NEW YORK — One day last year, a social worker came knocking on the door of Michael Carroll's home in West Berne, N.Y.
The trouble: The father of four had been reported to Child Protective Services for putting his seven-year-old son, Kyle, at risk.
Stunned, Mr. Carroll asked what he'd done.
The answer infuriated him and put the Carroll family at the center of a heated debate about the educational system and the larger culture's increasing use of psychotropic drugs, such as Ritalin, to cope with difficult kids.
Carroll's supposed misdeed was not abusing the drugs, but refusing them. He'd been reported by the local school district for taking Kyle off Ritalin. The stimulant, whose use in the United States has increased 700 percent in the past decade, had, Carroll says, turned the once-rambunctious boy into a withdrawn insomniac with no appetite. And his reading level, which was the original cause of Carroll's concern, had not improved.
"The school never objected, it just immediately called child protection, without any contact with me whatsoever," he says. "It was crazy."
While the case may be extreme, it is not unique. Parents who question the use of Ritalin increasingly find themselves at odds with educators, psychologists, and a medical community firmly convinced of the drug's ability to help hyperactive kids lead relatively normal and stable lives.
The controversy has prompted a series of congressional hearings, proposals for a national policy to guide schools in their advocacy of the drug, and several class-action lawsuits. The suits charge the American Psychiatric Association and the drugmaker Novartis with conspiring to promote the fraudulent use of Ritalin in American children.
"The drugging of children has gotten so out of hand that America is waking up to this," says Peter Breggin, a critic of the use of Ritalin. "This is a national catastrophe. I'm seeing children who are normal who are on five psychiatric drugs."
But advocates of the use of medicine to help disruptive and impulsive youngsters worry the controversy will create a backlash that could prevent millions of children from getting the help they need to focus and do better in school.
The National Institute of Mental Health estimates that 3 to 5 percent of American children - as many as 6 million - suffer from attention deficit hyperactivity disorder (ADHD). If untreated, NIMH says, the disorder could lead to serious problems in later life. In the largest clinical study of its kind, NIMH researchers concluded that Ritalin can eliminate the symptoms up to 85 percent of ADHD children. Currently, Ritalin is prescribed to as many as 2 million US children.
"People need to stand back from the issue and let reason and factual understanding of what these medications do and don't do prevail," says Patricia Dalton, a clinical psychologist in Washington. But she is also troubled by the intervention of child welfare services and the courts in the Carroll case. Short of a life-threatening situation, she says, parents should have sovereignty in making decisions that affect their children.
"But if you see a child that improves greatly on medication, that's important, too," Dr. Dalton says. "If they're better able to learn and function, you have to look at the cost of not being on it."
From the start, Carroll says he simply wanted Kyle to get special education to improve his reading. After local pediatrician prescribed Ritalin, the school gave Kyle speech and occupational therapy. But Carroll saw that as a way for the school to say Kyle was getting special help, without really addressing his reading problem.
"From the beginning ... I kept asking for special-education classes," he says. "They just wanted him to sit still and to push him through the system."
After child welfare officials told Carroll to put his son back on Ritalin or risk losing custody on grounds of neglect, Kyle resumed taking the drug.
But this summer, a judge ruled that if Carroll could find another doctor to say Ritalin was unnecessary, Kyle could stop taking it. Carroll succeeded. Since August, Kyle has not used Ritalin. He's regained his appetite, and his father says Kyle is his old outgoing self and is doing well in special-education classes at a different school.
Lawrence Diller, author of "Running on Ritalin," says more and more parents who buck the medication find themselves, like the Carrolls, at odds with schools. The problem is indicative of a growing cultural acceptance of what he calls a misperception - that physiological factors are primarily responsible for influencing children's misbehavior and underperformance.
"In most of these situations, the kids are dealing with a host of issues," says Dr. Diller. "What's being overlooked is that there are alternative strategies to medication that work well for hard-to-handle kids."
The problem is they take more time, money, and effort than Ritalin. But class-action lawsuits in California and New Jersey, brought last month, accuse the makers of Ritalin and APA of worse than expedience. They claim the two conspired to create a market for the drug by concocting the ADHD diagnosis and putting out pamphlets in schools that touted the drug's effectiveness without advising that it has "no long-term effect" in improving academic performance or in helping kids overcome hyperactivity.
In a prepared statement, the APA contends that's "unfounded and preposterous." At a hearing last week in Congress, the APA's Dr. David Fassler defended its definition of the disorder. "The diagnostic criteria are ... the product of extensive and numerous research studies."
But Breggin and other critics say there is still nothing physical that a doctor can point to, besides behavior, to determine if a child has ADHD.
That, among other factors, led the Frasers of Rockville, Md., to question the pattern of increasing drug use their son was subjected to.
Andrew has a high IQ. When he was in second grade, a teacher recommended he get treatment for ADHD. After a visit to a doctor, Andrew was put on Ritalin. But, like many children on the stimulant, he eventually had trouble sleeping. To make a long story short, side effects of one drug were addressed by prescribing additional drugs - until Andrew was taking four psychotropic medications at once, including Prozac.
The Frasers, deciding enough was enough, looked for alternative treatments. Andrew's now in eighth grade in a private school. "He's doing great. He's not taking any medications at all, his behavior has improved," says Fraser. "There's no question in anybody's mind that getting him off the medication was the right thing to do."
Fraser says he never felt pressured by the schools to medicate his son. But when he began the withdrawal process, it was clear the school would have preferred Andrew continue with the medication. "He is an active and an energetic kid, and I think a lot of times schools are looking for that leveling device, which certainly these medications can be," he says.
The Frasers say they learned a difficult lesson themselves. In retrospect, they wish they'd never put their son on the drugs, and instead, had taken a look at their family situation and made some hard career choices so they could spend more time with him.
"If you have a child that has a higher level of need, maybe more than you'd like, you have to bite the bullet," says Fraser. "That's what you have to do, labor in anonymity and become that world-class parent."
(c) Copyright 2000. The Christian Science Publishing Society