Silent Epidemic: Children Voices

What would reaction of society be if within the past 12 months approximately:

• 124,000 college students complained of abdominal pain?
• 82,000 government workers suffered severe headaches and became anorexic?
• 62,000 therapists suffered insomnia, upper respiratory tract infections and sinusitis?
• 20,000 airline workers, including pilots, displayed twitching and nervousness like cocaine addicts?
• 14,500 world-renowned business leaders and professors had mental breakdowns or other psychological problems, such as abnormal thinking and visual hallucinations?
  

What if all the incidences above were linked to a single class of medication?

Responsible citizens would call for an immediate ban and withdrawal of such medication from the marketplace. Government agencies such as the U.S. Food and Drug Administration (FDA), U.S. Drug Enforcement Administration (DEA), U.S. Centers for Disease Control and Prevention (CDC), and Department of Homeland Security would support such actions and encourage people not to use the medication. Under no circumstances would the agency responsible for determining the safety of medications still consider such medication safe and do nothing to protect consumers while it investigated and called for more research.

Unfortunately, the statistics above are the estimated number of adverse reactions (above the norm) expected in children being treated for ADD/ADHD with methylphenidate.

Yes, dozens—if not hundreds—of children die each from the use or abuse ADHD medications.

Government agencies are doing little or nothing to protect this vulnerable population and many doctors do not follow clinical practice guidelines for diagnosing and treating ADHD. Tragically, many parents sacrifice their children’s health to manufacture well-behaved and intelligent children.

Other medications used to treat ADHD are amphetamines and antidepressants. They are considered even less safe than methylphenidates.

Parents should learn all they can about these medications before giving them to their children. Parents should not abruptly stop their children from taking medication and should consult with their doctor on the appropriate actions. Abruptly stopping medication could cause serious health and mental problems.

The purpose of this blog (created first as a newletter in 2005) is:

• to be a voice for the millions of children diagnosed with ADHD and the tens of thousands each year who cry out for help but are heard by no one
• to inform citizens of the dangers of methylphenidates, amphetamines and antidepressants and of various agencies’ response to the threat
• to insist that parents, doctors and governmental agencies act responsibly
• to ask you to join in this fight to protect our children.

One child’s death is one too many!

What is ADHD?
ADHD stands for attention-deficit/hyperactivity disorder. It is one of the most common psychiatric disorders diagnosed in children and adolescents.

There are numerous clinical practice guidelines available for various sources. Most of them agree that children with attention-deficit disorder (ADD) exhibit six or more of the following symptoms:

• fail to give close attention to details or make careless mistakes


• have difficulty sustaining attention


• do not listen


• do not following through


• have difficulty organizing


• avoid or dislike sustained mental effort


• lose things


• are easily distracted


• are forgetful.

Children with hyperactivity/ impulsivity disorder exhibit six or more of the following symptoms:

• act fidgety


• get out of their seat


• run or climb excessively


• have difficulty playing quietly


• are on the go or as if driven by a motor


• talk excessively


• blurt out answers


• have difficulty awaiting their turn


• often interrupt or intrude on others.

Diagnostic criteria require some of the symptoms to be present before the age seven, functional impairments to be present in two or more settings and the absence of other psychotic disorders that could better account for the child’s behavior. The symptoms must be inconsistent with the child’s developmental level and intellectual ability.

Before making a diagnosis of ADHD, a doctor obtains a comprehensive history, including gathering information from the child, the child’s parents and school, and a medical and psychological history. The doctor completes a physical examination and standardized rating scale. [3],[4]

It is the responsibility of the child’s doctor to ensure that the child meets the diagnostic criteria for ADHD before making a diagnosis, and to follow treatment guidelines after the diagnosis.

How many children have ADHD?
An estimated 3 to 5 percent of children between the ages of 5 and 17 years in the United States have ADHD. [3] There are approximately 55 million children in that age range, which means anywhere between 1.6 million and 2.7 million children have ADHD.[5] An estimated 1.2 percent of children under 5 years of age have ADHD.[5] There are around 21 million children in this age range, which means about 252,000 of them have ADHD.[5] In total, approximately 1.9 million to 3 million children have been diagnosed with ADHD.

