Child Medication Safety Act Of 2003
Mr. Speaker, I thank the gentleman from Georgia (Mr. Burns) for putting together this legislation which actually is extremely important. I know I have seen in my own practice as a psychologist the importance of helping to make sure that…
Mr. Speaker, I thank the gentleman from Georgia (Mr. Burns) for putting together this legislation which actually is extremely important. I know I have seen in my own practice as a psychologist the importance of helping to make sure that children get to the right professionals and that there is not coercion or threat that goes to the families.
I want to take a few moments, first of all, to lay out with regard to this bill the issues involved with attention deficit hyperactivity disorder, an often misunderstood and often maligned diagnosis that because of that lends itself to prejudicial comments as certainly the gentleman from Rhode Island (Mr. Kennedy) was also alluding to. Attention deficit disorder has a number of diagnostic criteria which are laid out in what is called the ``Diagnostic and Statistical Manual.'' They include categories of inattention, hyperactivity and impulsiveness. Because psychiatric and psychological symptoms are described in behavioral terms they oftentimes seem vague and only behavioral. For example, under the inattention category, it might mean a person who fails to give close attention to details or has difficulty sustaining attention in tasks or often does not seem to listen when spoken to directly or does not follow through on instructions to finish school work, et cetera; often has difficulty organizing tasks and activities or avoids or is reluctant to engage in tasks that require sustained mental effort.
When one just hears some of those symptoms, one may think that those could cover a wide range of behaviors that may not necessarily reach a diagnosis that requires medication, and there is something to that. That is why it is so very important when there is a concern raised about a child's symptom picture perhaps fitting the diagnosis of attention deficit disorder that that child be thoroughly evaluated by perhaps a team of professionals psychiatrists, psychologists, people who are trained to do this, but not simply referred on the basis of this child is difficult in the classroom.
And let me lay out why. In terms of attention behaviors, we look upon this as a primary, secondary, and tertiary diagnosis. A primary attention deficit disorder is one where a child actually has the symptom pictures of attention disorder related to the biological and in some cases some inherited factors for that, but it is pretty clearly in that category. They meet the diagnostic criteria.
Secondary attention deficit disorder is when the child may have the same problems with concentration and attention and getting their work done, but it is secondary to some other problems. For example, a child may have an anxiety disorder. They may be suffering from depression. They may have sensory problems. I have known children who were referred to me for attention disorder only to find out they needed glasses or they had a subtle hearing loss. They may be having social problems, cultural problems, as they are moving from one school district to another and have a great deal of difficulty. They may have speech and communication problems where they have trouble understanding the teacher. And yet those children's symptom picture can look similar. They are not paying attention, not concentrating, they are not getting their work done, they are agitated and hyperactive. It is important that those other problems are diagnosed clearly and those are treated and those are not the children who should be given medication.
A third type is a tertiary problem, and this is not the problem with the child so much as it is a problem with expectations. That is, people may expect a pre-school child to sit still. People may expect a teenager to concentrate and not daydream. We know anybody with any rudimentary knowledge of having children knows that those are not realistic expectations, and yet there are those sometimes who feel that children who are out of sync with their expectations will somehow require medication, and that is inappropriate.
These diagnostic criteria, I should also add, in the testimony that was given to the Committee on Education and the Workforce, there were some who raised the question of whether or not this was biological. I draw some attention to some research that was done, I believe, in 1990 where they did Positron Emission Tomography. That is, they could look at the activity in the brains of people who were identified with attention disorder and those who were not and found in those who had a diagnosis of attention disorder, their brain activity was somewhat lower.
That is not to mean that they had brain damage. It simply meant by looking at levels of brain activity, they found that those parts of the brain that generally control impulses and thought, that is, the frontal lobe, et cetera, were not as active as those in people who did not have attention disorder. That lent a great deal to the science of understanding attention disorder because all along before that we thought that the brains were overstimulated and it may actually be they were undercontrolled in some regions.
This of course also lends credence to why sometimes one may use medication. The medications used, such as Ritalin or Adderall or Dexedrine, are stimulant medications; and we for many years wondered about this paradoxical effect of why would you give a stimulant medication to actually slow someone down. And the point is that it appears to stimulate those portions of the brain. Basically, sometimes a layman can understand that if they feel tired and groggy and overwhelmed and they are having trouble staying alert and staying focused, sometimes a person, as they are driving down the road, will be overactive.
But the point is this: What I am trying to lay out here is the complexity of this.
Let me end with this one anecdote. When I was practicing as a psychologist, I received a call to evaluate a child, and did so. Then, calling back to the school district, said this child does not appear to have primary attention disorder. I think there were some other issues here, but not that.
I was told then by the referring source in the school district, put this child on Ritalin, or we will never refer another child to your practice again. I challenged that person on that immediately and said I need to go by what I believe an appropriate diagnostic criteria is and suggested they withdraw that threat.
But that is the very reason why we need legislation like this, to say this is not something that should be done to control children. This should be something that is done to help do the best thing in the child's best interest with the best people involved using the appropriate diagnostic criteria.
This is a positive thing for children and ultimately a positive thing for families, and I certainly implore my colleagues vote yes on this bill.