22nd September, 2006
The exuberance of childhood celebrated in books such as Just William is now frowned upon as inappropriate behaviour, resulting in more and more children being prescribed behavioural drugs. Rachel Ragg investigates
William, 10, has just added smashing his neighbour’s greenhouse to his list of crimes. Other recent misdemeanours include breaking into an artist’s studio, turning his sister’s best hat into a plant-pot, almost blinding his aunties with a catapult, flooding the hall (during a water-fight with his cousin), defacing school text-books, and locking an especially deadly relative in a shed.
This particular William is, of course, Richmal Crompton’s fictional Just William – back in the days when such behaviour was put down to ‘boyish high spirits’, and merited a hefty slipper on the backside from Father.
But what would happen to ‘Just William: the 2006 re-make’? That’s obvious: he would be diagnosed as suffering from attention deficit hyperactivity disorder (ADHD) and given Ritalin until he sat still and reflected on his Personal, Social and Emotional Development, as dictated by the National Curriculum. Never mind plant-pot hats and wild adventures: his fantastic Standard Assessment Test (SAT) scores in Maths, English and Science would be helping his primary school to creep up yet another percentage point in this year’s league table, and his head teacher would be counting the extra pennies to spend on yet another white-board.
Drugs for children have become big business. This summer a British Medical Association (BMA) report concluded that as many in one in 10 children and young people between the ages of one and 16 have been diagnosed as suffering from a serious mental health problem, ranging from sleep and eating disorders through to severe obsessive and depressive conditions. According to government statistics, 345,000 children aged between six and 16 are suffering from ADHD alone. So the boy who can’t sit still and careers around the classroom is defined as ‘hyperactive’, while the reserved one who prefers drawing churches to playing at superheroes is labelled ‘possibly autistic’. As for the girl who won’t eat her chicken nuggets and smiley potato faces: evidently an anorexic in the making.
Ritalin (aka the ‘chemical cosh’) is the great beneficiary of these diagnoses. An amphetamine given in tablet form to deal with a whole collection of behavioural syndromes, Ritalin was virtually unknown at the start of the 1990s. Last year, however, 361,832 prescriptions were written for Ritalin, Concerta and Equasym, the three methylphenidate drugs licensed in the UK.
And the cost is not insignificant: Ritalin alone costs the NHS around £200 a year for a child on an average daily dose of 30mg, but the bill rises to up to £1,000 when assessment and follow-up costs are taken into account. Families of children diagnosed with ADHD are also entitled to a disability living allowance (up to £5,350 per year), a carer’s allowance (up to £2,376 per year) and a disabled child tax credit (up to £2,300 per year).
Then there’s the possible cost to the child’s health: in terms of pharmacological effect, Ritalin is a powerful stimulant in the same class as the street drugs amphetamine (‘speed’) and cocaine. Because Ritalin is swallowed in tablet form, it works over a much longer period than cocaine – so while it doesn’t have the sudden ‘hit’ of cocaine, its effects are the same.
Never mind that it now carries a ‘black box’ health warning in the US, having been linked to 51 deaths since 1999 among children and adults taking the drug. And while the UK’s National Institute for Clinical Excellence (NICE) recommends the use of pharmaceuticals only as a last resort, the number of children prescribed drugs from Ritalin to Prozac continues to rise.
Reports are circulating that children as young as 15 months have been prescribed Ritalin in the US – although it is not licensed in any country for use in children under six – and Prozac is now being prescribed to UK children considerably younger than the recommended 16. According to a 2004 study of US prescription purchases conducted by Medco Health Solutions, a US pharmacy benefits management company, around 65 per cent of all children and adolescents taking behavioural medicines are on antidepressants, and many of these take both antidepressant and attention disorder drugs.
Indeed, a ruling by the European Medicines Agency (EMEA) in June means that now, children as young as eight can be given Prozac. The EMEA said that the drug was safe for young people to take, despite concerns that it can trigger suicidal feelings in patients. An earlier study, published in February 2000 in the Journal of the American Medical Association, reported a 200–300 per cent increase in antidepressants and stimulants given to children aged three and under. And that’s despite the fact that nobody has yet studied the long-term effects of this policy. Are the drugged-up generation more likely to end up in a lifelong cycle of prescription drug-taking? A disturbing thought indeed.