There is no way to determine the exact number of children with ADHD because some doctors prescribe ADHD medications without coding ADHD on claim forms. In addition, studies found that, in some communities, between 72 percent and 87 percent of children diagnosed with ADHD and prescribed stimulant medications did not meet the diagnostic criteria for ADHD.[6] So if these children do not have ADHD … why are they on ADHD medications?

"Performance enhancement drugs include medications that boost intelligence!"

Medications used to treat ADHD: Are they safe?
The FDA has approved various methylphenidates (brand names Ritalin and Concerta) and amphetamines (brand names Adderall and Dexedrine) for the treatment of ADHD.[7] These are stimulant medications that the FDA considers safe but the DEA considers “drugs of abuse,” with addictive properties and side effects similar to cocaine. [8] Mild side effects associated with methylphenidates and amphetamines are expected, but they require action if they become moderate or severe. These include:

• anorexia


• insomnia


• negligible tics


• headaches


• GI cramps


• picking at skin


• nail biting


• anxiety


• irritability


• depression


• dull, tired, listless.
  

Children can experience hallucinations and can act like zombies and become psychotic even at prescribed doses. [2],[9]

Although not approved by the FDA for such use, some doctors prescribe tri-cyclic antidepressants to treat ADHD.[4] The most commonly known is Imipramine (brand name Tofranil). Children on these medications may experience chest pains, rapid or irregular heartbeat, difficulty urinating, nightmares, ringing ears, excessive drowsiness, uncoordinated movement and fainting. Such events should be promptly reported to the doctor. Children who experience agitation, confusion, hallucinations, fever, irregular eye movements, seizures, change in the amount of urine, dry mouth or nose, constipation, large pupils, drowsiness, slow or shallow breathing, dizziness, unconsciousness, unusually fast or slow heartbeat or flushing require immediate medical attention.[10]

Are the medications safe? No. They are effective in making children attentive to and compliant for their parents/guardians and in helping children achieve the academic aspirations of their parents/guardians.

However, as the list of side effects indicates, these medications are far from safe and require vigilant monitoring by parents, doctors and teachers to ensure that the child is not suffering needlessly just to make caregivers proud.

"So what if little Timmy is suffering 10-12 side effects! He is making mother very proud!"

Many of the side effects go away if the medication is properly adjusted or discontinued, when appropriate. [11] Only the child’s physician should take such action; however, data suggest that appropriate monitoring of children diagnosed with ADHD often does not occur.

There is no safety in these numbers!
Most children on ADHD drugs are between the ages of 3 and 16 and totally depend on their primary caregivers to protect them by listening and looking out for side-effects. Children will take medication provided by their caregiver, even if it makes them feel bad. The statistics given above are the number of incidences expected for school-age children on methylphenidate above the norm (those not on ADHD medications). The estimated numbers are much worse if the unadjusted rates of incidences are used:

• 289,000 with headaches


• 164,000 with urinary tract infections


• 145,000 with abdominal pain.

The rates of side effects in preschoolers are higher than in school-aged children. Most preschoolers are on amphetamines. It is estimated that out of 252,000 preschoolers:

• 65,000 will show irritability


• 50,000 will have a loss of appetite47,000 will be lethargic. [1],[2],[5]

My mind is playing tricks on me!
The most reported adverse events are psychiatric-related problems and include:

• agitation/behavior disturbance


• psychosis (hallucinations or abnormal thinking)


• visual hallucination


• suicidal ideation/suicide attempt


• depression


• bad dreams.
  

The labeling on many ADHD medications does not adequately describe psychiatric side effects and tends to use one term for them all: “toxic psychosis.”[2]

In simple terms, “agitation” means the child is easily upset and agitated over simple things. “Psychosis” means the child has lost touch with reality to some degree and is acting out or expressing things heard or seen in his or her mind (hallucinations). “Abnormal thinking” is when the child communicates and believes things that are not normal and is out of touch with reality. “Depression” means the child gets “down” (feels low or blue), probably because he or she does not understand what is happening and blames himself or herself. “Suicidal ideation/suicide attempt” means the child thinks about or tries to kill himself or herself.

