House Subcommittee Convenes Hearing Where
On September 29, a House Subcommittee held a hearing to challenge the legitimacy of attention deficit/hyperactivity disorder (AD/HD), witnesses called both AD/HD and all mental illnesses frauds. The hearing was organized by U.S. Representative Bob Schaffer (R-CO) and supported by House Education and the Workforce Committee, Oversight Subcommittee Chair Peter Hoekstra (R-MI).
Four anti-psychiatry witnesses presented at a hearing titled, "Behavioral Drug Use in Schools: Questions and Concerns" The Church of Scientology, active participants in this U.S House of Representatives public hearing, had a film crew filming not only the testimony but audience conversations and press interviews following the hearing. Dr. Fred Baughman, M.D., described by the subcommittee in its press release announcing the hearing as a child neurologist with a career studying "real, bona fide diseases," called AD/HD "the biggest fraud in America." He called both AD/HD and mental illnesses "a neuro-biological lie." Later he called "psychiatry as a profession," a "fraud."
At the insistence of Representative Marge Roukema (R-NJ), a member of the full Education Committee but not a member of the Subcommittee, Dr. David Fassler testified, representing both the American Psychiatric Association (APA) and the American Academy of Child and Adolescent Psychiatry (AACAP).
Dr. Peter Breggin, founder of the Center for the Study of Psychiatry and Psychology, was also a witness at the hearing. Dr. Breggin emphasized that there were no scientific studies validating ADHD and emphasized that all these kids need is "discipline and better instruction." He declared that the medications used to treat AD/HD "are the most addictive drugs known in medicine today." He further declared that AD/HD is not an illness, just normal child behaviors.
Every point made by Dr. Fassler was rejected by Drs. Baughman and Breggin. Perhaps the most alarming outcome of the hearing was Chairman Hoekstra's conclusion at the end of the hearing - "that there is no professional consensus between professionals about the origin and nature of AD/HD and that our nation is over-prescribing drugs to treat whatever AD/HD is."
The Subcommittee members made no effort to hear from the Surgeon General of the United States, the director of the National Institutes of Health (NIH), director of the National Institute of Mental Health (NIMH), nor any other leading researcher at the hearing. Instead, the Chairman was willing to declare a lack of professional consensus based on the testimony of two anti-psychiatry physicians and Dr. Fassler.
There were three other witnesses at the hearing. The first witness was a parent from Millbrook, New York, Patricia Weathers. She told a horror story of a school district that forced her son onto psychotropic medication as a condition of receiving a public education. Her son, Michael, had many serious side effects from the medications, and today he is in private school and not on any medication. She declared: "What concerns me is the intimidation tactics a school can use" and she also observed that she believed there were financial incentives for schools to identify children as disabled. Chairman Hoekstra asked the three physicians to discuss how medications are prescribed and what impact they have on children. Ms. Weathers discussed the serious side effects of medications on her son. She observed that her son had stayed the same size for three years. As soon as the medications were terminated, she said, he grew 3 sizes in 3 months.
A second witness was Ms. Patti Johnson, member of the Colorado State Board of Education, who authored a resolution accepted by the state school board promoting the use of academic solutions to the behavior, attention, and learning problems of children with disabilities. She declared that schools tell parents that their children must stay on drugs in order to stay in school. She declared that violence was a side-effect of medication. She said that mental health professionals were medicalizing "failures in instruction and discipline." She criticized the Child Find program as an incentive to identify children as disabled and declared that schools have become "cash cows" by becoming Medicaid providers. She read a memo from the Illinois Department of Education to schools announcing what a financial bonus Medicaid is. She declared that federal payments under the Individuals with Disabilities Education Act (IDEA) go up with the number of children identified as disabled. She said that the intent of IDEA should be to help children with "actual" handicaps rather than children "with vague psychiatric disorders." She asked Congress to repeal the Child Find program.
The last hearing witness was the Assistant Secretary of Education for Special Education and Rehabilitative Services, Judy Heumann. Assistant Secretary Heumann observed that IDEA does not encourage the use of medications; that this is a decision made by families and physicians. She emphasized that in 1997 Congress changed the IDEA funding formula so that the number of identified children with disabilities does not impact the funds received. IDEA funds are distributed by the number of school age children and poverty. She acknowledged that teachers should have open lines of communication with parents but they make no diagnosis, only observations on how children are learning. She said that IDEA has strong parental rights provisions and schools may not insist that kids receive medications.
