KIDDIE COCAINE: WHAT'S HITTING THE NEW GENERATION

Debate is raging, and accusations of a conspiracy flying, over US
psychiatrists' use of Ritalin to treat attention disorders, writes
Mark Riley in New York.

A little over a year ago, the New York State Government threatened to
take Mr Michael Carroll's seven-year-old son, Kyle, away from him.

Mr Carroll's attitude towards drugs was said to be putting the boy at risk.

It was not that he was abusing drugs. He was refusing them.

Mr Carroll had taken Kyle off the so-called child "wonder drug"
Ritalin because it had turned his once-active, inquisitive son into
an idle and brooding insomniac and done little, if anything, for the
reading problem it was supposed to address.

Kyle was one of an estimated 2 million American children - an average
of one in every classroom - who take Ritalin each day to treat
attention deficit hyperactivity disorder (ADHD).

The boy's school doctor reported Mr Carroll to the authorities and
asked the Child Protective Services to intervene and force Kyle back
onto the medication.

"The school never objected, it just immediately called child
protection without any contact with me whatsoever," Mr Carroll said
in a recent interview.

"It was crazy."

The case is one of the more extreme examples in a growing national
debate over Ritalin that has exploded from the classrooms, to the
courts, to the Congress, spawning three class actions and two
congressional inquiries.

Dr Peter Breggin, the author of Talking Back to Ritalin, told a
recent congressional hearing that American teachers have become
strong advocates of the drug because it makes active, demonstrative
children more docile and manageable at a time of ever-increasing
class sizes and ever-decreasing school resources.

"The drugging of children has gotten so out of hand that America is
waking up to this," Dr Breggin said.

"This is a national catastrophe. I'm seeing children who are normal,
who are on five psychiatric drugs."

Opponents claim a conspiracy between the drug's manufacturer,
psychiatrists and ADHD support groups has led to Ritalin becoming
widely and routinely over-prescribed in a way that unnecessarily
changes children's characters and places them at risk of potentially
damaging side effects.

At the same time, the availability of the drug has bred a booming
black market in which children sell their Ritalin to high school and
college students to be crushed and snorted as the latest recreational
drug of choice on campus.

Ritalin has been prescribed since the 1950s as a mild stimulant that
works directly on the brain stem to calm children with attention
deficit disorders. But when it is snorted its active ingredient,
methylphenidate, produces an acute rush not unlike amphetamines.

The growing epidemic of Ritalin abuse among children has already
earned it the label of "kiddie cocaine".

The analogy may not be far from the mark. A continuing study of
Ritalin use into adulthood by the University of California, Berkeley,
has found a connection between the drug and later addiction to harder
substances, including cocaine.

Figures issued recently by the National Institute of Mental Health
show prescriptions of Ritalin have increased 700 per cent in the past
10 years.

Although the manufacturer, Novartis, recommends that the drug not be
administered to children younger than six years, recent US newspaper
reports claim it is being routinely prescribed to toddlers as young
as two.

The institute, in the largest clinical study of Ritalin, concluded
the drug can eliminate the symptoms of up to 86 per cent of ADHD
sufferers.

Most US psychiatrists support the increasing use of the drug, saying
that if children with attention disorders are not treated, they will
develop a pattern of bad decision-making that could lead them to
experiment with sex and illegal drugs.

Dr Russell Barkley, the director of psychology at the University of
Massachusetts Medical Centre and author of 14 books on behavioural
disorders, believes ADHD is greatly under-diagnosed.

"We're not even reaching half the people," he said. "The fact that
we're seeing a rise is not bad news, it's good news. Twenty to 30
years ago we didn't pay attention."

The class actions in New Jersey, California and Texas claim the
reason ADHD was not widely diagnosed in the 1960s and '70s is that
the nexus between the drug companies, psychiatrists and support
groups was not yet in place.

The actions claim the American Psychiatric Association and Ciba-Geigy
(later Novartis) conspired in the '80s to "create, develop, promote
and confirm the diagnoses of attention deficit disorder and attention
deficit hyperactivity disorder in a highly successful effort to
increase the market for Ritalin".

Documents filed in the cases show Novartis and other drug companies
directly fund the psychiatric association and deliver grants to ADHD
support groups. The claimants allege the payments are kickbacks for
the groups' support for the broadened definition of the disorder and
the increased use of Ritalin.

Novartis, which took over the manufacture of Ritalin from Ciba-Geigy
in 1996, says the claims are "unfounded and preposterous". The
psychiatric association has said the conspiracy theory is "ludicrous
and totally false".

Professor Peter Jensen, a member of the advisory board for the
support group Children and Adults with Attention Deficit
Hyperactivity Disorder (CHADD), conceded drug companies contributed a
quarter of his organisation's funds but said Novartis was responsible
for only a small fraction of that amount.

"Alleging that CHADD created ADHD to help a pharmaceutical
manufacturer reap profits is akin to accusing the American Diabetes
Association of conspiring with the makers of insulin to invent
diabetes," he said.

Despite those emphatic denials and endless case histories showing the
drug's success in improving the marks of inattentive students,
Ritalin's advocates are finding it difficult to compete with the
alarming accusations being made by their opponents in one of the US's
most rancorous debates on public health.

At the heart of the court cases is the question of what constitutes
"normal" behaviour. The psychiatric association's diagnostic manual
says ADHD can be diagnosed if a child displays a persistent pattern
of inattention or hyperactivity in two settings - typically, school
and home - and if that behaviour interferes with social and academic
performance.

"As it is now officially defined, the diagnosis of ADHD would fit
every child in America," said one lawyer in the class actions, Mr
Dickie Scruggs. "At least 90 per cent of those who are taking Ritalin
in the United States are inappropriately medicated."

Michael Carroll was certain that Kyle was one of the children using
the drug unnecessarily.

A court ruled recently that he could keep his son at home, and keep
him off Ritalin, after he found a doctor who testified that
non-medical approaches to Kyle's reading problem would be more
effective.

Kyle has since changed schools and is in a special-education class.
His appetite and his outgoing nature have returned, and his marks
have improved.

"From the beginning, I kept asking for him to go in to special
classes," Mr Carroll said. "They just wanted him to sit still and to
push him through the system."