What kind of things do these children hear, see, think and act out? The answer depends on the type of environment they are raised in, their social interactions and what they have been or are currently exposed to. During the normal development process, children from birth to about 12 learn their environment and take on the attributes of their primary caregivers (parents). To a child, parents do not lie. The caregiver’s beliefs, fears and value system become the child’s.

Children are inquisitive and want to know the facts. They depend on their parents, teachers and friends for information. Children want to be like parents or famous people in books and on television. For children raised the fundamental Christian church, God, the devil, demons, heaven and hell are real.

Children on ADHD medications can become delusional and believe that they are Jesus, the president, the Pope or a prophet. They can become paranoid and believe that the devil, demons or persons that they consider evil are after them. They become puppets to the puppet master, who is any individual who uses the drugs to control and manipulate their children’s actions for their own purpose. There have been countless reports of cults using these type drugs to exploit people. Children on ADHD medications are not immune from exploitation. A sadistic parent could implant untrue ideas the child’s mind about a love one, such as a divorced spouse, that the child will eventually accept as reality. These children are living in hell on earth.

Heart attacks and other complications
Dozens of children are projected to die this year due to complications associated with the use of ADHD medications. Certainly, some of the deaths will have “confounding variables,” meaning that medications were misused or abused.

• Cardiovascular disease is the second most observed adverse event. Some children on these medications will suffer heart attacks, high blood pressure and strokes.
  
• Some children will think about killing themselves; others will try and some will succeed.
  
• Some children will think about killing other people, some will try and others will succeed.
  
• Some children will mutilate themselves.Some children will develop cancer from these medications. [1],[2]

A street drug by another name is still a street drug!
What parents would give their child street drugs like speed, meth, crank, crack, ice, cristal, krystal, illy’s and metadate? Those are some of the street names that the DEA gives to methylphenidate and amphetamines. [8] Each time a child receives a dose of prescription Ritalin, Concerta or Adderall, he gets a legal fix of an illegal street drug.

The DEA placed these drugs in the same class as cocaine in the 1970’s because the drugs have identical addictive properties and side effects, and create the psychological dependency as cocaine. The users of these ADHD stimulant drugs experience the same “high”, withdrawal symptoms and overdose dangers as cocaine addicts. [8]

• Users of these drugs experience increased alertness, concentration excitation, wakefulness, physical performance, and a feeling of well-being (euphoria).


• Users who discontinue use (withdrawal) of these drugs experience apathy, irritability, intense fatigue or sleepiness, depression and disorientation. Enhanced alertness diminishes as the users of these drugs develop tolerance such that higher doses are sought.[8],[12]


• Users who overdose experience agitation, hallucinations, convulsions and possible death.[8]

Paranoid psychosis almost inevitably results from the long-term use of amphetamine. The user’s psychosis typically includes delusions of persecution, ideas of reference, and feeling omnipotence. Overtime the user’s awareness may fail and the he may responds to the delusion. The drugs may lead to serious antisocial behavioral and can precipitate a schizophrenic episode. [12]

The medical community has known since the 1970’s that can occur at typical doses in children. Incredibly, FDA continues to consider the medications safe and approves higher doses periodically.[2]

Imipramine is not on the list of drugs of abuse; however, it is believed to be more hazardous to children than methylphenidate and amphetamines.

How Do ADHD Medications Work?
Ask doctors how methylphenidate works and some will honestly tell you that they do not know! [2] To understand how methylphenidate works, you must first understand a little bit about the nervous system, which includes the brain and spinal cord (central nervous system) and peripheral nerves. Here is a very simplified description your nervous system.

The brain is the control center of the body. In its various compartments, the brain houses your memory, intellect, dreams and fears. It releases hormones or signals the release of hormones that make:

• your heart beat faster, slower or stop


• your digestive system break down food, absorb nutrients and release waste


• your legs walk, run and feel tired


• your body know when it is time to sleep and time to get up


• your eyes, ears and extremities know when they see, hear or sense danger


• your mouth knows when it is time to talk and time to shut up.
  

