At a September Congressional hearing, most of the witnesses testifying about psychiatric medications in children presented a distorted view of attention deficit/hyperactivity disorder (ADHD) and its treatment.

That was APA’s conclusion in a letter delivered to the chair and members of the House Education and the Workforce Committee last month. With one exception, the witnesses did not "accurately describe the vast scientific literature and research available on children being successfully treated for ADHD and related conditions," APA wrote to Rep. William Goodling (R-Pa.).

The National Alliance on Mental Illness (NAMI) also sent a letter last month protesting the biased hearing to Rep. Peter Hoekstra (R-Mich.), chair of the Education Subcommittee on Oversight and Investigations.

"The hearing offended me and thousands of parents who conscientiously struggle to get diagnosis, treatment, and support services for our children," wrote Executive Director Laurie Flynn.

Rep. Robert Schaffer (R-Colo.), a member of the House Education committee, organized the hearing because "children are being overidentified with ADHD and overmedicated with powerful drugs."

APA and NAMI were dismayed that four of the six witnesses were Peter Breggin, M.D., author of Talking Back to Ritalin and a medical expert in lawsuits against Novartis, the maker of Ritalin, APA, and Children and Adults With ADD (CHADD); Fred Baughman Jr., M.D., a pediatric neurologist who testified that ADHD is the biggest health care fraud in U.S. history; a parent who reported that her son suffered psychotic and violent side effects from psychiatric drugs; and a Colorado school board official, who said more recesses and discipline are needed, not school psychologists who label children as disabled.

David Fassler, M.D., who represented APA and the American Academy of Child and Adolescent Psychiatry (AACAP), and Judith Heumann, assistant secretary for special education and rehabilitative services in the U.S. Department of Education, were the only witnesses who mentioned the benefits of early diagnosis and treatment with medication, psychotherapy, or both.

Fassler, chair of APA’s Council on Children, Adolescents, and Their Families, was allowed to testify at the last minute because Rep. Marge Roukema (R-N.J.), a member of the House Committee on Education and the Workforce, insisted on having a witness who represented mainstream psychiatry, according to APA’s Division of Government Relations.

Baughman testified that the diagnosis of ADHD is a "fraud" and that there is no scientific evidence to support claims by professional and patient advocacy groups that ADHD is a neurobiological disease.

Breggin testified that stimulants including methylphenidate cause drastic impairments in children and are "gateways to illicit drugs."

When Fassler responded that PET scans have shown reduced functioning in certain areas of the brain in children with ADHD, Baughman immediately dismissed the study, saying that it shows only that methylphenidate is harmful.

Fassler also testified, "We have literally hundreds of studies clearly demonstrating the effectiveness of this medication on many of the target symptoms of ADHD."

Baughman challenged Fassler to produce any scientific studies to back up his claim. When Fassler handed Breggin and Baughman a study from the online Journal of Psychopharmacology and another study from the online Journal of the American Medical Association, Baughman said they were not credible because they were from Web sites.

APA also complained in its letter to Goodling that the hearing presented a distorted view of "important issues surrounding the roles and responsibilities of parents, physicians, and school systems in assessing children for mental illnesses and choosing appropriate treatment options."

Schaffer said federal programs such as the Individuals With Disabilities Education Act (IDEA) have turned schools into "aggressive identifiers" of children with ADHD.

Heumann responded that in 1997 the Department of Education eliminated its ChildFind program, which gave states 10 percent of the funds for special education services for every child identified with an eligible disability. "Any financial incentive to overidentify children with disabilities has been removed," said Heumann.

Schaffer also said that parents have complained to him that they have been pressured by schools to put their children on Ritalin.

Patricia Weathers of Mill Brook, N.Y., whose son was diagnosed with ADHD, testified that "what concerns me is the intimidation tactics that a school can use on parents to coerce them to drug their child."

She said her son’s teacher, a school psychologist, and a principal told her that putting Michael on drugs "was the right thing to do" and the alternative was sending him to a special education center.

Michael was diagnosed with ADHD and put on Ritalin based on an ADHD checklist filled out by his teacher and sent to his pediatrician and a brief evaluation by the pediatrician, said Weathers.

She testified that Michael became socially withdrawn. He was then diagnosed with social anxiety disorder and put on an antidepressant. Michael began hearing voices and having wild mood swings. "When I tried to get him to sit down for dinner, he ran at me and attacked me," testified Weathers.

She took Michael off the drugs against the advice of the psychiatrist and school psychologist, who she said did not recognize how the drugs were affecting Michael.

The school dismissed her son and called Child Protective Services, charging Weathers and her husband with medical neglect, she testified. "If I had not gotten another psychologist to state that Michael did not need to be hospitalized, he would have been removed from our custody."

She added that nine months later, "Michael is in private school, and I am home-schooling him. He is once again a social, happy, outgoing boy."

Fassler urged Hoekstra and Schaffer not to jump to the conclusion that what had happened to the Weathers family is common.

"While we share the view that schools play an important role in identifying kids with problems, they should not make diagnoses or dictate treatment," Fassler testified.

He emphasized that a diagnosis of ADHD requires a comprehensive evaluation and should not be made in a five- or 10-minute office visit. "Many other problems including anxiety disorders, depression, and learning disabilities can present with signs and symptoms that look similar to ADHD."

Fassler read the extensive criteria in DSM-IV-TR for making a differential diagnosis after Schaffer read from a checklist of ophthalmology symptoms and said they sounded very similar to ADHD symptoms.

Fassler emphasized, "Medication including methylphenidate, or Ritalin, can be extremely helpful in many children, but should only be used as part of a comprehensive treatment program that usually includes individual therapy, family support and counseling, and work with the schools."