findings of abnormal brain morphology in children with
[ADHD]& (p. 1705). The simplest way to properly evaluate this confounding effect
would have been to compare the 15 medicated ADHD children with the 12 unmedicated
ADHD children. However, Sowell et al. consciously chose to not make that comparison:
&We did not directly compare brain morphology across groups of patients on and off
drugs because the sample size was considerably compromised when taking lifetime
history of stimulant drugs into account& (p. 1705).
The authors further explain that this comparison, between unmedicated and medicated
ADHD children, is not needed because a prior study by Castellanos et al. (2002)
suggested that medications do not affect brain size [a contention which ignores
the problems we identified in our lengthy review].
Sowell et al.'s methodological choice, and its justification, is both unconvincing
and puzzling. First, although one can obviously sympathize with their judgment that
&taking lifetime history of stimulant drugs into account& compromised their sample
size, this judgment ignores that for thirty years ADHD neuroimaging researchers
have deemed it perfectly acceptable to compare ADHD subjects and normal controls
regardless of medication history (Leo and Cohen, 2003). Indeed, virtually all the
studies Sowell et al. cite to contextualize their study and interpret their results
exemplify this practice. Thus, it is difficult to see why Sowell et al. would feel
that they should not compare medicated and unmedicated ADHD subjects. Clearly, just
as they acknowledged limitations to their main study results, Sowell et al. could
obviously have reported the results of the more specific comparison with an acknowledgement
of appropriate limitations.
Second, Sowell et al. cite Castellanos et al. to support the methodological choice
of not comparing medicated and unmedicated ADHD subjects. But, Castellanos et al.
made that very comparison regardless of medication history!
Third, and most important, Sowell et al.'s data appear directly relevant to either
support or refute the conclusions that Castellanos et al. (2002) drew from their
comparison. Put another way, the results of Castellanos et al.'s comparison of brain
volumes of medicated and unmedicated ADHD children were deemed worthy of a major
press release by the NIMH concerning stimulant drugs' effects on developing brains,
yet the same comparison in the Sowell et al. study is considered insignificant and
not even reportable.1 For the above reasons, we suspect that the comparison of medicated
with unmedicated ADHD subjects in Sowell et al.'s study might have produced results
that would have diluted the findings that Sowell et al. chose to emphasize instead.
Following the publication of the Sowell et al. (2003) study, the media paid significant
attention to it. In one interview, the study's last author stated: &The next phase
of the work will be to see whether the magnitude of the abnormalities in these individuals
might influence the course of the condition, their response to medication, and which
medications different children respond to& (cited in Edelson, 2003, italics added).
We assume that this next phase of investigation will involve a comparison of medicated
with unmedicated children - but how this will differ from their previous study,
or from most ADHD neuroimaging studies, remains completely unclear.
Discussion:
In our earlier review (Leo and Cohen, 2003) we discussed our concern about the
careless or distorted way that imaging results were often reported in the sci-1Following
the publication of the Sowell et al. study, we corresponded with the lead author
who graciously answered our queries but expressed no interest in comparing brain
volume data of medicated and unmedicated ADHD children. A month before submitting
the current article for publication, we communicated with all authors of the Sowell
et al. study, asking them to share the data to allow us to make the stated comparison,
but received no reply.
Scientific literature, professional publications and the media. In several discussions
with imaging researchers since our review appeared, we have heard repeatedly that
the media is the culprit when it comes to &reading too much& into a study. However,
examples of oversimplification abound within the professional and scientific literature.
For instance, in a recent article about the Castellanos et al. study on the Internet
site Medscape, excerpted from the 2004 Child and Adolescent Psychiatry Meeting,
the author declares: &On an anatomic level, total cerebral volume is approximately
3% smaller in youth with ADHD& (Gutman, 2004). It is hard to conceive of a more
fitting example of a complex study being presented in an overly simplistic manner.
Gutman discusses no problems or limitations of the C she simply
asserts to a huge audience of clinicians that it is a fact that ADHD children have
smaller brains. The website includes a test that clinicians can take after reading
the article if they wish to earn continuing medical education credits, and one of
the questions reads: &When looking at ADHD and cerebral volume in children, researchers
have found . . . & - and the &correct& answer is given as: &Total cerebral volume
is approximately 3% smaller in youth with ADHD.& It is deeply troubling to us that
a professional society can propagate such a statement based on a single study with
major limitations. Ruling out the effects of psychotropic medication is merely one
of the tasks confronting researchers conducting neuroimaging research with ADHD
patients. Even if the field accomplishes this task, several other important tasks
remain. One of these will involve trying to make sense of findings of brain abnormalities
or differences among some individuals diagnosed with ADHD.