It’s all the more disturbing when you think that very few of the drugs currently prescribed to children have been tested on children: at present, children are taking smaller doses of medicines that have only been tested on adults, and which may in fact be completely unsuitable for them. A House of Lords report earlier this year, based on evidence gathered from doctors, stated that 90 per cent of medicines for new-born babies and 50 per cent of those aimed at children are untested. The response? A new European regulation covering paediatric medicines, requiring pharmaceutical companies to test drugs on their target market – i.e. children.
Fair enough, you might say. After all, the idea that a child could simply be given a smaller dose of an adult drug on the basis that he or she is simply a shrunken adult is somewhat worrying. But how exactly do they plan to test drugs on children? And why have governments suddenly become interested in this issue?
The pharmaceutical companies may know the answer to this – as they are partly responsible for manufacturing the problem (‘selling sickness’) as well as the solution. They feign concern that adult drugs are being used on children, employ ‘experts’ to back them up, and lobby governments across Europe. How can any government resist the argument that they’re putting a whole generation of children at risk by prescribing them drugs intended for adults? And how can any government disagree that there’s a need for these drugs, given that the pharmaceutical companies can provide any amount of evidence to ‘prove’ that vast numbers of children are suffering from ADHD or other behavioural syndromes?
The result – the 2006 European Regulation on Paediatric Medicines – is highly satisfying for all concerned. Not only do the drug companies get an extra six months added to the patent protection period: they also create a fund to finance research into the possible adaptation of existing drugs, which are not covered by patents, for use by children. Moreover, the regulation leads to the setting up of a network of researchers and research centres designed to prevent duplication of research and tests on children. What will these researchers and research centres find? Almost certainly: that more drugs need to be provided for children. US psychologist and lawyer Dr Bob Jacobs is well known for his research into ADHD – and for his conclusion that the condition does not exist as an ‘illness’. He believes that the ‘need’ for children’s drugs is entirely manufactured by governments, drug companies, teachers and even the parents. “Drugs ensure the conformism that Western society demands. They have no therapeutic or medical purpose; they simply turn children into zombies,” says Jacobs. “Public consciousness is offended by seeing a child in physical restraints, but because chemical restraints are internal they are a much less ‘sexy’ issue, even though they are arguably even more destructive.”
For Jacobs, this suppression of children’s nature goes right to the heart of Western society and its ideas about ‘normality’. “Capitalist society is based on people dressing, looking and thinking alike. If a child has high energy levels or is extremely creative, he represents a threat: he has to be groomed, trained – or drugged – to comply and conform.” And while most adults claim to celebrate diversity, he adds, they nearly all hate behavioural diversity. As this diversity constitutes the very essence of children and childhood, they thus want to suppress the very essence of what it is to be a child.
According to Jacobs, then, it isn’t so much our children’s behaviour that has changed, but the way in which it is viewed in our capitalist society. But is that the full story? Perhaps it’s more the case that children’s behaviour has indeed been affected by our culture and environment; which in turn affects the way we view their behaviour, which in turn changes the way we deal with their behaviour, which then further exacerbates these behaviours, and so on. But whatever the reason, something has gone terribly wrong if we are impelled to drug our children for them to learn.
Twenty-five years ago, children starting school were encouraged to play, to skip, and to learn useful life skills like how to carry scissors safely. Now, though, the focus is on reading and writing and the Six Areas of Learning (to quote the Sure Start propaganda, which sounds suspiciously like something from Soviet Russia). So instead of just letting the children play with sand and water, we have ‘knowledge and understanding of the world’ (where they are officially assessed on their response to planting a sunflower seed), ‘creative development’ (can they colour a ladybird in red rather than purple? If so, tick that box...), and ‘physical development’ (i.e. do they bump into other children? If so, they’re obviously autistic). Then there is the dreaded round of National Curriculum tests and assessments that have all but replaced singing, art and PE – and which have led directly to a rise in behavioural problems. In 2004, the Mental Health Foundation published a report, 'Tested To Destruction'. It found that the government-imposed Standard Assessment Tests (SATs) had created a huge rise in anxiety and stress levels, including mental health problems in children as young as four. The most common problems were difficulty in sleeping, being tearful and upset, feeling ill, loss of appetite and difficulty in relaxing. There were clear gender differences, with girls more frequently affected.
