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The Hazards of Treating "Attention-Deficit/Hyperactivity Disorder" with Methylphenidate (Ritalin)Peter R. Breggin a & Ginger Ross Breggin ba The Center for the Study of Psychiatry, Bethesda, MD 20814b Director of Research and Education, The Center for the Study of Psychaitry, Bethesda, MD,20814Published online: 18 Oct 2008.

To cite this article: Peter R. Breggin & Ginger Ross Breggin (1996) The Hazards of Treating "Attention-Deficit/HyperactivityDisorder" with Methylphenidate (Ritalin), Journal of College Student Psychotherapy, 10:2, 55-72, DOI: 10.1300/J035v10n02_06

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The Haaads of Treating " "A~ention-Defiei~yperaetivi~ Disorder ''

with Methylphenidate Peter R. Breggin

Ginger Ross Breggin

Few mental health professionals can recite the American Psy- chianic Association diagnostic criteria as delineated in the Diag-

Peter R. Breaiin and Gkgm Ross Bnggk are afFIIiated with The Cents for &e Smdy of P s y c ~ a q , 46B 8 e s b u t Sewt, Berlrea, PvfD 20814. Perm B r e ~ h is Executive D5mtor m d &ga Brczggh is D m r m of Resewch md Muca~sn.

This micile is condemd and redt ien from a much longa chaptm in the 'book The War against Children (1994) by Peter a d Ghgm Breggh It is king grab- lishd shdbmeoaasly in the Review of his len t i l Pqeboolon and Pqchiotv md is publish& here with the p ssisn of &at Jowa19s publisba9 H m ~ t i b e s

'

Press, as well as S S t w t h Press, New York, w ~ c k publishd &e thank these publishm m d Mitor Keith HHolm of the Review for the siom and msistmce,

ssicsn from The War against Children, S t Mmk9s Press, hc , New Yak, CopMghtB by Peter Breggh, bfD, ad. Gkgm Ross Breg-

ssisn from H m d t i e s Press, htmationd, hc., Atlmbie

J o w d of College S&&wb Psyckofierapy, Vole 10(2) 1995 55

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nostic and Stmisrical Manual of Mental Disorders-N (DSM-N) (American Psychiatric Association, 1994), even for the diagnoses they routinely use. But the diagnostic smdards are impeat in setting chicai and research trends. Their existence creaes a strong, if potentidly misleading, impression of validity for psychiaeric diagnosing in general, as well as for ihe individual diagnostic cate- gories. The prescription of medication to children, for example, i s largely justified on the bask of these diagnoses.

The existence of the diagnoses also influences how millions of parents and teachers view the children in their care. Most teachers and many parents of young people have heard of "hyperactivity" and,

&ally, Anention-Deficim vity Disorder (ADHD). Marmy non-mentd health professionals klieve they can diagnose it.

THE DISRUPTWE BEHAVIOR DISORDERS (DBDs)

Along with Conduct Disorder and Oppositional Defiant Disor- der, ADHD was originally considered one of the Disruptive Behav- ior Bisorden in the DSM-111-R (Ameficm Psychiat~c Association, 1987). In the DSM-IV, an attempt is made to separate ADHD from the o&er two dkmptive disorders at Ileast when ADHD mmzests

d y as inattention rather than hyperactivity. The DSM committee found that while disluptive behavior and attention prob- lems "often occur together," "some" ADHD children are not hy- peractive and disruptive (Fasnacht, 1993).

Despite my aaempt to s &=mes o k n overlap with each other and refer to &em as one goup, the DBDs. The tion of c M h n fed to CMCS with Amma~on-kfic Disorder also have Oppositional D e b t Disorder or

hdme of' Mena m n d ~ h o d = or Md samples, with most

an amw~ondeficit disorder diagnosis" (KNesi et al., 1992). The D S M - N does not discuss the definition of Disruptive Behav-

ior Disorder? DSM-f11-R states that DBD chi1ben me ""chwzter- i d by behavior that is socially disruptive and is often more dis- tressing to othels than to the people with the disorders." The

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Peter R. Breggin and Ginger Ross Breggin 57

