Despite the failure of this first study in the 1960's, the idea lived on and over time, a wide range of behavioral traits were associated to the various labels that were used, while various drugs were experimented with to potentially remedy the condition of the children that were diagnosed. The label still in used today was finally adopted in 1980.

Finally, after 30 years of groping, studies and experimentations, the final text of the Concensus Conference on ADD/ADHD held from November 16th to 18th of 1998 at the National Institute of Health in the U.S.A., declared unequivacally that: "There are no data to indicate that ADD/ADHD is due to a brain malfunction.". Moreover, there exists no objective testing procedure allowing to single out the children that are assumed affected by this problem, the official diagnostic criteria of ADD/ADHD being strictly behavioral.

Despite these conclusions, more than 5 million American children in 1997 (9 million in 1999) and tens of thousands of French-Canadian children are needlessly treated with Ritalin or other drugs to control behavioral traits for which no medical cause was ever discovered. And the trend is gaining in popularity.

The Effects of Psychostimulants

An important study (James Swanson et al.) was published in 1993 summarizing the results of the thousands of studies done regarding the effects of Ritalin on children:

It was shown that all children, diagnosed or not, as well all animal on which testing was done, react in exactly the same manner to the drug.

For all tested subjects, psychostimulants seemed to increase concentration and effort while minimizing impulsivity and increasing obedience for a short initial period of 7 to 18 weeks, to subsequently lose all effectiveness.

Medication does not improve complex abilities like reading, or social interaction. Results in school can be improved but the medication cannot correct any learning disability. No improvement has been noted for any significant emotional problem.

There exists no evidence of long term improvement for children submited to psychostimulant prescription regarding an improvement of their academic results or a decrease of their antisocial behavior.

The possible unwanted side effects of medication are a decrease in appetite, dificulty in going to sleep, harmful effects on cognition (creativity and spontaneity diminished) and on self image, stereotyped behavior, restlessness, nervousness, emotional instability, and occasionally, exacerbate or cause the emergence of verbal or motor twitches or mannerisms, and psychotic behavior.

The long term effects are unknown. Depression and psychological dependence symptoms have been noted, as well as a thwarting of the growth curve, head and belly aches.

The Pressure from the School System to Diagnose and Medicate

Here are the main points determining the diagnostic and prescription of the medication:

In the very first year of school, teachers identify various problems as possible symptoms of ADD/ADHD: inattention, disturbance in the classroom, behavioral problems, failure.

The teachers refer the child for psychological evaluation, and suggest to parents to have the child evaluated by a physician. In fact, teachers are the initiators of the whole process of initial refering of children, but their involvement is afterwards minimal.

Parents tend to resist considering medication and the child is eventually refered to a specialist for medical evaluation (pediatrician or neurologist) only after the child has been evaluated by the psychosocial authority in the school.

Physicians are forced by circumstances to diagnose on the basis of incomplete or unsatisfactory psychological or psychosocial evaluations. They are overloaded with cases and are sensitive to the pressure exerted on the parents by the school.

The schools' psychosocial personel are critical of the rigor of the medical evaluation while front line physicians experience difficulties in establishing a proper diagnostic considering the absence of biological criteria, and the contradictions between the various evaluations done by the parents, the teachers and the psychosocial personel. The specialists on their part harshly criticize the lack of knowledge of the psychosocial school personel.

All of the actors are aware of a lack of communication between the various groups, and note that resources are minimal after the diagnostic. A lack of support is observed for all actors and the families. But most critical, there is a lack of follow up for the children.

"Family physicians and specialists alike are unanimous regarding the pressures exerted by the school on parents for them to consult a physician. Consequently, parents understand that they must consult a physician, or else their child will be removed from the class and suspended from the school." [Page 22 of the Report]. The requirement of the school for parents to have their child be prescribed psychostimulants is so intense that in some cases parents go so far as to ask their physician to "reassure" the school personnel on the intellectual abilities of their child.

The intensity of the pressures exerted by the school on parents is a major worry for physicians and specialists, as well as the pressure exerted directly on themselves by the school, those who do not prescribe the medication ending up not being refered children any more by schools, who would rather provide references to names of physicians that are more open to medicate. [Page 26 of the report]

Frontline physicians and specialist assert that once medicated, the school witdraws all support to the child and his family. One of the physicians party to the study went as far as stating that "a school problem has been medicalized because the school has abandoned its primordial role towards children."

It is observed that medication should not be the only action taken, but that it factually is. It is observed that medication is used as a pretext to diminish services to children, because none of the actors feels capable of taking on the responsibility of following up medicated children, in the current situation.

The availability of the medication and the insistance of the school that it be used even without complementary resources force the actors to act against their convictions. The interviews of the various actors brings to light that each actor feels helpless, isolated and unable to counter the pressure to prescribe stimulants that emanates from the other actors or the school.

The final conclusion is so damning that the authors have expressed it in the form of a question: "Is medication used mainly to restore "order" and "calm" in the system?".

It can also be wondered if the extremely restrictive budgetary policies applied for years to all levels of the schooling system by our governments could be an important factor in this explosion in the number of "declaration" of cases of hyperactivity, which coincided with the establishment of these policies, because, point which is not covered by the study, the amounts allocated to schools by the Ministry to support children "declared" in difficulty is superior to the amount allocated for children who are not declared in difficulty, and this applies even if the diagnosed children receive no extra service besides the actual psychostimulant prescription, for which the school incurs no costs at all.

Class actions are currently considered in the United States against the manufacturers and the promoters of their prescription of these drugs for a cessation of the excessive promotion of this type of prescription. Maybe a public inquiry should be set up here in the province of Québec to determine if pressures are exerted on teachers for "quotas" of children in difficulty be filled.

Note from the analyst

It has been established in the 1950's by French neurophysiologist Paul Chauchard that an inadequate activation of the verbal centers between birth and the age of approximately 7, resulted in an incomplete development in children of these centers, which causes a significant thwarting in the development of the ability of verbal comprehension and expression. (See The Neurolinguistic Foundations of Intelligence)