Dr Adrian Sutton is a consultant in child and family psychiatry at the Department of Child Psychiatry at the Winnicott Centre, a child and adolescent mental health unit that provides services for the Central Manchester and Manchester Children’s University Hospitals NHS Trusts. He says that school league tables, the National Curriculum and a narrow focus on academic achievement can have ‘severely adverse effects on vulnerable children.’ What’s more, it appears that boys fare worse than girls. Thirty years ago, ADHD was diagnosed in 0.5 per cent of children; now it’s somewhere between three and seven per cent, with boys accounting for three quarters of these cases. Diagnosis is most commonly made when children start school or nursery, and is made with reference to a checklist of ‘symptoms’: ‘runs or climbs when inappropriate’, ‘fidgets with hands or squirms in seat’, ‘is constantly on the move’. Drugs are the most common treatment.
The National Curriculum suppresses – pathologises – anything that doesn’t fit. Never mind creativity or invention: homogeneity is what matters. And this homogenisation begins at the vast majority of nurseries, regardless of whether they be state-run or private. At even the very nicest and kindest nurseries, children of two are frequently made to sit on a particular square of carpet so they can listen quietly to the teacher. It is bordering on the sinister to think that your child could be offered drugs because he ‘runs or climbs when inappropriate’ – ‘inappropriate’ being one of the most weasel words of the 21st century, almost always meaning ‘when it doesn’t fit the prevailing agenda’.
It’s not unreasonable for teachers or nursery nurses to devise crowd control measures. But when children are being fed Ritalin because their natural exuberance is inconvenient and, ultimately, threatens the school’s position in the league table: that’s a different matter altogether.
Boys will be boys
If there’s no room in the curriculum for boisterous and exuberant behaviour, the obvious losers are boys. One boisterous boy can disrupt a whole class, and this in turn affects the class’s ‘learning outcomes’, which in turn affects the school’s league table position – so it’s in everyone’s interests to drug him into submission.
A shy boy, for his part, risks being highlighted as ‘pathologically withdrawn’ when he fails to hit the required target for ‘social interaction’.
In his recent book, 'The Minds Of Boys', Michael Gurian argues that boys’ ‘behavioural problems’ are actually the result of an education that’s out of tune with their ‘impulsive, exploratory, kinaesthetic’ natures. Dr Leonard Sax, psychologist and physician and the author of the controversial book Why Gender Matters, agrees.
According to him, we have to accept that there are hard-wired differences between the sexes, and our failure to recognise and respect these differences has done substantial educational and developmental harm – particularly to boys, whose achievement levels over the past decade has been a widely publicised increasing cause for concern.
But what exactly are these gender differences? MRI scans have demonstrated that male and female brains have measurably different neurological responses. So, for example, the language area in a five-year-old boy’s brain generally looks like that of a three-year old girl’s – hence small boys’ frequent lack of interest in reading and writing. Then there’s hearing. A girl’s sense of hearing is substantially more sensitive than a boy’s. The result? A boy can’t hear the teacher, so loses interest – and is diagnosed with ADHD and prescribed amphetamines. Even the lighting and temperature in schools have been shown to affect girls’ and boys’ performance: schools tend to be warm, but boys perform better in bright light and at lower temperatures. In addition to that, says Sax, it’s a fact that boys have an aggressive drive, and that aggressive play is a vital part of male development. “The aggressive drive needs to be recognised and transformed into something positive. This is how boys learn boundaries and rules.” This, of course, flies in the face of current pedagogical thinking, namely that if boys are prevented from playing aggressive games they will become less aggressive.
The gentle slide into quasi-compulsory schooling for four-year-olds doesn’t help. The current legal requirement is that children attend school from the start of the term following their fifth birthday – yet the vast majority of education authorities insist that children start full-time school in the September following their fourth birthday if they are to gain a place at their chosen primary school – meaning that many children are herded onto the educational conveyor belt when they are only just four.
Sally Bunday, founder of the Hyperactive Children’s Support Group, finds this trend disturbing. “Parents complain that their four-year-old is behaving badly at school – when in fact their four-year-old is being made to act against his nature and his age by being there at all.” Bear in mind that testosterone levels double at around a boy’s fourth birthday – hardly the ideal time for him to be sitting still and learning pencil control. Treating their behaviour with medication is, she adds, ‘downright wrong’.
Pressure on girls
As a result of this early schooling, boys are prone to being labelled either socially defective or hyperactive.