"'illness" consists of being disruptive to the hives of adults-a defmi- tion seem tglord for social eoneol,

The DSM-N distinguishes betvveen two types of ADIID, one marked by inanention and the other by hyperactivity-impulsivity. The oficial standard for ADHD requires any six of nine items under each category. For hyperactivity-impukivity the Tmt four items in descending order include:

1. often fidgets with hands or feet or squ 2. often leaves seat in c1ssroorn or h o

* . rem seated is expected

3. ofte about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)

4. often has difficulty playing or engaging in leisure activities quietly (p. 84)

The first four items in the list for diagnosing the inmention form of the disorder helude::

1. often fails to give close attention to details or makes mistakes in sschoolwork, work, or other activities

2. often has difficulty sustaining attention in- tasks or play activi- ties

3. often does not seem to listen when spoken to directly 4. often does not follow through on instructions and fails to fm-

ish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand insactions) (pp. 83-84)

Those who advocate medicating children often view ADHD as a specific "mental illness" with a genetic and biochemical cause. But as the List of criteria demonstrates, it is one more DBD-another way a child gets labelled as a source of frustration or disruption. This is true even in regard to some of the criteria for the inattention aspect of the disorder. As Gerald Golden (1991) observes: "The behavior

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is seen as being disruptive and uacceptable by parents and teach- ers, and the child is socially handicapped as a result."

Russell Barkley (1991, p. 13) states, ""Although ha~ention, ovesactivitg: and poor impulse control ate the most co tom cited by others as primary in hgperactive ch2&en, my o m work with these children suggests that noncompliance is also a P roblem." It is not surprising that some children are non- Q: with Barkley. He not only wants to medicate them, he blames the child for conflicts that the child is having with family and school. As he puts it, "' . . there is, in fact, something 'wrong9 with these chaben" (p. 4). He does not make a similar indictment of the authorities in the child's life, such as parents or teachers, although they have much more control over the conditions that

e the ch2d9s life md mental condition.

A DISEASE THAT GOES AWAY WKTH AmENTION

The symptoms or rn tations of ADHD often disappear when n have something interesting to do or when they are given mount of ddt attention. This is w& upon by most or rs and indirealy h d s its way into the DSM-111-R and

D M . The DSM-N specifies that the symptom may become apparent when the c enhgs "that lack intrinsic appeal or novelty" and may be or absent when "the person is under very shict control, is vel setting, is engaged in especially

ivities, is in a one-to one situation," including being the doctor. Most advocates of ADHD as a diagnosis

tends to go away d

WHO3 SOT THE PROBLEM?

If the list of criteria for ADHD has any use, it identifies children who are bored, anxious, or angry around some of the adults in their lives or in some d u l t hstimtions, such as the: school a d fmi- lye These "symptom e children as mentally ill. They should red flag new eRoes to atrend to the n d s of the g:ha&en,

When a small child, perhaps five or six years old, is persistently

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Peter R. Breggin and Ginger Ross Breggin 59

disrespcthl or angry, there is always a stressor in that child's Me-something over which the child has little or no control. Some- times, the child is not being respected, because children leam more by example &an by anything else. When itreatedl with respect, they tend to respond respec~lly. IVhen loved, they tend to be loving. Mile the source of the child's upset may out to k m o ~ complicated than that-perhaps the parent is too afraid or distracted to apply rational discipline and lets the child run wild, or perhaps the child is being abused outside the home-the source always lies in the larger world. Children do not, on their own, create severe emo- tional conflicts withh &emselves md with the du l t s xound them,

Children aren't bored, inattentive, undisciplined, resentful or vio- lent by their individual natures; but the stigmatizing label ADHD implies that they are. These children are usually more energetic and more spirited, or more in need of an interesting environment, than their parents and teachers can handle. One of the early advocates of hyperactivity as a diagnosis describes them as unusually dynamic bundles of energy (Wender, 1973). Yet they are being diagnosed with a mentd ihess-a l ak l fiat can follow them kto adulhood to m h their h r u ~ lives,

D m ATTENTION DEFICIT DISORDER (DmD)

In my clinical experience, most so-called ADHD children are not receiving sufficient attention from their fathers who are separated from the family, too preoccupied with work and other things, or othenvise imp&ed in their ability to parent. In many cases the appropriate diagnosis is Dad Attention Deficit Disorder (DADD) (Breggin, 1991).