And in this task, a few observations will deserve serious consideration, though
they are very rarely discussed in the ADHD neuroimaging literature. One exception
is an article by Rubia (2002), from which we find it useful to quote at some length,
despite our disagreement with the author's characterization of ADHD as a &disorder&:
Neurodevelopmental psychiatric disorders, as opposed to neurodegenerative disorders,
are known to be dynamic and are very likely to be even more dynamic than currently
assumed . . . . Only about a third of children with ADHD still meet criteria for
ADHD in adulthood . . . . A highly dynamic interplay between nature and nurture
is likely and the causalities between them may be bi-directional rather than unidirectional.
Until today, it has been erroneously assumed that biological correlates of abnormal
behavior are necessarily the cause of brain &basis& of abnormal behavior. Recent
reports from neuroscience point towards a much more plastic concept of the brain-behavior
relationship with bi-directional causalities . . . . Use-dependent functional and
structural reorganization in sensory cortices, for example, has been observed in
skilled subjects, pianists and musicians.
Post-traumatic stress disorder in war veterans and victims of child abuse causes
smaller hippocampi and abnormal amygdala activation. Amputation studies show that
function is necessary for structure to develop. These examples show that behavior,
experience, and function can alter and determine brain structure. This has fundamental
implications especially for psychiatric research, given that psychiatric disorders
are characterized and defined by deviation from normal functioning. (Rubia, 2002,
In sum, brain differences (or &abnormalities&) may be related to the state rather
than the trait of the syndrome or behavior in question, and this fundamental issue
will require immense creativity and rigor to tackle. By comparison, the issue of
prior medication is extremely uncomplicated: to rule out effects of medication exposure
on brain volume, one simply needs to compare a group of ordinary medicated ADHD
patients with a control group of ordinary, age- and weight-matched unmedicated ADHD
patients. A single study of this type with no more than 60 subjects could practically
settle the question. Unfortunately, given how the ADHD neuroimaging field has so
far treated this simple issue, it is doubtful to expect that researchers in this
field will make progress on the more significant scientific challenge ahead.
Online Medical Resources - Health training provider for medical practitioners.
References
Castellanos, F.X., Lee, P.P., Sharp, W., Jeffries, N.O., Greenstein, D.K., and
Clasen, L.S. (2002).
Developmental trajectories of brain volume abnormalities in children and adolescents
with attention-deficit hyperactivity disorder. Journal of the American Medical Association,
Edelson, E. (2003). Better brain images could lead to better ADHD treatment.
Parent Center News Gutman, A. (2004). Introduction to new research: Navigating complex
treatment options for ADHD (March 2004). Medscape from WebMD.
464787 Leo, J.L., and Cohen, D. (2003). Broken brains or flawed studies? A critical
review of ADHD neuroimaging studies. The Journal of Mind and Behavior, 24, 29-56.
MacMaster, F.P., Carrey, N., Sparkes, S., and Kusumakar, V. (2003). Proton spectroscopy
in medication- free pediatric attention-deficit/hyperactivity disorder. Biological
Psychiatry, 53, 184-187.
Mostofsky, S.H., Cooper, K.L., Kates, W.R., Denckla, M.B., and Kaufmann, W.E.
(2002). Smaller prefrontal and premotor volumes in boys with attention-deficit/hyperactivity
Biological Psychiatry, 52, 785-794. NIMH. (2002). Brain shrinkage in ADHD not
caused by medications.
Rubia, K. (2002). The dynamic approach to neurodevelopmental psychiatric disorders:
Use of fMRI combined with neuropsychology to elucidate the dynamics of psychiatric
disorders, exemplified in ADHD and schizophrenia. Behavioral Brain Research, 130,
Sowell, E.R., Thompson, P.M., Welcome, S.E., Henkenius, A.L., Toga, A.W., and
Peterson, B.S. (2003). Cortical abnormalities in children and adolescents with attention-deficit
hyperactivity disorder. The Lancet, 362, .
Request for reprints should be sent to Jonathan Leo, Ph.D., Department of Anatomy,
Lake Erie College of Osteopathic Medicine Bradenton, 5000 Lakewood Ranch Blvd, Bradenton,
Florida 34211. Jonathan Leo may be reached at jonleo@lecom. David Cohen may
be reached at David.Cohen@fiu.edg
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