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Excerpted from an article titled, "Psycho-Stimulant Effects on Children � A Primer for School Psychologists and Counselors" by Peter R. Breggin, M.D.
...Based largely on double-blind placebo-controlled clinical trials and on animal laboratory research, this paper will focus on the emotional and behavioral effects of dextroamphetamine (e.g., Dexedrine, Adderall), methamphetamine (Desoxyn, Gradumet) and methylphenidate (Ritalin). Emphasis will be placed on two relatively ignored areas: the mechanism of action that enforces specific behaviors and adverse drug effects on the central nervous system, mental life and behavior of the child. An overview of all adverse reactions will also be provided.
Stimulant drugs lend themselves readily to suppressing behaviors that are unwanted in the classroom or highly controlled family situations, and for enforcing obsessive-compulsive behaviors that adults desire in the classroom or the controlled family. Animals, like children, have spontaneous tendencies to move about, to explore, to innovate, to play, to exercise and to socialize. Dozens of studies have shown that stimulant drugs suppress all of these spontaneous tendencies, sometimes completely inhibiting them (Arkawa, 1994; Hughes, 1972; Randrupt & Munkvad, 1967; Schiorring, 1971, 1981; Wallach, 1974). In effect, the animals lose their "vitality" or "spirit." They become more docile and manageable.
Animals, like children, resist boring, routine, rote or meaningless tasks. Stimulant drugs enforce these behaviors in animals, producing what is called stereotypy or perseveration in animal research (Bhattacharyya et al., 1980; Costall & Naylor, 1974; Koek & Colpaert, 1993; Kuczenski & Segal, 1997, Mueller, 1993; Randrup & Munkvad, 1967; Rebec & Segal, 1980; Rebec & Bayshore, 1984; Segal, 1975; Segal et al., 1980; early studies reviewed in Wallach, 1974 and Schiorring, 1979). In human research, it is called obsessive-compulsive or over-focused behavior (see below). For example, instead of struggling to escape a cage, the animal will sit relatively still carrying on rote, useless behaviors, such as compulsive grooming, chewing on its paws or staring in the corner. If the drugged animal does move about, it will pace a constricted area in a purposeless manner.
In summary, in animals stimulant drugs (1) suppress spontaneous and social behaviors, rendering them more submissive and manageable, and (2) enforce perseveration or obsessive-compulsive over-focusing.
The effects of stimulants on children are identical to those in animals. This is not surprising since the basic biochemical or neurological impact is the same. Similarly, the effects on children are the same regardless of the child's mental state or diagnosis.
...Firestone et al. (1998) found that 0.5mg/kg of methylphenidate caused marked "deterioration" compared to placebo in several variables, including "sad/happy" (69% of children) and "uninterested in others" (62%). Mayes et al. (1994) found that 18.5% of children on methylphenidate became "lethargic," displaying symptoms such as "tired, withdrawn, listless, depressed, dopey, dazed, subdued and inactive." Barkley et al. (1990) found an increased proneness to crying in 10% of children on a low dose of methylphenidate. Schachar et al. (1997) documented that more than 10% of children dropped out due to methylphenidate-induced ADRs, including serious behavioral aberrations such as "sadness and behavior deterioration, irritability, withdrawal, lethargy, violent-behavior," "withdrawal and mild mania," and "withdrawal and dysphoria." Stimulants commonly cause obsessive-compulsive behaviors, including over-focusing, that are similar to stereotypy in animals. In a study of single small doses of methylphenidate on the day of the experiment, Solanto and Wender (1989) found "cognitive perseveration" (over-focusing) in 42% of children. Castellanos et al. (1997) found that 25% of children on methylphenidate developed obsessive-compulsive ADRs. In the most thorough study of the subject, Borcherding et al. (1990) found that 51% of children taking methylphenidate and dextroamphetamine developed obsessive-compulsive ADRs. Some children exhausted themselves raking leaves or playing the same game over and over again. The authors note that these behaviors were sometimes considered improvements in the classroom.