The '%we'% for these ch2&en is more raiond a d Iovhg agen- tion from their dads. Young people are nowadays so hungry for the attention of a father that it can come from any male adult. S ly impulsive, hostile groups of children will calm down

g, relaxed, and adult male is around. Arlington High School in Indianapolis was cmcelting many of its after-school events h a u s e of lhess, when a father happened to anend one of them (Sfi&, 1993):

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That evening there was an odd quietness on [the father's] side of the audito~um, It 4 out that when he would tell his group to settle down, some students would second hh. One said: "That's Lena3 father. You head him. Be quiet; act right." (p. 5)

Since then rhe school has begun to enlist volunteer dads for its a&er-school events*

At other tbes , the so-cdld dkorder should be c d l d T m D : Teacher Agention Deficit Disorder. Due more to problem in o w educational system than to the teachers themselves, few smdents get the individualized educational programs that h e y need.

PROFESSIONAUY DISCREDITED

In 1993 neurologist Fred Baughmm, Jr. noted that studies have any definite improvement from the drug treatment

of these children. Baughman cites estimates of the frequency of ADD that vary from 1 in 3 to 1 in 1000. He therefore asks, "Is anention-deficit hyperactivity disorder, after all, in the eye of the kholder? The eye of the beholder theme echoes Dime McGuhess who

has systematically debunked ADHD as the "emperor's new clothes.99 According to McGuinness in a chapter in The Limits of Biojogkal Treatmentsfor Psychological Distress (1 989):

The past 25 years has led to a phenomenon almost unique in history. Methodologically rigorous research . . . indicates that ADD [Attention Deficit Disorder] and hyperactivity as "syn- dromes" simply do not exist. We have invented a disease, given it medical sanction, and now must disown it. The major question is how we go about destroying the monster we have created. It is not easy to do this and still save face . . . (p. 155)

According to Richard E. Vatz (1993), "Attention-deficit disorder (ADD) is no more a disease than is 'excitability.' It is a psychiatric, pseudomedical tern. "

Fr& h m a m (19W), a dkector of one of units, recently applauded "the growing number of clinicians and

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Peter R. Breggin and Ginger ROSS Breggin 61

researchers condeming the iyr y of our psychiatric md educa- tional classification systems." h m a m Fmds that i t is "exceedingly dficult to assign valid ~lassifications~~ to childrein, md yet "'chi& dren are by far the most classified and Labeled group in ow soci- ety." Me warns against "the hrimriondl prescriptions of a system that seeks to pigeonhole them." (p. I)

A P W S I C M BASIS TO m H D ?

A study led by NMH9s Nan et al,, 1990) received a great deal of publicity b r ~ n metab- olism in posit~on emission tomography (PET scans) of a d u h with a hktoq of A D m in ch2dhood. However, when &lie sexes were compared separately, there was no statistically significant differ- ence between the controls and ADHD adults. To achieve signifi- cance, the data was lumped together to include- a disproportionate numkr of women in the cow&ols, PBrrxi ad&tion, when hdividud areas of the brain were compared between controls and ADHD adults, no differences were found. It is usually possible to massage data to produce some son of statistical result and is a clasig: aarswationn.

Shce ABHD is not a disorder but a mmZestation sf confict, we doubt that a biological cause will ever be found. Golden (1991) put it simply:

Attempts to defme a biological basis for ADHD have been consistently unsuccessful. The neuroanatomy of the brain, as demonstrated by newimaging studies, is normal. No newo- pathologic substrate has been demonstrated . . . (p. 36)

Meanwhile, the emphasis on possible genetic and biological causes of upset behaviors in children obscures the growing body of

g their psychosocial origins (reviewed in Green, 1989; Breggin, 1992).

