by Gwen Olsen
The following excerpts from my case notes recorded during interviews with foster parents, teachers, and therapists of the children support my concerns and chronicle the progression and magnitude of this problem over time. The names of the children have been changed in order to protect their identities.
8/18—Spoke with children’s new foster mother. She said Juan Carlos was prescribed clonidine following his psychiatric evaluation. (Dr. Numnuts works for the placement agency.) She said he was adjusting to the medication, but initially was very lethargic on the drug. [It should be noted that clonidine is an alpha-antagonist also known as Catapres. It is indicated to treat high blood pressure and is not approved for use in children under the age of eighteen. However, psychiatrists frequently prescribe it for children with attention deficit/hyperactivity disorder.]
9/4—Spoke with foster parents. Juan Carlos appears to be responding to his medication but is having behavioral difficulties off and on. They say, Roberto, the four year old, has gotten more difficult to handle and they are going to talk to the doctor about getting him on medication as well. 9/12—Spoke with foster father. He said the boys had been acting-out considerably and that the youngest boy, Albert, age 2, was using the ‘F’ word frequently of late. He said he’s been very aggressive and kicks a lot. Foster father emphatically remarked that he didn’t think Juan Carlos’ dose of .1 mg. of clonidine twice a day was working.
10/30—Supervised visit between mother and children. Talked briefly with foster parents who said Juan Carlos is doing better now that his medication has been increased (remember to check on this). Mother basically ignored the children as she tried to catch me up on the saga with their father. The baby is walking now and was all over the place as she explored her surroundings. There appears to be very little emotional bond between Mom and her baby. The kids started to get wild and restless, and Roberto started to hit, bite, kick, and talk back, which required him to be put in ‘time-out.’ This was the second occasion mother has appeared to have been up all night without having slept prior to the visit. When I questioned this, she said she had stopped taking her Prozac because the prescription ran out, and she was having difficulties sleeping. (Note: Mother’s psych eval indicates passive aggressive tendencies and borderline personality traits.)
11/28—Placement Progress Meeting was held. Therapist say Juan Carlos is improving although he still has anger issues, and fights and takes things from other children. Juan Carlos doesn’t respond well to punishment and starts bawling in time-out. Psychiatrist added imipramine to Juan Carlos’ meds for bed-wetting issues but he is still wetting his pull-up diaper nightly. [Imipramine, also known as Tofranil, is a tricyclic antidepressant and is not approved for use in children under eighteen. Several deaths have been associated with the use of its main metabolite desipramine.]
Roberto—Has appointment with psychologist to check out the possibility of Fetal Alcohol Syndrome or neurological damage. Roberto is very absent- minded and has outbursts of aggression and anger. Foster father says he doesn’t listen well, but hasn’t been put on medication yet. Albert—Now 2 ¡, is developmentally on target and always smiling. He has started to finally make eye contact with adults. He is not currently in therapy or on any meds.
Maria—Now 17 months, walking, and very content to play alone, is devel- opmentally on target.
5/28—Children were returned to their mother. Juan Carlos has about one month’s supply of his medication according to the foster mother. 6/15—Judge Hathaway removed the kids again today and they were placed back with the foster family. It was discovered that the father—who had been forbidden visitation without services—had been with the children every week since they’d gone back home. Not only that, but mother had left the children in state-funded daycare for the two weeks they were with her and she was unemployed! Mother went berserk in court. Next hearing is in six weeks.
6/19—Contacted foster parents. They say Roberto is taking it the hardest and is very angry. Juan Carlos’ bed-wetting continued and encopresis has gotten worse—he was having frequent involuntary bowel movements. Discovered today that parents of the children had gotten married on April 12, because mother is pregnant again!
