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US education board advises against drugs for behavioural problems

BMJ 1999; 319 doi: (Published 04 December 1999) Cite this as: BMJ 1999;319:1456
  1. Fred Charatan
  1. Florida

    A US board of education has passed a resolution urging teachers to use discipline and instruction to overcome problem behaviour in the classroom, rather than encouraging parents to seek drug treatment for their children.

    The resolution passed by Colorado Board of Education carries no legal weight but sounds a warning on the growing use of drugs such as Ritalin (methylphenidate hydrochloride) to deal with disruptive behaviour in schools. Board members supporting the resolution believed that many violent crimes committed by school students are committed by young people taking psychotropic drugs. In the massacre last spring at Columbine High School in Littleton, Colorado, one of the teenage shooters, Eric Harris, had been taking the antidepressant Luvox (fluvoxamine).

    The board's action, believed to be the first in the United States, is sure to intensify the debate over the use of psychotropic drugs in conditions such as attention deficit hyperactivity disorder (BMJ 1998;317:1545). An estimated 2.5 million children in the United States are now taking drugs for this type of problem.

    Dr Peter Breggin, director of the International Centre for the Study of Psychiatry and Psychology, a non-profit research organisation in Bethesda, Maryland, believes that doctors are overprescribing psychotropic drugs. “It's a tremendous mistake to subdue the behaviour of children instead of tending to their needs,” he said. He is convinced there is a direct link between the drugs and violent acts.

    The use of psychotropic drugs in children with attention deficit hyperactivity disorder was examined last May in the Journal of the American Academy of Child and Adolescent Psychiatry. A review of a sample of nearly 1300 children in four US communities showed an overall rate of the disorder of about 5%, based on formal diagnostic criteria. Results showed that fewer than one in eight children with the disorder received stimulant drugs. Reassuringly, the researchers concluded that children with the disorder were more likely to receive other forms of treatment than to receive stimulants.

    Dr Stephen Stahl, a professor of psychiatry at the University of California in San Diego said: “If a kid is acting out in class and a stimulant like Ritalin calms him down, it would be immoral not to give him the medicine.” He cautioned, however, against giving such treatment in isolation, “as an excuse to avoid tough decisions, or talking with teachers and doctors to learn what's going on.”

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