Contemporary expelts agree that methylphenidate affects all children in the same way and is in no way specific for children

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diamosed AQHD. Golden (1991) observes, " * . . the response to ot be used to vdidate ssis. N o m d boys as

with mm show s anges when given a single dose of a psycho

Wi&h an how after le dose of a stirnulmt drug, any child tends to kcome t9 more n m o w in focus9 more wiUing to concentrate on humdrum tasks and ins~ructions. Parents in conflict with a little boy can hand him a pill, knowing he'll soon be more dw2e.

It is commonly held that stimulants have a paradoxical effect on children compared to adults, but these drugs probably affect chil- dren k d adults in the same way. At the doses usually prescribed by physicians, children and adults alike are "spaced out," rendered less in touch with their real feelings, and hence more willing to concentrate on boring, repetitive schoolroom tasks.

At higher doses, both children and adults become more obvious- ly stimulated into excitability or hyperactivity. There is, however, great variability among individuals and a number of children and adults will become more hyperactive and inattentive at the lower doses as well,

The British are much more cautious about using stimulants for c~ldren. G r h m e - S ~ ~ md horinson (1992), a u t h o ~ of the Ox- ford Teabook of Clinical Psychopharmocology and Drug Therapy, suggest that stimulants may work in children the same way they impact on rats, by "inducing stereotyped behavior in animals, i.e., in reducing the number of behavioural responses . . ." (p. 141). Stereotyped behavior is simple, repetitive, see gly memhgless activity? often seen in br& dmaged hdividu&. The textbook states somewhat suggestively, "It is beyond our scope to discuss whether or not such behaviourd conml is desirable" (p. 141).

One way to understand the routine effect of any psychiatric drug is to look at its more extreme or toxic effects (Breggh, 1991). The clinical or "therapeutic" effect is likely to be a less intense expres- sion of the toxic effect. In discussing methylphenidate9s "cognitive

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Peter R. Breggin and Ginger Ross Breggin 63

toxicity," James M. Swmson 9 1992) m d his eoa.u&ow su the literahre :

In some disruptive children, hg-induced compliant behavior may be accompanied by isolated, wirhdrawn, and overfocused behavior. Some medicated children may seem " zombie-me9' and high doses which make ADIID children more "somber," '"uuiet," and "still" may produce social isolation by increas- ing "time spent alone" and decreasing "time spent in positive interaction on the playground.

Memwhile, a Swmson et d. $1992) eon , there9s sno evidence that methylphenidate improves learning demic performance.

ed in various reviews (Breggin (1991); Coles (1987); McGuinness (1989); md Swmssn et d. (1992)).

THE LONG-TERM EFFECTS "REMAIN IN DOUBT9'

As the National Znstitute of Mental Health succinctly stated, "The long-term effects of stimulants remain in doubt" (Regier and Lesher, 1992). The FDA-approved infomation put out by the drug company, Ciba-Geigy, admits "Long-term effects of Ritalin in chil- dren have not k e n well establkhed" ((Physicians' Desk Reference, 1994, p, 836). Yet me&ylphenidate is tpically dvscated as a long-tern treatment.

H & h e r states that s ~ d i e s have demons&ated sho~-tern effects such as reducing "class room disturbance" and improving "compliance and sustained attention." But it recognizes that the drugs seem "less reliable in bringing about associated improve- ments, at Ileast of m enaduhg name:, in socid-emotiond md aca- demic problems, such as antisocial behavior, poor peer and teacher relationships, and school failure. "

While estimating that ". . . between 2 and 3 percent of all ele- school g:hil&en in no^ h e ~ c a receive som of ological intervention for hyperactivity," (p. 3) N n-

thues to encourage giving methylphenidate to increasing numbers of chd&en.

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Parents are seldom told that merhylphenidate is "sped9'-&tha( it acologied classfid with mphetmhes a d causes Phe

very same effects9 side effects, and risks, Yet this is weH-hswn in the prof= sion. For example, Treatments of PvcJychiatric Disorders obsemes that cocaine, amphet es, and methylphenidate are

ologicdy &e" (Am s ychiahc Association As evidence, the te points out that abuse

patterns me the same for the three dmgs; that people c tell their clinical effects apart in laboratory tests; and that em substimte for each other md cause s 1% khavior in addieted animals (American Psychiatric Association, 1989, p. 1221. Also see Breggin, 1991, and Breggin and Breggin, 1994a&b). The DSM-N

these observations by lumping cocaine, amphetamine and methylphenidate abuse and addiction into one category. The Food and Dmg Adminisaation (FDA) classifies methylphenidate in a

addiction category, Schedule 119 which also includes mphet- es, morphine, opium, and barbiturates (Goodman et al., 1991).