8/14—Children are not doing well at all according to their therapist and foster parents. They are all extremely aggressive and defiant. Juan Carlos started first grade on Tuesday and the younger boys are going to Head Start next week. Therapist is requesting Juan Carlos’ meds be adjusted. 8/18—Attended Placement Progress Meeting. Juan Carlos’ clonidine has been increased to .1 tablet three times daily, Wellbutrin has been added for depression. (Find out if imipramine was discontinued!) He has started wearing pull-ups again for bed-wetting and day-time encopresis. After return to foster family, his anger has increased as well as his aggressive behavior with siblings. His teacher called to report to foster parents that he is falling behind quickly in his studies, staring into space, not able to follow well in class. [It should be noted that Wellbutrin is an antidepressant not approved for use in children under eighteen.]
Roberto—Yesterday was his first day at Head Start. His aggression has been so serious he was given an EEG to rule out silent seizures. Nothing was found. Roberto is now wearing pull-ups at night for bed-wetting too. He is in play therapy with other children. An appointment with the psychiatrist is scheduled for next Monday.
Albert—Doesn’t wet the bed like the older boys, but his behavior deteriorated over the past four months. He also has an appointment with the psychiatrist next Monday.
Maria—She had no special needs at this time but has become more aggressive in her own defense.
9/9—Talked with foster father who says kids are regressing horribly. Juan Carlos is falling behind at school. His teacher says he ignores her and won’t respond to questions, and doesn’t recognize words. Psychiatrist put Roberto on 5 mg. of Paxil but it doesn’t seem to be doing any good. Albert was given 5 mg. of Adderall at his last psych evaluation. [It should be noted that Paxil is an SSRI antidepressant and Adderall is a combination of amphetamine and dextroamphetamine. Neither drug is approved for use in children under the age of eighteen, but both are frequently prescribed to children.] 9/12—Talked with foster mother following a teacher/parent conference for Juan Carlos. She said the teacher remarked that Juan Carlos appears to be ‘jumpy and jittery.’ Teacher said they were considering putting him in kindergarten because he couldn’t answer even the simplest questions about letters. She also told me that Roberto and Albert are having difficulties at Head Start and have been sent home for aggressive behaviors repeatedly. They appear to be getting wilder rather than better on their drugs. 9/19—Spoke with Juan Carlos’ teacher, who said that J.C. is there physically but not mentally. He won’t do his homework. She’s been giving him special assignments out of kindergarten books. She said she thinks he may be brain damaged—he doesn’t respond when questioned, has inappropriate affect and a ‘lost look’ in his eyes.
9/30—Talked with caseworker who said the doctor had added 5 mg. of Adderall to Roberto’s Paxil. She reported his aggression was out of control, and they had started him in another elementary school for early childhood. Head Start will no longer take him! Juan Carlos has improved somewhat since they lowered the dose of his clonidine again to twice daily. They also switched his antidepressant to Paxil. His teacher was complaining he appeared excessively drowsy in the afternoon.
10/12—Children’s caseworker called to relate the following incident which occurred with the transporter yesterday. Apparently, following the visit with their mother, the children had to be corralled from the street. Then, while in transit, they attacked the transporter! Roberto pulled the emergency brake as they were driving at about 60 mph. Juan Carlos reportedly told Roberto to ‘poke her eyes out and cut her titties off!’ and began to spit, hit and bite her while she was driving. The caseworker was so traumatized that she refuses to transport the children any more. As a result, the caseworker said Juan Carlos has been switched from clonidine to
Adderall and Paxil. Roberto’s and
Albert’s Adderall have been increased to 10 mg. daily. I asked about the combination use of Adderall with Paxil, she said the psychiatrist claimed they work better in combination.” (Note: Could this incident have been caused by the children’s meds?)
The children’s progress continued to deteriorate. In December, the unborn baby boy arrived and was attached to the case. Parental rights were eventually terminated. Four of the children were placed in another state. The baby was put in a separate family, but all of them were placed for permanent adoption. They had lingered and suffered at the hands of the system for more than two years. This was the last case I would handle as a CASA. I had lost my faith in and respect for a system run amok. The child welfare system had more problems than I was able to cope with. Plus, I just knew this was the end of that particular journey for me. Somehow, I knew it had fulfilled its purpose, so I walked away.
