DRUGGING OUR CHILDREN

Thousands of kids are being given drugs to control their behavior.

Many don't need them, a Province investigation shows.

Thousands of Canadian children are being prescribed stimulant drugs for a
disorder they do not have.

Kids who are having trouble behaving in school are increasingly diagnosed
with attention-deficit and hyperactivity disorders. They are given the drug
methylphenidate, which includes the brand name Ritalin.

Health Canada, which classifies the drug in the same category as cocaine
and amphetamines, reports consumption has increased 456 per cent since 1991.

The government agency has become so concerned that it is is launching a
national survey of doctors later this year to determine how they make the
diagnosis and on what basis stimulant medications are prescribed.

There is currently no estimate of how many children are misdiagnosed, said
Dr. Jean-Marie Ruel, special medical advisor with the bureau of drug
surveillance for Health Canada.

``There is no way to know,'' he said. ``That is one of the questions we aim
to look at with the survey.'' Dr. Ruel said some of the increase could
result from an upsurge in diagnosis and treatment of adults. But 83 per
cent of the patients receiving Ritalin in 1996 were 18 years or younger.

Meanwhile, the misdiagnosis of ADD is so common that American authorities
report about half of diagnosed children referred to specialists for a
second opinion did not have the disorder.

``The net result is that children are given stimulant medication they don't
need,'' according to a 1996 report by the U.S. department of justice Drug
Enforcement Administration.

Canadian ADD specialists are also seeing an alarming number of children who
have been previously misdiagnosed as having the disorder.

``We did a little pilot study a couple of years ago where we just took the
next 10 kids coming in diagnosed with attention-deficit and hyperactivity
disorder (ADHD), and only two of them really fit the criteria,'' said Dr.
Wendy Roberts, a developmental pediatrician and director of the Child
Development Centre at Sick Children's Hospital in Toronto.

``Two out of 10 is pretty scary.'' Even the the United Nations has warned
``all governments to exercise the utmost vigilance in order to prevent
`over-diagnosing' of ADD in children and medically unjustified treatment
with methylphenidate and other stimulants.'' Vancouver child psychiatrist
and public school consultant Dr. Patrice Dunn said ADHD has become ``the
diagnosis of the decade. It's the diagnosis that every teacher knows, that
everyone has seen.'' In fact, it is often teachers who first alert parents
that their children may need drugs to control their behavior and focus
their attention. Most children are diagnosed by a family doctor or
pediatrician following a referral from their school.

Sitting quietly in class is virtually impossible for an untreated child
with ADHD.

Stimulant medications such as Ritalin are effective in about 70 per cent of
cases in making the ADHD child quieter, less restless, more attentive,
focused and compliant.

Dr. Derryk Smith, head of child psychiatry at Children's Hospital in
Vancouver, believes the treatment could be of benefit to most patients with
ADHD.

``About 90 per cent of kids who have an ADHD diagnosis will benefit from
the use of stimulant medication,'' he said.

He believes the effectiveness of treatment combined with greater public
awareness explains the dramatic increase in diagnosis.

``What has happened is that we have become more aware of it and, therefore,
there are more cases being diagnosed.'' But Smith admitted, ``there is
always a danger of misdiagnosis regardless of who is doing (the
diagnosis).'' Many experts worry greater public awareness is a double-edged
sword.

Children with the disorder are quickly identified, but those with other
disorders producing similar symptoms are often misdiagnosed.

``I think attention-deficit disorder has become synonymous with difficult
behavior,'' said Dunn, who is employed by the Vancouver public health
department.

Dr. Stuart Fine, head of the ADHD Clinic at Children's Hospital, agreed
that the heightened public awareness of ADD can result ``in a fair bit of
pressure'' to make the diagnosis.

But he said ``not many'' of the children referred to his clinic have been
misdiagnosed. ``We do see some.'' Dunn is seeing an increasing number of
children who have been misdiagnosed.

Both Dunn and Smith warn that diagnosing ADHD takes time and expertise,
which general practitioners sometimes lack.

``You can't just look at the symptoms and say this child has ADD,'' said Dunn.

``I've seen kids with post-traumatic stress disorder so severe that they
are distracted in class because they are trying to deal with all the things
that have happened to them.'' A doctor survey by IMS Canada, a health
information company, shows about 35 per cent of ADHD patients are diagnosed
by a general practitioner.

American pediatricians were recently warned to use more caution in making
the diagnosis or face public backlash.

Symptoms of ADHD can easily be confused with the kind of disruptive
behavior also seen in children with learning disabilities.

Children who are clinically depressed, anxious or traumatized by events in
their lives can also be inattentive or hyperactive.

Giving medication to the wrong child is worse than doing nothing, doctors
say. It can muzzle a cry for help.

``Contrary to popular belief, stimulants like methylphenidate will affect
normal children and adults,'' warned the DEA in its 1995 report.

``Medicated children are less disruptive and more compliant than
non-medicated children,'' said the report.

Pediatrician Dr. Lionel Traverse, head of the Child Development Centre in
Abbotsford, fears society will live to regret over-prescribing stimulants
for children.

``I think in the next generation they are going to look at us and ask,
`What did you do to these children?' ''

ABOUT OUR TEAM Reporter Ann Rees and photographer Les Bazso spent more than
five months investigating the rising rate of ADHD diagnosis and the use of
stimulant-drug treatment. Rees interviewed well over a hundred experts
across North America. And she listened to children with ADHD who are
successfully treated with Ritalin, to those who have been wrongly
prescribed Ritalin, as well as to many who are managing their symptoms
without drugs.