efore it was replaced by other stimulants in the 1 9 8 0 ~ ~ methyl- phenidate was one of the most commonly used street drugs (Spotts and Spotts, 1980). In our home town of Bethesda, youngsters nowa- days sell their prescribed methylphenidate to classmates who abuse it along with odler ~ t h u l a n t s . ~ In working with co we often hear anecdotal repolts of individuals who have graduated from using medically prescribed methylphenidate to alcohol or sweet drugs. One of the authors (RB.) has seen some cases in his own practice. Like my addictive stimulant, methylphenidate can cause with-

drawal symptoms, such as "crashing" with depression, exhaustion, withdrawal, irritability, and suicidal feelings. Parents will not rec- ognize a withdrawal reaction when their child gets upset after mis - sing even a single dose. They will mistakenly believe that their child needs to be put back on the medicatione3

MORE FACTS W I T H E E D FROM PARENTS

Parents are not told that methylphenidate, as a stimulant, can cause the very disorders it is supposed to cure-inattention, hyper=-

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Peter R. Breggin and Ginger Ross Breggin 65

tiviry, and aggression. \rChen the child becomes worse while the medication, he or she is likely to be given higher doses drug, or an even stronger medication, such as the neuroleptics thio- I-idazine (MeUaril) or haloperidol (Haldol). This can result in a vicious circle of increasing drug toxicity (side effects of methylphe-

discussed and documented in Breggb, 1991). nts infomed that methylphenidate can cause per- g tics. One of us (PB) has recently consulted in g boy in whom routine dosage produced disfigur-

ing muscle spasms and tics of the head, neck, face, eyes, and mouth. Parents are sometimes told that meth y lphenidate can suppress

growth (height and weight), but the explanation is usually given in a er calculated not to frighten them. Much of the brain's growth

takes place during the years in which children are given this drug; but doctors don't tell parents that there are no studies of the effect of this growth inhibition on the brain itself. If the child's body is smaller, including his head, what about the contents of his skull? And if size can be reduced, what about more subtle and perhaps immeaurable

Pmn& are md that like my form of speed, methylphenidate can often make children anxious and sometimes cause them to behave in ways that seem "crazy." Most surely, par- ents will not be told about any danger of permanent brain damage from long-term exposure to methylphenidate. While no consistent b r h abnomdties hav fomd in c h 2 d ~ n lakHd mm, one study has found brain in du l l , 1akltned mm who have

g methylphenidate for years (Nashrdah et al., 1986). The the study suggested "cortical amphy may be a long-term

advelse e E ~ t of this [methylphenidate] treatment. " by their doctor that there are almost

e conduct of nearly all

IS Al3HD AN AMERICAN DISEASE? A BOYS' DISEASE?

mm is rmely diamosed in cowt~es with more evident con-- cern for children, suck as Denmwk, Nomay, a d Sweden, where

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gsycbis~c drugs of my Lhd axe much more rarely given to chil- dren. A doctor working in England's National Health Service is not allowed to give methylphenidate in routkine practice because it is not on the approved dmg list. The doaor could prescribe m~phet-

es, which have a sinnilax effect, but this is discouraged m d relatively rarely done,

Males are fa more frequently given DBD diaaoses than fe- males. According to the DSM-N, ADHD occurs in boys up to four to nine times moIle frequently than in girls and Conduct Disorder is "much more common in males" in whom the rates vary from 6% to 16%. Aside from feeling bored or in conflict with adults, why would boys ordinarily tend to act resentfully and rebelliously to- ward the authority of their mothers and female teachers? The sim- plest answer is that they are trained to be that way toward women in general. In fact, most grown men in the world today resent being told what to do by women,

A multiplicity of factors contribute to the conflicts and confusion in little boys: How boys are trained to suppress their tender ("femi- nine") side and encouraged to be competitive, dominating and hos- tile toward women; how these lessons are imprinted through TV and the enteltainment media, and reinforced in sports and on the playground, as well as in the family and almost everywhere else in society

In our modem society, in which girls receive increasingly con- fusing messages about asseltiveness, more and more young girls are being diagnosed with one or another DBD. Often they are girls with special gumption.