Rep. Schaffer declared that his objective in convening the hearing was the improvement of education and that he was not elected to Congress to spend more money. He declared that federal funding programs - Supplemental Security Income's $440 a month to poor families with seriously disabled children, IDEA's funding formula where school districts are financially rewarded for having higher numbers of children with disabilities, and the Child Find program requiring states to locate children with disabilities - all encourage children to be mislabeled as disabled. In response, Assistant Secretary Huemann emphasized that the IDEA funding formula is not based on the number of children who are disabled, but Rep. Schaffer persisted in making these three claims.
Rep Schaffer criticized the federal government for having any role in special education saying that these should be local decisions. He also suggested that parental consent should be the cornerstone of all education decisions. He and Assistant Secretary Huemann engaged in a discussion of parental rights and the role of IDEA.
Rep. Schaffer was also very critical of school systems for "forcing parents" to medicate their children. He discussed a friend whose child was diagnosed with ADD and was placed on Ritalin. His friend, who happens to be teacher from Pennsylvania, went to a CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder) chapter meeting and a parent suggested that her son have an eye exam. It was discovered that the child had double vision and glasses solved the attention problem. However, Rep. Schaffer did not acknowledge CHADD, a mutual support group focused on finding solutions to educational problems. He only recognized that the child was medicated inappropriately.
In response, Dr. Fassler reminded the Subcommittee of the need for a comprehensive and individualized assessment by appropriately trained professionals and physicians. Ms. Johnson immediately declared that "we can't have a push for more psychologists. We need common sense, not psychologists... Children need recess and challenges, not psychologists and psychotherapy: The more psychologists a school has the more kids will be labeled disabled." Dr. Breggin agreed: "We don't need more mental health professionals." All that a comprehensive assessment will do is label normal child behaviors as illnesses. Likewise, Dr. Baughman agreed, declaring that drugs destroy child brains and that a multi-million dollar parasitic industry is damaging children.
Assistant Secretary Huemann responded by calling the statements of both Dr. Breggin and Baughman "unfortunate and misleading," and said that we have to "grapple with these issues in a reasonable way." Rep. Schaffer then flatly rejected Ms. Heumann's response and declared that teachers were drugging children to "pacify" children and repeated his accusations that SSI-Medicaid-IDEA-Child Find was a "virtual gravy train" and that everyone follows the money, resulting in an aggressive pursuit of children labeled with disabilities to get more money.
Ms. Weathers declared that we cannot have psychologists in schools; it was the school psychologist that caused her son the most problem with medication. Dr. Baughman again decried the false labeling of children. Rep. Schaffer and Assistant Secretary Heumann then debated the need for training teachers.
Chairman Hoekstra closed the hearing with the following observations: there is a divergence of professional opinion about the physical and medical nature of AD/HD and mental disorders; parents are overwhelmed by school systems; pressure is exerted on parents to medicate their children; and medications for children are over-prescribed. He appreciated Representative Schaffer bringing this issue to his attention.
All NAMI members and advocates are encouraged to contact members of the Subcommittee and express outrage at this hearing dominated by anti-psychiatry rhetoric. Subcommittee members should be asked to convene a separate hearing to receive testimony from the Surgeon General of the United States, the director of the National Institutes of Health, the director of the National Institute of Mental Health, and leading academic researchers to testify on childhood mental illness and the efficacy of new treatments. It is particularly important that NAMI members who live in the districts of the Subcommittee members (listed below with district areas) make contact and express their outrage and request a separate hearing.
Urge that they also include as witnesses parents associated with NAMI, CHADD, and other groups whose children have been helped by appropriate medical intervention. NAMI wants to ensure that the Subcommittee hear testimony to rebut assertions made by Chairman Hoekstra that there is no professional consensus about the nature and origin of childhood mental illness.