These data in this section, derived from several controlled clinical trials, further confirm the emotional and behavioral suppression caused by stimulant drugs.
Swanson et al. (1992) reviewed "cognitive toxicity" produced by methylphenidate. They summarize the more extreme effects on children:
In some disruptive children, drug-induced compliant behavior may be accompanied by isolated, withdrawn, and over-focused behavior. Some medicated children may seem "zombie-like" and high doses, which make ADHD children more "somber," "quiet," and "still" may produce social isolation by increasing "time spent alone" and decreasing "time spent in positive interaction" on the playground.
Arnold and Jensen (1995) also comment on the "zombie" effect caused by stimulants:
The amphetamine look, a pinched, somber expression, is harmless in itself but worrisome to parents, who can be reassured. If it becomes too serious, a different stimulant may be more tolerable. The behavioral equivalent, the "zombie" constriction of affect and spontaneity, may respond to a reduction of dosage, but sometimes necessitates a change of drug. (p.2307)
The "zombie" effect is mentioned by a number of other investigators (e.g., Fialkov & Hasley, 1984, p. 328; Swanson et al., 1992, p. 15). It is a more extreme manifestation of the supposedly "therapeutic" effect that makes a child more compliant, docile and easier to manage. When a child seems more compliant in class or seems to attend more readily to boring, rote activities, the child is experiencing an adverse drug reaction. The seeming "improvement" is an expression of a continuum of drug toxicity with the zombie effect at one extreme. The toxicity is considered "therapeutic" unless it becomes so extreme that the child seems bizarre or disabled.
As already described in detail, routine stimulant doses given to children or adults commonly cause ADRs that seem paradoxical, such as depression, lethargy and apathy. It is uncertain why stimulants at clinical doses so commonly cause these suppressive effects. Stimulants also cause more classic signs of over-stimulation or excitation, such as anxiety, agitation, aggression and insomnia, as well as manic psychoses the more suppressive effects, as in a mixture of agitation and depression.
Frequently stimulants cause tachycardia and cardiac arrhythmias and can even weaken heart muscle (Ishiguro & Morgan, 1997; Henderson et al., 1994). The FDA has received many reports of methylphenidate-induced heart attack (Food and Drug Administration, 1997).
In addition to the many serious central nervous system ADRs that are apparent in the child's behavior, stimulants also cause gross brain dysfunction. Methylphenidate, for example, in routine doses caused a 23%-30% drop in blood flow to the brain in volunteers (Wang et al., 1994). All stimulants directly disrupt at least three neurotransmitter systems (dopamine, norepinephrine and serotonin). There is strong evidence that stimulant-induced biochemical changes in the brain can become irreversible, especially in regard to amphetamine and methamphetamine, which can cause permanent neurotransmitter system changes and cell death (Battaglia et al., 1987; Melega et al. (1997a, b; Wagner et al., 1980). One study demonstrated that adults can develop atrophy of the brain after being treated with stimulants as children (Nasrallah et al., 1986). These potentially disastrous irreversible effects have been ignored in most reviews (see details in Breggin, 1998; updated in 1999, in press).
Through a combination of anorexia and disruption of growth hormone, stimulants also inhibit growth, including the growth of the brain (reviewed in Breggin, 1998; 1999, in press; Dulcan, 1994; Jacabvitz et al., 1990). Bathing a child's growing brain in toxic chemicals must ultimately impair its development.
Stimulants are highly addictive. The U.S. Drug Enforcement Administration (DEA) places methylphenidate, amphetamine and methamphetamine into Schedule II along with cocaine and morphine as the most addictive drugs used in medicine. The DEA and the International Narcotics Control Board have both issued warnings about the danger of widespread stimulant prescription in North America (Drug Enforcement Administration, 1995; International Narcotics Control Board have both issued warnings about the danger of widespread stimulant prescription in North America (Drug Enforcement Administration, 1995; International Narcotics Control Board, 1996; 1997). The United States uses 90% of the world's methylphenidate. Typical of addictive drugs, they often cause withdrawal or rebound. Rebound commonly occurs after only one or two doses in normal children, and it can last many hours and even more than a day (Rapport et al., 1978). During rebound, the child's original ADHD-like symptoms may become worse than before the drug was ever taken, including hypomania and mania. Even when children do not become addicted to stimulants, they sometimes give them away or sell them to friends who abuse them.