But while the more compliant little girls appear to forge ahead, their mental health may be suffering. Girls are all too often the victims of the high standards expected of them, and more prone than ever to feel like ‘failures’ as teenagers. An American study of 615 adolescents found that before the age of 11, girls and boys have more or less equal rates of depressive symptoms – but between 11 and 15, girls’ rates of depression rise steeply while those for boys increase only slightly. By the age of 18, the depression rate among females is twice as high as that among males. In a second study, researchers found that girls with higher intelligence were more likely to suffer from depression, whereas depression was more common among boys of low intelligence.
For the past decade or more, schools have been operating to repair a more fundamental societal breakdown. Shifting economic structures have led to profound changes in the organisation of family life: 57 per cent of mothers of children under five are now employed outside the home, and the vast majority of parents have to live where their work takes them – thus reducing the opportunity for the extended family to be involved in child-rearing. Both parents are often unavailable for the children – and when physically present, they are all too often so busy checking their emails, watching TV, texting, or generally multi-tasking that they are to all intents and purposes absent. With potentially dire consequences, says Sue Palmer, literacy consultant and author of 'Toxic Childhood'. She believes that children need nurturing more than anything else – and that this nurturing should ideally be the job of a parent. “If babies get that input in the first year or so of life, they will be able to understand, think, communicate, learn. If they do not, their human potential is damaged. Attachment, interaction, communication – this is what teaches souls to fly.” And, Palmer adds, there is a growing body of neuroscientific research connecting successful early attachment with the development of neural networks in the prefrontal cortex of the brain – the area associated with rational thought, decisionmaking, social behaviour and self-control. All the things the ADHD child lacks.
Of course, there are also many families in which fathers are entirely absent during the critical formative years. Dr Peter Breggin is a psychiatrist at the US International Center for the Study of Psychiatry and Psychology. He believes that ADHD is in truth DAAD – Dad’s Attention Deficit Disorder. “In my clinical experience, most so-called ADHD children are not receiving sufficient attention from their fathers, who are separated from the family, too preoccupied with work and other things, or otherwise impaired in their ability to parent,” he says. Where the father is physically present, he’s often not doing his parenting job properly.
“If a kid is smacking his mother over and over again, who’ll stop the kid? The father is supposed to step in and take charge so the child knows. But fathers aren’t doing this today.”
Time with either parent is, though, the one thing that children are denied. First, the government threw money at parents of three-year-olds to scare them into believing that their child would be socially, emotionally and academically disadvantaged by not attending a childcare institution; now they’re targeting two-year-olds. All the while cajoling/bribing/bullying mothers into going out to work and becoming ‘useful’ – i.e. materially productive – members of society. In the process, they totally disregard the fact that a 2004 survey carried out in association with the Department for Trade and Industry’s Work-Life Balance Campaign, suggested that three in five mothers would prefer to be at home with their children.
The latest example of this dragooning is ‘wraparound care’. Launched by the government in October 2000 as part of its early years expansion programme, the aim was to raise the quality of early years’ provision for children and attract more parents back into the labour market or into training by providing more flexible care wrapped around a free early-years education place. So instead of simply sending your child to an institution for the traditional school day, you can send them for breakfast and tea as well. Rather like what used to be called detention. While the government is keen to plug the scheme’s social, intellectual and emotional benefits, it’s debatable whether there are any such benefits at all. Indeed, a 2005 study headed by psychologist and childcare guru Penelope Leach suggested quite the reverse. The study – one of the longest and most detailed of its kind – said quite unambiguously that children aged 0 to 3 should ideally be at home with their mothers. Children who attended group childcare were, for their part, inclined to become ‘withdrawn, compliant and sad’.
Moreover, the academic benefits of starting ‘proper’ school at four or even five are dubious, to say the least: for all our extended schooling, we seem to struggle even to achieve basic literacy and numeracy in our school-leavers. Only last year, CBI research showed that almost half of employers (42 per cent) say they are unhappy with the basic skill levels of school-leavers and 50 per cent believe teenagers do not have sufficient communication, team-working and problem-solving abilities. In mainland Europe, by contrast, children normally start school at seven, and their ‘learning outcomes’ (to quote another bit of government Newspeak) are generally regarded as distinctly superior to our fail-proof ‘Gold Standard’ ‘A’- levels.