A Plea for the Children
Children are so vulnerable because of their smaller size, limited cognitive skills, and dependence on others. They are three times more likely to experience adverse drug reactions than adults. It is sad to think that state agencies responsible for child welfare would further exploit and abuse children in their custody by excessive use of psychiatric medications.
However, it is well known in the pharmaceutical industry that children are a lucrative market for drugs and are possibly the single most promising growth area in the industry. The mere fact that children are forced by parents and teachers to take medication ensures a compliant patient. That means refilled prescriptions and more sales. Psychiatric drugs are marketed aggressively for use in children. Antidepressant use is up, especially among kids age five and younger. According to Express Scripts data, antidepressant use in these kids doubled from 1998 to 2002, up one hundred percent (DeNoon). Eli Lilly even proposed a peppermint- flavored Prozac to market for children. (The FDA denied its application.) However, adolescents between the ages of twelve and seventeen are the biggest child consumers of antidepressants (Huffington).
Children have an increased risk for antidepressant-induced mania. In one clinical trial involving Prozac for depressed children, six percent were forced to drop out because of Prozac-induced mania—six percent! Internal documents for the FDA show a rate for mania of slightly above one percent. However, in the data submitted by the manufacturer for Prozac’s approval, hypomania/mania was listed to occur at 0.7 percent (Breggin and Cohen 61). Quite the discrepancy, don’t you think? But, remember, the approval trials were conducted on select adult candidates with mild to moderate depression. All serious psychiatric illness had been screened out. Therefore, one would expect these figures to increase in routine clinical practice because the average child who receives a prescription for an antidepressant is not screened for a potential predisposition to mania.
If you are a parent trying to determine if psychiatric medications are appropriate for your child, remember one thing: Most of these drugs have not been tested on and are, therefore, not approved to be used in children under the age of eighteen. Many may escalate your child’s emotional issues. Children require love, attention, nurturing, and healthy boundaries to feel emotionally secure and well- adjusted. Even if the drugs manage to restrain or numb their feelings and behavior, if the root of their origin is not addressed, they will soon return, often with a vengeance, once the drugs are removed.
Developing brains are far more vulnerable to brain damage than adult brains. Damage received in childhood may only become apparent after the brain is fully developed. The drastic increases in cortisol produced by the SSRIs and SNRIs can cause brain damage. In addition, they can cause a multitude of serious physical reactions in children, such as impairment of linear growth and the interference with development and regeneration of liver tissue, kidneys, and muscles, and so forth (Tracy 2001). Most recently, Eli Lilly’s new drug, Strattera, which was launched in 2002 and enjoyed $667 million in annual sales in 2004, received a bolded warning regarding the potential for severe liver injury. Strattera is a SNRI (the same category as Zoloft) and is indicated for attention deficit/hyperac- tivity disorder (ADHD) (Swiatek).
Stimulants such as Ritalin (methylphenidate) and Adderall (d-amphetamine and amphetamine mixture) can cause excessive stimulation of the brain and result in insomnia, seizure, agitation, irritability, nervousness, confusion and disorientation, personality changes, apathy, social isolation, sadness, and depression. They may also cause paranoia resulting in violence toward others.
Regulators briefly removed Adderall XR from the Canadian market on February 9, 2005, because of reports linking the drug to twenty sudden deaths (fourteen children and six adults) and a dozen strokes, including two in children. (I wonder what our genius interviewed at UT would think about that?) The FDA evaluated these same reports and determined it did not feel the data warranted such action in the United States. Currently, there are approximately 700,000 Americans taking Adderall XR. Another 300,000 take Adderall. However, the FDA has modified Adderall use instructions to include a warning against use in patients with cardiovascular disease (Gardner, A.).