The nerves deliver messages from the brain to specific organs, which make adjustments and send a signal back to the brain via the nerve cells. This cycle of communication is continuous and is what makes the body function normally. The messages travel from nerve cell to nerve cell via electromagnetic impulses (EMI), which must leap across the space between nerve cells called the “synaptic gap.” The EMI is actually carried across the synaptic gap by specific hormones called “neurotransmitters.” There are many neurotransmitters, but four of the most well known are:

• epinephrine


• norepinephrine


• serotonin


• dopamine.
  

Epinephrine and norepinephrine carry messages associated with stress and make the heart rate speed up.

Serotonin and dopamine affect mood, sleep, attention and learning.

Antidepressants bind to serotonin receptors in the brain and block the movement of the hormone across the synaptic gap. [13],[14]

Methylphenidates bind to dopamine receptors in the brain and block the movement of the hormone across the synaptic gap, increasing the amount of dopamine in the brain.

The brain is very sensitive to levels of serotonin and dopamine. At certain levels, these hormones may improve attention, learning and confidence; however, an imbalance of these hormones in the brain is the primary cause of the previously mentioned psychiatric side effects and others.[13]

In many ways, these drugs effect hormones in a manner similar to cocaine and cause the same types of side-effects. Users are motivated toward a primary purpose: to get more drugs.

ADHD drugs interfere with the normal production and transportation of neurotransmitters, which interfere with the brain’s interpretation of signals and its subsequent response.

"Doctors who prescribe ADHD medications and parents who give the medications to children are playing Russian roulette with their children’s minds and lives."

How often should a child on ADHD medication visit the doctor?

Unfortunately, professional medical and psychiatric societies are not in uniform agreement on the monitoring schedule. Certainly, the frequency of follow-up depends on how a child responds to the medication and whether the child has other conditions (comorbidities). Doctors are responsible for establishing a monitoring schedule as a part of the child’s treatment plan; however, it is not unreasonable for parents to insist on:

• weekly telephone follow-up with the doctor for the first 2–4 weeks after starting or changing medications


• monthly office visits with the doctor until the child is stabilized


• visits at least every 3 months for a young child and


• at least every 3-4 months for an adolescent who is stable


• Children with comorbidities require more frequent monitoring. [3],[4][9],[11]

"Little Timmy still enjoys playing with his puppy even though she died 2 years ago!"

Given that most children diagnosed with ADHD and on medications do not actually have ADHD, and that side-effects occur frequently, it is important that parents insist on proper follow-up.

Why the government is slow to act: A theory
The government, pharmaceutical companies and—to some degree—the medical profession have known about harmful side effects of methyl-phenidates and other ADHD medications (amphetamines and tri-cyclic anti-depressants). In 1961, Dr. John Saunders called the use of psychiatric medications “a sinister battle for men's minds.” Profoundly, he further stated, “Here at our disposal, to be used wisely or unwisely, an array of agents that manipulate human beings...the new techniques introduce social, ethical, and religious complications of great consequence.” [15]

The cardiovascular risks have been known since the 1960s. The risk of psychosis associated with the use of methylphenidates has been known in the clinical world since the 1970s. The DEA has listed methyl-phenidates and amphetamines as Schedule II controlled substances since 1971, and reported that these drugs have properties identical to cocaine.

Even with the known harmful and addictive properties associated with these drugs, the government allowed their propagation in American society. Exactly why is unknown; however, consider the fact that in the 1930’s it was found that these drugs in improve attentiveness, comprehension and desired behavior in patients (subjects). In essence, it became possible to augment intellectual capacity and to control behavior with these drugs.

These drugs are probably responsible for producing some of the greatest minds (geniuses), the most successful people and technological advancements over the past 40 years. They are probably equally responsible for producing generations of junkies and for thousands upon thousands of mental breakdowns each year. There have also been countless reports of the use of these medications in the exploitation of people within religious and satanic cults.