Members of the Oversight and Investigations Subcommittee and the communities they represent:
Peter Hoekstra (R- Holland/Muskegon, MI) Chairman
Charlie Norwood (R- Augusta, GA)
Van Hilleary (R- South Central Tennessee,TN)
Bob Schaffer (R- Ft. Collins,CO)
Tom Tancredo (R- Littleton, CO)
Ernie Fletcher (R- Lexington, KY)
Tim Roemer (D- South Bend, IN) Ranking Member
Robert C. Scott (D- Richmond,VA)
Ron Kind (D- LaCrosse / Eau Claire,WI)
Harold E. Ford, Jr. (D- Memphis, TN)
All NAMI members are urged to write their members of Congress and ask how such a biased hearing can be held without the mainstream of the scientific establishment being asked to testify. All members of Congress can be reached by calling the Capitol Switchboard at 202-224-3121. Contact information can also be obtained from going to the policy page on the NAMI website at http://www.nami.org/policy.htm and click on "Write to Congress."
NAMI NATIONAL NEXT STEPS
NAMI will be meeting during the next months with APA, AACAP, National Mental Health Association, CHADD, and others, including members of Congress who recognize that childhood mental illness is legitimate to plan affirmative activities to emphasize the evidence base of science underlying childhood mental illness.
THE SURGEON GENERAL'S REPORT ON MENTAL HEALTH
No witness at the hearing, including Dr. Fassler, ever mentioned the Surgeon General's Report on Mental Health. This is the most recent and definitive statement of the research and the science underlying mental disorders. Pages 142-150 describe the evidence-based research on attention deficit/hyperactivity disorder (ADHD). Dr. Fassler included the SG's report in both his written prepared statement and the attachments given to the subcommittee.
The Surgeon General states that "ADHD, which is the most commonly diagnosed behavioral disorder of childhood, occurs in 3 to 5 percent of school-age children in a 6 month period...The exact etiology of ADHD is unknown, although neurotransmitter deficits, genetics, and perinatal complications have been implicated..." (page 144). "Because the symptoms of ADHD respond well to treatment with stimulants and because stimulants increase the availability of the neurotransmitter dopamine, the 'dopamine hypothesis' has gained a wide following." (page 145) "Psychostimulants are highly effective for 75 to 90 percent of children with ADHD...These medications have the greatest effects on symptoms of hyperactivity, impulsivity, and inattention and the associated features of defiance, aggression, and oppositionality...However, psychostimulants do not appear to achieve long-term changes in outcomes such as peer relationships, social or academic skills, or school achievement...Common stimulant side effects include insomnia, decreased appetite, stomach aches, headaches, and jitteriness..."(page 146)
The Surgeon General's report emphasizes (pages 148-149) the NIMH Multimodal Treatment Study of ADHD, called the MTA Study. The study compared 14 month outcomes of 579 children randomly assigned to one of four treatment conditions - medication management alone, behavioral treatment alone, a combination of medication and behavioral treatments, and standard treatment in the community. Medication and the combination treatment were "generally more effective." The conclusion; "Carefully managed and monitored stimulant medication, alone or combined with behavioral treatment, is effective for ADHD over a period of 14 months."
The Surgeon General's report does recognize the concerns "that children, particularly active boys, are being overdiagnosed with ADHD and thus are receiving psychostimulants unnecessarily." (page 149) The report also observed that "even though the MTA Study found no safety issues over a 14 month period...research is needed to examine the long-term safety of treatment..."(page 150)
DR. FASSLER's STATEMENT
Dr. Fassler observed that "ADHD is not an easy diagnosis to make, and it's not a diagnosis that can be made in a 5 or 10 minute office visit." "The diagnosis of ADHD requires a comprehensive assessment by a trained clinician." Dr. Fassler included in his submissions to the subcommittee:
2.American Medical Association Council on Scientific Affairs report, "Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder in School-Age Children." [Drs. Breggin and Baughman dismissed this as "political" documents by "political" organizations, after Dr. Fassler quoted from them.
3.Archives of General Psychiatry summary of the NIMH MTA Study.
4.AACAP Practice Parameters for the Assessment and Treatment of Children with ADHD.
5.AACAP Comprehensive Psychiatric Evaluation Suggestions
6.AACAP Questions to Ask About Psychiatric Medications for Children and Adolescents
7.Suregon General's Mental Health Report on ADHD
8.November 1998 NIH Consensus Statement on the Treatment of ADHD
Support NAMI to help millions of Americans who face mental illness every day.Donate today
Inspire others with your message of hope. Show others they are not alone.Share your story
Become an advocate. Register on NAMI.org to keep up with NAMI news and events.Join NAMI Today