But so far as the UK is concerned, school has become more akin to a battery farm for children, set up for parental (i.e. economic) convenience. And if a child wants to explore the world in his own way? If he wants to spend a day working out how the loo-flush works, why that gutter is leaking on the far side of the playground, or what happens when you apply felt-tip pens to five-year-old skin? Then the problem is most easily solved by diagnosing a medical condition.
Home life also is all too readily made to dovetail with the increasingly straitjacketed timetable. Gone are the days when children played out on bikes, kicked footballs and built dens in the woods: now they’re caged up at home with their TVs, DVDs and PC games. When they are allowed out, it’s a case of being shunted into another box (preferably a black 4WD) and transported to a parent-directed activity. Children don’t even walk to school. In 1971, 80 per cent of seven- and eight-year-olds walked – but by 1990, it was only nine per cent.
Priscilla Alderson is Professor of Childhood Studies at London University. She believes that children have always been restless and excitable – and that their problem of excess restlessness could be solved quite simply by parents engaging more with children and allowing them to let off steam in traditional fashion by playing in parks and climbing trees. “Playgrounds and parks are empty, because of the scare stories about abductions. But children need the space and freedom to play, run and climb – without that, they are restless, and come to be seen as abnormally ‘hyperactive’.”
Of course, our changing lifestyles go hand-in-hand with dietary changes. No matter what their parents’ intentions, children invariably have access to highly sugared foods and drinks, and even the best behaved child can turn into a sugar saturated monster. BMA research indicates that children’s behaviour can improve on a diet low in sugar, artificial colourings and carbonated drinks. But it’s also possible that forces beyond the parents’ knowledge are affecting their children. For example, chemicals in the environment such as pesticides, or high levels of lead, mercury or other substances toxic to humans are known to play a role in children’s behavioural problems. Research trials have also shown that deficiencies of essential fatty acids in the body correlated with symptoms of ADHD, and similar relationships have been found between iron, zinc and magnesium deficiencies and ADHD symptoms. This, of course, is a consequence of more deep-rooted problems associated with how our food is produced.
Regular use of synthetic fertilisers causes long-term depletion of organic matter, soil compaction, and degradation of overall soil quality. Overfertilisation also causes important minerals such as calcium, magnesium, and potassium to gradually leach out of the soil. So even if we think we’re doing our best to provide our children with a healthy diet, we are likely to be feeding them vegetables grown in over-fertilised and nutrient-depleted soil.
Sally Bunday found that her son’s horrendous list of symptoms disappeared within four days of starting the Feingold Diet, which excludes all synthetic additives and all foods containing salicylates (an aspirin-like substance found in foods such as oranges, blackcurrants, tomatoes, chocolate, cola, coffee and tea). She is convinced that extra medication is not the solution. “Recent research by the Foods Standards Agency concluded that yet more research into the link between diet and children’s behaviour was necessary. But why are we still questioning it?” She believes it’s part of the ‘rush-rush’ nature of modern society. “It’s easier to give children a pill than to worry about the underlying causes.”
John McLaren-Howard, Laboratory Director of Biolab Medical Unit, a medical referral laboratory specialising in nutritional and environmental medicine, agrees. “This is the quick-fix age. We should be looking at diet, allergies, nutrition deficiencies and direct environmental factors before even thinking about drugs – but people don’t want to wait that long. They want a GP to come up with a diagnosis and treatment package within a 15-minute appointment slot, and feel angry if he can’t give them an immediate answer. This is no way to practise medicine.” In the circumstances, it’s hardly surprising that so many children are feeling ‘depressed’. On top of this, they’re also subjected to a highly consumer-driven culture which is almost created to produce depression.
Elaine Douglas is a childhood psychologist who specialises in children, adolescents and families. She finds it very striking that children are generally more depressed and anxious than they were in the 1950s, despite the fact that they have far more by way of material comforts. However, she says, this may be the problem. “We live in a fast-moving society that’s entirely consumer-driven: we want everything and we want it now,” she says. “Children soak up media images of everything being better, faster, bigger – then feel miserable because they can never have that elusive One Thing that will make them happy.” And, she adds, the constant round of expensive after-school activities produces exhausted and miserable children who feel pushed out by their parents. Then the worried parent – who can’t understand why little Ella is so miserable when she has everything that money can buy – takes her to the doctor, and comes back clutching salvation in the form of a prescription.