In 2000, the DEA testified before Congress that continued increases in the medical prescription of these drugs without the appropriate safeguards to ensure medication compliance and accountability can only lead to increased stimulant abuse among U.S. children. The DEA concluded that a number of questionable practices have contributed to the diversion and abuse of stimulant medication, including improper diagnosis of ADHD. [16] Now consider the fact that many children diagnosed with ADHD and on these medications do not have ADHD.

It is difficult to call attention to a problem with ADHD medications, which millions of Americans have benefited and to which they owe their success; medications that the FDA has historically considered safe and continues to approve in ever-increasing concentrations. Tom Cruise’s comments about Ritalin and other psychiatric drugs on the NBC’s Today Show in June 2005 spurred a debate at whose center are the psychological effects of certain ADHD medications—something that has been known in the medical profession for 30 years.

So what is the FDA doing? The true issue that the FDA is debating is how to gain the “high ground” on the safety issues related to methyl-phenidate without admitting guilt about having done anything wrong or having missed something in the clinical trials. The FDA is debating how to control hysteria and prevent a public outcry. It knows it cannot be silent on this issue—but the message must be presented carefully and thoughtfully so that people do not overreact. In early 2006, the FDA plans to require labeling changes to better communicate the psychiatric side effects of these drugs.

It is a sad state of affairs when drug use among professional athletes receives more attention and action from the government than does prescribing of “cocaine-like” and “speed-like” drugs to children for a condition that many of them do not have.

The call for additional research is not the answer. Certainly, hundreds of researchers will gladly bleed millions of dollars to conclude what decades of data already show: that these drugs cause significant harm to children.

The FDA approval of higher concentrations of methylphenidate in the form of extended release capsules is irresponsible.

References:

1. Memorandum on Adverse events with methylphenidate products; U. S. Food and Drug Administration—Center for Drug Evaluation and Research, June 14, 2005.


2. Meeting transcript; U. S. Food and Drug Administration— Pediatric Advisory Committee, June 30, 2005.


3. Practice Parameters for Assessment and Treatment of Children, Adolescents and Adults with ADHD; American Academy of Child and Adolescent Psychiatry.


4. Diagnosis and management of attention deficit disorder in primary care for school age children and adolescents; Institute of Clinical Systems Improvement (ICSI)- (www. guideline.gov)


5. USA Statistics in Brief—Population by Sex, Age, and Region; U.S. Census Bureau, January 2005.


6. Practice parameter for the use of stimulant medications in the treatment of children, adolescents and adults; American Academy of Child and Adolescent Psychiatry; 2001.


7. Treatment of Children with Mental Disorders—Medication Chart; National Institute of Mental Health, April 2004.


8. Drugs of Abuse; U.S. Department of Justice: Drug Enforcement Administration; 2004 Edition.


9. Practice parameters for the use of stimulant medications in the treatment of children, adolescents and adults; American Academy of Child and Adolescent Psychiatry; 2001.


10. PDR Health—http://www.pdrhealth.com/drug_info/rxdrugprofiles/drugs/tof1448.shtml.


11. Summary of the practice parameter for the use of stimulant medications in the treatment of children, adolescents and adults; American Academy of Child and Adolescent Psychiatry; 2001.


12. Drug Use and Dependence—Amphetamine Dependence; The MERCK Manual; Section 15, Chapter 195, 1995.


13. Neil Campbell, Lawrence Mitchell and Jane Reece; Chapter 28, Biology: Concepts and Connections—Third Edition, Addison Wesley Longman, Inc., 2000.


14. Bruce Wingerd; Chapter 9, The Human Body: Concepts of Anatomy and Physiology, Saunders College Publishing, 1994.


15. Joseph Douglass, Jr., PhD; Influencing Behavior and Mental Processes in Covert Operations (Internet document).


16. DEA Congressional Testimony—Statement by: Terrance Woodworth; Deputy Director Office of Diversion Control Drug Enforcement Administration, May 16, 2000.