CHILDREN WITH AnENTION DEFICIT DISORDERS (CHeAeD.D)

Founded in 1987, Chilbemrt with A ~ e n t o n Deficit Disorders (CH.A.D.D.) is an organization of parents who have cha&en la- belled with attention deficit disorders. CH. A.D.D. 's ofticid policy views these children as suffering from genetic and biological prob- lems. In the words of CH.A.A.D. president Sandra E Thomas (1 992), "Our kids have a neurological imp ent that is pervasive and affects every area of their life, day and night."

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Peter R. Breggin and Ginger Ross Breggin 67

CHeA,D,D, leaders children's emotional upset and anger is in no way y conflicts, poor parenting, indqua te schook, or broad s brochme, Hypemciivel Inatre~ive? Impu "baling with. parental guilt. No, it's not all your fault9' (CH.A.D.B., undated). After stating that ADHD is a neurological disorder, the brochure goes on to explain:

Fmstrated, upset, and anxious parents do not cause their chil- dren to have ADD* On the c o n t r q ? m D cha&en u s u d y cause their parents to be frus~ated, upset, and anxious. (p. 1)

n e r e could be no better example of child-blaming and parental exoneration.

CH.A.D.D. has followed the model of its adult counterpart, the National Alliance for the Mentally IL1 (NAMI) (Breggin, 1991). NAMI parents usually have grown offspring who are severely emo- tionally disabled, and they promote biochemical and genetic ex- planations, drugs, electroshock, psychosurgery, and involuntary treatment. NAMI also tries to suppress dissenting views by haras- sing professionals who disagree with them (Breggin, 1991). Now NAMI has developed an agia te , NAMI-CAN-the National Al- limce for the Mentdy SU1; Chad md Adolescent Network ( Bong, 1993). NAMI-CAN, like CH.A.D.D. believes in BBBD-bio- logically based brain diseases.

POWER SOURCES

CH.A.D.D. and NAMI parents have developed enormous influ- ence by joining forces with biologically -oriented professionals, na- tional mental health organizations, and the drug industry. But where is the money coming from to support high-pressure lobbying, media campaigns, and upscale national conventions a hotels like the Chi- cago Hyatt Regency? CH.A.D.D.'s convention program, "Path- ways to hogess," states (CH,A.D.D,, 1992):

CH.A,D.D. appreciates the generous con~but ion of am educa- tional grant in support of our projects by CIBA-Geigy Corpo- ration.

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CIBA-Geigy rnmufac~ren S t a h , the sthulmr with the lion's share of the ADHD market,

The adult counterpart of CH.A.A.D., NAM, has had equal suc- cess in its political efforts. It too is closely aligned with biological p s y c h i a ~ and takes money from the h g compmies.

A recent CH,A.D,D, Educators Manual was w ~ ~ e n with tihe collaboration of professionals, including Russell B mlde y (Mary Fowler, 1992). It makes clear the intention to diagnose and drug children who fail to conform to strict discipline:

Attention Deficit Disorder is a hidden disability. No physical maker exists to ident* its presence, yet ADD is not very h a d to spot. Just look withi your eyes md listen with your e m when you walk through places where children xe-particularly those places where children are expected to behave in a quiet, orderly, and productive fashion. In such places, children with ADD will identify themselves quite readily. They will be doing or not doing something which frequently results in their receiving a

ts and criticisms such as "Why don't you k before you act." "Pay attention."

LIKE SHINING STARS

Our children relate to us mostly through home and school. In both places we need a new devotion to their basic needs rather than to treating presumed psychiatric disorders. Above all else, our chil- dren need a more c g connection with us, the adults in their lives. This is now being realized in some school systems as they begin to abandon the large, factory-like facilities of the past in favor of " "sd is kautf i l . "

There are many advantages to smaller schools, but perhaps the most s i ~ g i c m t one is this: 'They &ow teachers to get to h o w their students well enough to understmd and to meet their basic educa-

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Peter R. Breggin and Ginger Ross: Breggin 48

tional md emotional needs, At the same time, s m d schools and classes meet the teachers' basic needs for a satisfying, effective professional identity. Conflict can be more readily solved as it ideally should be-bough mutually satisfykg solutions-rather than thxough medical diagnosis and ph acological suppression.

