USING DRUGS TO REIN IN BOYS

When he was 11 years old, Michael Gurian was diagnosed as hyperactive, and
for six months he was given regular doses of a drug called Ritalin to
control his behavior.

"It helped me and my parents," recalls Mr. Gurian, now a family therapist in
Spokane, Wash. But what he really needed, he sees now, "was a different kind
of school and family environment - a better structured, more attentive one."

The Littleton, Colo., school-shooting tragedy has highlighted the widespread
use of powerful prescription drugs to treat what are diagnosed as emotional
and behavioral problems in adolescents - the great majority of them boys.

Several of those involved in recent school shootings were being treated with
drugs, and the number of young Americans regularly taking prescription drugs
for such things as depression and "attention deficit disorder" has shot way
up in the past few years. It's now in the millions - many times higher than
in any other country.

Advocates say such drugs can help certain kids through the already-tough
teen years, preventing antisocial and even criminal behavior later in life.

Russell Barkley, director of psychology at the University of Massachusetts
Medical Center in Worcester, Mass., calls Ritalin "the most effective
treatment we have available for the management of this disorder."

Critics charge that some of these substances have not been adequately tested
on young people, and federal agencies warn of possible adverse side effects.

Some experts say such heavy reliance on drugs is an easy and relatively
cheap cop-out favored by disengaged parents and insurance companies who'd
rather have kids pop a pill than deal with root causes through counseling
and the family. There's also evidence that widely used prescription drugs
such as Ritalin (a stimulant used to treat those diagnosed with attention
deficit disorder) are being abused by teens and college students, much like
amphetamines and cocaine.

"Our society has institutionalized drug abuse among our children," says
Peter Breggin, director of the Center for the Study of Psychiatry and
Psychology in Bethesda, Md., and one of the most outspoken critics. "Worse
yet, we abuse our children with drugs rather than making the effort to find
better ways to meet their needs."

"In the long run, we are giving our children a very bad lesson - that drugs
are the answer to emotional problems," says Dr. Breggin, whose recent book
is titled "Talking Back to Ritalin."

"We are encouraging a generation of youngsters to grow up relying on
psychiatric drugs rather than on themselves and other human resources," says
Breggin, suggesting that creativity - perhaps even brilliance - is being
stifled in such young people.

Nonsense, says Dr. Barkley, who recommends the use of drugs as part of a
treatment regime. "Characterizing this group of children as our best, most
creative, and brightest does a severe injustice to the facts of the matter
and is woefully misleading to the public in general and to parents of these
children in particular," says Barkley, who accuses Breggin of violating the
physician's oath to "do no harm."

Characteristics of ADD

Simply put, attention deficit disorder (ADD), also known as attention
deficit/hyperactive disorder (ADHD), means the inability to sit still, pay
attention, and concentrate on an assigned task - such as classroom
schoolwork.

>From time to time, any exasperated parent or teacher may think they spot
these ants-in-their-pants characteristics in offspring or pupils. But the
scientific symptoms attached to such behavior can be fuzzy and therefore
controversial.

In their book "Driven to Distraction: Recognizing and Coping with Attention
Deficit Disorder from Childhood through Adulthood," physicians Edward
Hallowell and John Ratey suggest 100 questions to ask a patient to determine
the presence of ADD (the more "yes" answers, the greater the likelihood of a
problem). Among them: "Do you change the radio station in your car
frequently?" "Are you particularly intuitive?" "Are you a gung-ho, go-for-it
sort of person?" "As a kid, were you a bit of a klutz at sports?" "Are you a
maverick?"

Many of these characteristics, critics say, amount to nothing more than
rambunctious, boy-like behavior. Harvard psychologist William Pollack
estimates that 90 percent of those so diagnosed are boys. While some
adolescent males may need such drugs, says family therapist Michael Gurian,
many others are misdiagnosed and do not.

"Most boys are Huck Finn and Tom Sawyer," says Mr. Gurian, author of "A Fine
Young Man" and several other books on adolescent boys, "and if Huck and Tom
were alive today and going to school, they'd be drugged."

Rise in prescriptions

Ritalin (known generically as methylphenidate or MPH) is a stimulant that -
paradoxically - is said to calm agitated children. Estimates of the number
of children in the United States taking Ritalin range from 1.5 million to
upwards of 4 million - most of them white, middle-class boys who live in the
suburbs.

(In addition, more than 800,000 American children are taking antidepressant
drugs such as Prozac or Luvox. Eric Harris, one of the alleged assailants in
Littleton, had been taking Luvox.)

The number of prescriptions for MPH products reportedly has increased by 50
percent over the past five years, to more than 9 million prescriptions in
1998. According to the federal Drug Enforcement Administration (DEA), the
United States "manufactures and consumes five times more MPH than the rest
of the world combined," noting also that MPH "is now the most commonly
prescribed psychotropic medicine for children in the US."

"Treatment rates for ADHD in some American schools are as high as 30 percent
to 40 percent of a class and children as young as one year old are treated
with methylphenidate," the International Narcotics Control Board, a United
Nations agency, reported in March.

In addition, the report noted, "American culture and its drug-taking
behavior have a strong influence on other regions. Methylphenidate use for
children has rapidly increased in Australia, Canada, and several European
countries."

The DEA describes MPH as "a central nervous system stimulant {that} shares
many of the pharmacological effects of amphetamine, methamphetamine, and
cocaine." The DEA warns that a "significant number" of children and
adolescents are misusing Ritalin.

"Students are giving and selling their medication to classmates who are
crushing and snorting the powder like cocaine," reports the DEA, which urges
"greater caution and more restrictive use of MPH."

Such caution appears to have been confirmed in a recent survey of family
physicians and pediatricians.

At a meeting of the Pediatric Academic Societies in San Francisco May 1,
clinical scholar Jerry Rushton of the University of North Carolina School of
Medicine at Chapel Hill reported that 72 percent of 600 family physicians
and pediatricians surveyed had prescribed antidepressant drugs for patients
under age 8. But just 8 percent of those surveyed said they had adequate
training in the management of child depression.

"Our survey data suggest that despite a lack of research support, adequate
training, and comfort with the management of depression, {antidepressant
drugs} are gaining physician acceptance and becoming incorporated into
primary care practice," says Dr. Rushton.

While such drugs "show promise," he adds, "they should be used with caution
and monitored closely, not used haphazardly for transient problems - not for
school problems or nebulous behavioral problems."

Some medical professionals have begun to see that there are broader issues
involved here.

"Demands on children have grown, while the strength of their social
supports - school and family - has decreased," says Lawrence Diller, a
pediatrician in Walnut Creek, Calif., and author of "Running on Ritalin: A
Physician Reflects on Children, Society, and Performance in a Pill."

"Children are expected to learn earlier and learn more, yet we have higher
student-teacher ratios in the classroom," Dr. Diller wrote recently in the
San Francisco Chronicle. "Parents are working harder and longer. That means
less time for their children and more structured day care and latchkey
kids."

In the wake of the school shootings in Springfield, Ore., and Littleton,
Colo., (where the attackers had been taking prescribed drugs), some
lawmakers are urging greater government oversight.

In a letter to Food and Drug Administration commissioner Jane Henney earlier
this month, Rep. Dennis Kucinich (D) of Ohio expressed concern that the FDA
(which must approve prescription drugs) "has failed to provide adequate
oversight of the health consequences of prescribing certain drugs to
children."

Representative Kucinich called for "comprehensive clinical trials by the
pharmaceutical companies prior to FDA approval."

He wrote: "It should be apparent that this matter carries considerable
urgency."