Furthermore, millions of children now taking Ritalin and Adderall in order to function better in school are being forced to do so for the benefit of the teaching institution or teacher, not the child! Many schools are ill-equipped to handle the needs of energetic children who have difficulty sitting quietly still for hours on end in overcrowded classrooms. These stimulants are used to promote compliance, obedience, reduced initiative, and reduced autonomy, making children in group settings easier to manage (Breggin and Cohen 66).
Even if your child has been diagnosed with ADHD, you need to be objective about your school’s policy and determine if it has low tolerance for rambunctious kids. I would strongly suggest you explore other options before allowing your child to be subjected to the risks of psychiatric medications. With the proper dietary adjustments and the nutritional supplementation of Omega-3 essential fatty acids (EFAs), many symptoms of ADHD can be completely eradicated. If you are looking for a magic bullet in psychiatric medications, especially where children are concerned, you are playing Russian roulette.
Just in case you think I’m being an alarmist with that statement, consider this last tidbit about another ADHD drug that I found while browsing the FDA’s Web site. It was also potentially prescribed to children. On February 10, 2005, the FDA and Alliant Pharmaceutical notified all health care professionals and consumers on their Web site about the recall of all Methilyn CT (methylpheni- date HCL) 2.5, 5, and 10 milligram tablets. Their posting stated that some tablets may contain up to three times the active ingredient and could pose serious risk to some patients (U.S. Food 2005b). (Don’t you think children might be the most vulnerable to this potential overdose?)
The Fine Line Crossed Between Legal and Illegal Drug Use
Our blatant hypocrisy where psychoactive drug use is concerned has not escaped the notice of our teenagers. These kids have grown up on Ritalin and other psy- choactive substances prescribed by their doctors and endorsed by their parents. Meanwhile, their peers, as well as some parents, were abusing their prescription drugs and others in order to get high. The government has waged an open war on illicit drugs like marijuana and cocaine for years. Yet, we also need to aggressively teach our youth about the inherent dangers of prescription drug use so they don’t have a false sense of security when they experiment just because something is legal and prescribed by a doctor. It isn’t difficult to see why many kids feel society talks out of both sides of its mouth where drug use is concerned. For the most part, they have seen more of their friends die on prescription drugs than they have illicit ones.
For example, I have a half-brother, Ben, from my father’s second marriage. (His mother, ironically, is the daughter of my dad’s former mistress that I mentioned earlier.) He lives in Las Vegas. Ben is by passion, if not profession, a phenomenal rapper. His crew is called Tha List. Unfortunately, in his social circles,
he started experimenting with drugs and alcohol very early (about the sixth grade). This earned him the nickname “Benzo,” short for benzodiazepine. Ben became an alcoholic quickly and dropped out of school. Eventually, because of his drinking and drugging, he ended up on the wrong side of the law.
When we talked following Meg’s death, my brother told me about two of his homies that had also recently died. One was killed in a car wreck (driving while intoxicated), and the other had died of an overdose of Xanax, methadone, and alcohol. Apparently, the last guy had actually died on the couch in Ben’s apartment. Ben’s comment to me was, “Wow, and now this thing with Megan. I feel like God has been throwing lightning bolts at my feet and all around me lately, trying to tell me something.” Of course, my reply was, “Well, Ben, if you feel that way, maybe there’s something to it!”
PARENTS CREED
Author Unknown
If a child lives with criticism,
He learns to condemn.
If a child lives with hostility,
He learns to fight.
If a child lives with ridicule,
He learns to be shy.
If a child lives with shame
He learns to feel guilty.
If a child lives with tolerance,
He learns to be patient.
If a child lives with encouragement,
He learns confidence.
If a child lives with praise,
He learns to appreciate.
If a child lives with security,
He learns to have faith.
If a child lives with approval,
He learns to like himself.
If a child lives with acceptance