But the real solution to children’s mental health problems, say Douglas, is a return to the simple life: walking the dog, day-trips to the seaside and so forth. But here’s the uncomfortable truth: giving your children old-fashioned, stress-free lives means in effect that one parent – almost always the mother, as things stand – has to give up work. The phrase ‘work/life balance’ is all well and good, but it really doesn’t apply to most parents: short of cloning yourself, or having such a fabulously wellpaid job that you can work for four hours per week and ‘delegate’ for the other 38, you can’t be a productive member of the workforce and give your children the healthy, old-fashioned lifestyle.
Even if you ostensibly work a 9am–5pm day, it soon becomes an 8am–6pm day once you’ve factored in an hour’s commute either way. If you work part-time, you invariably find yourself working full-time for part-time pay, and with a guilty conscience as your colleagues watch you slope off for a long weekend. Work flexi-time, and you might bump into your partner in the bathroom at 3am if you’re really lucky. And, of course, for every parent who really has no choice but to work, there is a parent who does in fact have the choice: they could perfectly well stay at home, but they choose to work in order to buy that new 4WD and matching Boden clothes for their offspring, rather than walking everywhere in their charity shop bargains. And who pays the ultimate price? Emotionally, it’s the children; financially, the drug-providing NHS. Is feminism to blame? You could say it’s feminism’s ‘fault’ that women have come to believe that they are defined and fulfilled only by working outside the home, and that full-time parents are somehow deficient human beings. But on another level, economics over-rides feminism, and the whole of society is arranged in such a way that all full-time parents, male and female alike, are viewed as non-contributing members and a drain on resources. The word ‘feminism’ is bandied around, but as things stand, it’s not true feminism: it’s women being forced to conform to a male workplace. True feminism would surely value the strengths that women – and particularly mothers – bring to the workplace, and this in turn would mean that jobs could be adapted to accommodate parents and children alike. Childless workers may try to say that it’s a parent’s choice to work and have children – but if children en masse are paying the price for it, then the whole of society will pay the price in the long run. For everyone’s sake, we need to facilitate a huge cultural shift whereby parents can take time out, can take refresher courses, and can make job-shares work.
The feminism debate rumbles on. But in the meantime, one solution to the problem would be to pay the parents to stay at home. Having only 26 weeks of statutory paid maternity leave means that the mothers are depositing babies of just six months in some form of childcare if they need to or choose to return to work. As for fathers: they may be entitled to two weeks of paternity leave, but woe betide most if they actually take it (assuming they can even afford to).
Parenting has never been easy. But now children’s behaviour is in the public eye more than ever. From Supernanny to Little Angels everyone is wondering the same thing: how to be a good parent. Over the past 20 years, the task of child- rearing has become loaded with anxiety. Parents are confused about their role: they want their children to be independent, but daren’t let them out; they want to be their child’s ‘best friend’ but find that incompatible with discipline. Discipline itself is a minefield, and it’s often easier not to venture into it if your child appears to be out of control. Yet a lack of discipline may be the very problem.
Many specialists in children’s behavioural problems suggest ‘behaviour therapy’ as a possible solution – but if you look behind the psycho-babble, it’s basically sensible, old-fashioned ‘carrot and stick’ discipline. Praise the good, introduce clear sanctions for the bad, give clear instructions and reward compliance. Yet – not least because changing children’s behaviour often means confronting their own defective behaviour – parents find it easier to seek medical help and advice. Even if parents and/or teachers do want to discipline unruly children, they increasingly feel inhibited from doing so for fear of the consequences, now that families can be ruined and careers destroyed should the SS (social services) decide to intervene.
The breakdown in communities is a critical factor. “Once upon a time, all the neighbours would have known all the kids, and they’d all look out for one another,” says Dr John McLaren-Howard. “If someone saw a kid causing trouble, they’d be shouting ‘Oy, stop that!’ But with everyone out at work and all the children at school or nursery, that community aspect to children’s upbringing has disappeared.” And with it, the belief that children’s behaviour is everyone’s responsibility. So instead of whole communities passing on a down-the-generations sense of what’s normal behaviour, we have to read books, ask ‘experts’ and, if all else fails, ask prescription-brandishing doctors with an eye to their next Ciba-Geigy-funded five-star ‘conference’.