Stimulants commonly cause tics and other abnormal movements, and sometimes these become irreversible (Lipkin et al., 1994). Often the tics occur along with obsessive-compulsive symptoms. Too often, drug-induced ADRs lead mistakenly to the prescription of other psychiatric drugs rather than to the termination of the stimulant.
..Stimulant drugs, as we have seen, flatten the child's behavioral signal system. The child literally becomes neurologically unable to express feelings of boredom, frustration, distress or discomfort by displaying hyperactivity, impulsivity or inattention. Adults can then feel justified in teaching the class or managing the group without attending to the child's individual and often varied needs.
Reviews by stimulant drug advocates routinely demonstrate that stimulants have no positive long-term effects whatsoever on any aspect of a child's behavior. Short-term (a few weeks or months), they can suppress behavior, but they do not improve academic performance or learning. Based on the most extensive review in the literature, Swanson (1993) concluded:
Long-term beneficial effects have not been verified by research. Short-term effects of stimulants should not be considered a permanent solution to chronic ADD symptoms. Stimulant medication may improve learning in some cases but impair learning in others. In practice, prescribed doses of stimulants may be too high for optimal effects on learning to [to be achieved] and the length of action of most stimulants is viewed as too short to affect academic achievement. (p. 44)
Swanson (1993) defined "short-term" as 7-18 weeks. He also summarized:
No large effects on skills or higher order processes- Teachers and parents should not expect significantly improved reading or athletic skills, positive social skills, or learning of new concepts.
No improvement in long-term adjustment- Teachers and parents should not expect long-term improvement in academic achievement or reduced antisocial behavior. [italics in original] (p. 46)
Swanson is not alone in his conclusions. Popper and Steingard (1994) state:
Stimulants do not produce lasting improvement in aggressivity, conduct disorder, criminality, education achievement, job functioning, marital relationships, or long-term adjustment. (p. 745)
Richters et al. (1995) from NIMH conclude: "The long-term efficacy of stimulant medication has not been demonstrated for anydomain of child functioning" (italics in original, p. 991). They conclude that there is no evidence for even short-term positive effects on academic performance.
Stimulant drugs have two basic effects on animals and children regardless of their mental status. First, stimulants reduce all spontaneous and social behavior. This makes the child more docile, submissive and manageable (compliant). Second, stimulants enforce perseverative, obsessive-compulsive or over-focused behavior. This makes the child more easily led or compelled to do rote, boring activities. These twin toxic effects are readily misinterpreted as "improved behavior" in highly structured or controlled environment where children are given insufficient or inappropriate attention and where their genuine needs are being ignored. As a result of toxicity, stimulants suppress a child's behavior in a global fashion that has nothing to do with any diagnosis or disorder.
Stimulant drugs also produce a wide variety of other adverse effects. By causing anorexia and by disrupting growth hormone, they suppress the growth of the body, including brain size and development. They cause severe biochemical imbalances in the developing brain that can become permanent. They often worsen ADHD-like symptoms and can cause psychoses.
The ADHD diagnosis is tailored to justify the use of stimulants for the behavioral control of children in groups. It enumerates behaviors that healthy children often display in structured-over-controlled groups in which their individual needs are unmet.
Ultimately, by suppressing emotional and behavioral signals of distress and conflict, stimulants allow adults to ignore the needs of children in favor of creating a controlled environment. Meanwhile, stimulants do not improve academic performance and provide no long-term improvement in any aspect of a child's behavior or life.
School psychologists and counselors should strongly discourage the use of stimulant drugs for treating "ADHD" and other emotional or behavioral problems that surface in the classroom. Instead, more effort should be made to identify and to address the genuine individual needs of the children in our schools whether or not they are signaling their distress or conflict with ADHD-like behaviors.
