WASHINGTON - If Tom Sawyer, that rascally literary hero, were alive and in a US school today, he would likely be given a pill to rein in his mischievous habits, from squirming out of chores to skipping class.
Some five million children heading back to school in the United States this September, about five percent, are on prescription drugs, sometimes a combination of two or three, specifically to help them calm down, pay attention and complete tasks.
Many have been diagnosed with Attention Deficit-Hyperactivity Disorder (ADHD), the current term for learning problems that have been around for 150 years, since the advent of compulsory education, some experts say.
But the diagnosis remains controversial, and some see soaring use of behavior modification drugs by children -- stimulants such as Ritalin, anti-depressants such as Prozac, and the anti-psychotic drug Risperdal -- as a alarming trend.
"In the United States, societally, we are responding to children's problems, mostly for economic reasons, with drugs," said Lawrence Diller, a behavioral pediatrician and author based in the San Francisco area.
"I don't deny that Ritalin improves performance behavior in the short term but ... it is not a moral equivalent, or replacement for, helping parents parent and helping teachers teach."
Defenders of the diagnosis say ADHD is a debilitating neurobiological disorder and that critics are merely adding to the burden of families and teachers struggling to cope with it.
"We don't want to think about children having a mental disorder. It's easy to pick on because there are no physical manifestations ... It's much easier to say the kid is lazy, the kid is stubborn, the kid is stupid," said Evelyn Green, president of a national ADHD education and advocacy group called CHADD.
Her 15-year-old son Perry, on Ritalin or Adderall since he was seven, used to hate taking the drugs but "finally is understanding that he needs to have it," she said.
Perry used to get frustrated very easily, have problems concentrating in school, getting organized and interacting with other kids. The drugs are just one part of a treatment plan that has worked well for him, said Green, an early childhood educator in Chicago public schools.
To be diagnosed with ADHD, a child must display symptoms for six months continuously and they must be extreme, both at home and in school, said Stephen Hinshaw, a child psychologist at the University of California at Berkeley.
Such children are likely to fail in school, be disliked and rejected by classmates -- which often leads to dropping out and delinquency -- or be injured, due to poor judgment and impulse control, he said.
Experts say ADHD is caused by a genetically influenced biochemical imbalance in areas of the brain responsible for attention, planning and motor activity.
Bad diet and parenting style can exacerbate the condition, while premature birth and alcohol and tobacco use by mothers-to-be can be contributing factors.
Skeptics, however, see a broad range of cultural and economic factors at play in a fast-paced, performance-driven society where the pharmaceutical industry is offering what they see as a quick fix to complex problems.
Ten years ago, when he was working at the US government's Drug Enforcement Administration (DEA), Gene Haislip noticed an "enormous, unexplained and unexpected upsurge" in prescription of stimulants to children.
Ritalin production and use jumped 700 percent between 1991 and 1998, according to the DEA. UN statistics show that the United States used 80 percent of the world's Ritalin in 2000.
Ritalin is just one of the drugs used to treat ADHD, however. Over 12 months ending in June 2001, 20 million prescriptions for such drugs were written for Americans of all ages, according to IMS Health, a healthcare information firm.
In the last year, pharmaceutical companies jostling for a share of this lucrative market have begun advertising directly to consumers in mass media, a practice proscribed by the 1971 UN Convention on Psychotropic Substances.
According to Haislip, stimulants used to treat ADHD rank among the most highly addictive drugs that remain legal, and the most frequently stolen and abused prescription drugs.
"I'm not suggesting there are no cases in which this isn't appropriate or this is a bad drug that should never be used ... but it's not been satisfactorily explained," said Haislip, now a private consultant.
"The United States is unique and hopefully we'll remain unique because it would be a disaster for other countries to follow this example until this issue has been explored and determined in all of its ramifications," Haislip said.
Copyright © 2001 AFP