All this provides the ideal cultural preconditions for a growth of the idea that the real problem lies with a medical condition in the child – thus sparing parents from blame. This, says Bob Jacobs, is very seductive. “Once you have a diagnosis, you become the victim. Instead of being under suspicion of inadequate parenting, you’re a martyr, struggling to cope with a sick child.” So instead of going to family therapy and learning how you might understand why your child is really miserable or misbehaving or what you could do about it, you can go to support groups and receive tea and sympathy for having been dealt such a cruel biological hand. It is of course equally seductive to teachers, who are relieved of the burden of having to deal with ill-disciplined children – and their parents.
If we’re to avoid sliding ever further down the drug route, we have to confront some difficult questions. What exactly are our priorities as a society? Economic growth, and a generation of children on toxic and potentially addictive drugs? Or a generation of healthy, happy, creative children who are nurtured for who they are, and whose individual talents and personalities are allowed to flourish within the boundaries of a communal sense of right and wrong? As Sue Palmer argues so compellingly, it is this nurturing that children need more than anything else. “Switch off the technological wonders and concentrate for a year or so on the ancient virtues of attachment, interaction, communication,” she says. “If every parent does that, all but the most unfortunate souls could learn to fly.”
Hope for the future?
Yes, this challenges all our mantras about work/life balance and work/life rights. It means we have to decide what matters more to us: holidays and new cars or our children’s right to a free-range, drug-free childhood in which they can spread their wings and be themselves. Perhaps there is some hope for education in the growing number of parents who are now choosing to home-educate their children and spare them the horrors of SATs: figures released in 2005 showed a large rise in the number of children being educated at home over a five-year period. In 1999 just 12,000 children were being taught at home by their parents. In 2005, more than 21,000 were taught at home – a rise of 42%. But a proper education shouldn’t be the preserve of a minority of children with educated, middle-class parents. The government finally has to accept that children simply don’t flourish within a battery farm environment, and that they would be better off running, jumping and generally Being Children in all their imperfect, messy, noisy glory.
The major pharmaceutical companies are the big winners in this game. More disturbingly, they are also the ones who market the disorders in the first place, before providing the ‘miracle cure’. Few parents realise, when they accept a diagnosis of ADHD, that this is what the drug companies want them to do. The term ‘ADHD’ is no longer just a useful shorthand to describe a plethora of behavioural problems of varied origin: it has been hijacked into defining a physical problem within the individual child, causing that child to behave badly or perform poorly at school. The stage is thereby set for the pharmaceutical solution.
Long before a drug is launched, disease awareness campaigns are conducted to ‘create dissatisfaction in the market’, ‘establish a need’, and ‘create a desire’, as Ray Moyniham and Alan Cassels succinctly document in their book Selling Sickness. ‘Product champions’ and ‘opinion leaders’ are recruited from among the academic community to endorse the campaign.
Patient support groups are vitally important to the drug companies. Where a drug company’s own claims about its product would seem self-serving and biased, patient groups carry that all-important credibility and sense of objectivity. Take the case of Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), the Ritalin support group of America. Founded in 1987, CHADD, which estimates that 10-20 per cent of schoolchildren have ADHD, organises speaking events, publishes a glossy magazine and a monthly newsletter, and runs an impressive website. ‘No matter how many sources of information are out there, CHADD is the one you can trust,’ trumpets the website.
What it doesn’t mention, of course, is that the organisation has long-standing ties with pharmaceutical interests, recruits only pro-drug scientists to their advisory board, and regards ADHD as a genetic condition unaffected by parenting or environment. CHADD has received more than $1million since 1988 from the makers of Ritalin (then Ciba-Geigy, now Novartis).
CHADD does at least clearly disclose exactly how much it gets from drug companies, namely around $700,000 annually, just under one fifth of its total income. No such clarity exists for the main UK support group, the National Attention Deficit Disorder Information and Support Service (ADDISS). This is a Department of Health-funded charity set up ‘to provide people-friendly information and resources about ADHD’, and its website provides a fact-sheet giving details of the drugs that can be supplied to children. It has solicited and received around £20,000 in funding from Janssen-Cilag, UCB Pharma and Eli Lilly, three of the major pharmaceutical companies that make methylphenidate and other ADHD medications. The drug firms’ financing is not acknowledged on the site and nor do their names show up on the accounts lodged with the Charity Commission.
Equally disturbingly, the drug manufacturers have also managed to infiltrate schools as well as medicine and academia. Novartis, who make Ritalin, have a section on their website devoted to teachers who want advice on controlling their pupils’ behaviour, gently reminding them of their vital role in their student’s treatment programme.
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