Some smder? more ch2d-olb-iiented schools have shown &at the DBDs virtually disappear. There is no better evidence for how the environment powerfully shapes the behavior that results in children being psychiatrically diagnosed. In a July 14, 1993 New York E m s report enddd "Is Small Be~er?

Educators Now Say Yes for Egh School." Susan Chira repom:

[Slmdents in schools Gmited to about 400 studen& have fewer khavior proBSBems, k t te r attendmce m d gaduation rates, md somethes higher pades m d scores, At a time when more chgdren have less suppofi from their fmaes , s m d e n ~ in small schools can form close relationships with teachers. (p. 1)

Teachers in these schools have the opportunity for "building bonds that are particularly vital d g the eoulbled yeas of dolescence."

Even students from troubled homes respond to small, more car- ing schools. ""They are skinkg stars you bought were dull," said New York City teacher Gregg Staples. "If you're under a lot of pressure and stress, they help you through that," said student Joy G~mage. ""They won't put you down or put you on hold,"

Children respond so quickly to improvements in the way that adults relate to them, that most children can be helped without being seen by a professional person. Instead, the professional can consult with the parents, teachers, and other concerned adults.

Many psychotherapists, for example, routinely practice "child therapy" without actually seeing any children. They help their adult patients become more loving or disciplined paents through the routine work of psychotherapy, indirectly amsfo their children. The children "get better" sight unseen. These thera- pists, many of whom work only with adults, may not identify them- selves professionally as child psychiatrists or child therapists. But they are doing more good for children than the professionals who diagnose and medicate them.

Qlhild~ern don't have disoirders~ they live in .a disordered world.

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W e n adults provide &ern a better environme~, they tend to quick- ly improve their outlook and behavior. But, chg&en and teenagers can evenmdiy become so upset, confused and self-destuctive that they intemalia the pain or become compulsively rebeaous. They may need the &emention of a rherapeutic-unconditiondy c adult to help them overcome their inner suffering and outrage. Sometimes these children can benefit from learning how to help ease the conflicted situation. But they should never be given the idea that they are diseased or defective, as the primary cause of their conflicts with their schools md f a % e s ,

Children can benefit from guidance in learning to be responsible for their own conduct; but they do not gain from being blamed for the Baurna md stress that they are exposed to in the environment around them. They need empowerment, not humiliating diagnoses and mind-disabling drugs. Most of all, they thrive when adults show concern and attention to their bs ic needs as ehddren.

NOTES

1. Citation numhrs removed from the quote. 2. Fluowethe (Rozac) with its stimulmt eEec& is dso k c o

abuse (Breggh, 1984a). 3. Advase dmg reacdons to melljlylpke~date are pobably f a much mme

on than the litaahre suggests (Breggiq 1991). Except when a drug is hmd new, dmtors almost never report or publli cians do not h o w there is a m e c h a ~ s m for FDA. Goodmaarm et all. (1991. p. 78) obsme "Over 40% sf physicims are not awae that the l'7DA has a reporting system for advase dnvg reactions . . ." h addition, advocates of psychiatric dmgs for cEldaen have proven fiemselves es- pecially unwillhg to emphasize their hngersus effmts (Breggin, 1991).

h ~ e m P s y c s a ~ c Association. (1987). D i ~ n ~ s t i c and statistical manual of ment;rE disorders, Third Edition, Revised, Washgton, D.C.: MA.

h ~ c m P s y c G a ~ c Association. (1994). Diagnostic and statistical manual of mental ds'sorder~, Four& iEdition. Washgton, D*gJ.: APA,

&&can P s y c G a ~ c Association (1989). Treatments of psychikh&ric di~orders: A task force report of the American Pvchiatrie Association. Waskgton, D.C,: APA.

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