Drugs for Learning

Though handsome and obviously bright, Jeremy was a maddening problem to his parents and his teachers. He could not concentrate, would not learn in nursery school and the early years of elementary school. But in the last year Jeremy, now ten, has been earning A's and B's in his classes at Anaheim, Calif. The difference is that now, before every breakfast and lunch and after school during the academic year, Jeremy takes a pale green tablet of Ritalin, the trade name for methylphenidate, a mild stimulant.

He is not an isolated case. Tens of thousands of other American youngsters are, like Jeremy, "on drugs." Many of them take medication of a different type, one of the amphetamines similar to those gobbled or injected by thrill seekers with devastating effects. But these children become neither high nor addicted. Their drugs are prescribed by physicians to improve the children's behavior and learning ability.

Classic Case. What these children suffer from has no generally accepted understandable name. It is best illustrated by a case like Jeremy's. His mother found him "hard to handle" even as a baby. Later, his teacher complained that the child was hyperkinetic (overactive) and had an extremely short attention span. He was held back in second grade for failure in reading and spelling. Pressure for him to fulfill his supposed potential set up a vicious cycle in Jeremy, generating such hostility and anger that he performed more poorly than ever. He was still getting D's and F's in the third grade, and his mother took him to Dr. Sidney Adler, a neurological pediatrician. Adler had the parents fill out a 14-page questionnaire before he saw the child. Then, after 1 1/2 hours of neurological and other tests, he pronounced Jeremy a "classic case of minimal brain dysfunction."

Largely because doctors know so little about the basic cause of Jeremy's condition, they have coined at least 38 different names for it, many of which suggest that there is damage to the brain. But even the term "minimal brain damage" is rejected by some physicians because it implies a physical injury, of which there is often little or no evidence. For this reason they prefer something like "learning disabilities."

Jumping Jack. The affected children, estimated to number as many as 3,000,000 under 15 in the U.S. today, are not mentally retarded. Most are about average or above in IQ ratings, usually high on verbal skills but lower on muscular coordination tests. It is their achievement quotients that are distressingly low. As many as 70% of the victims are boys; no one knows why. While the children do not all exhibit all the same symptoms, the jumping-jack hyperkinesis is present in at least 80%. Almost invariably there is a passion for handling things, often clumsily so that they are broken. These children never seem to be listening to you; their eyes dart around the room while you are talking to them. They do not coordinate what they see and hear. Many of them talk a blue streak. If they do not instantly get their own way, they are apt to throw temper tantrums.

Since the children are overactive and irritable, it seems illogical to treat them with pep-pills. Psychiatrists doing research along traditional lines would not have been likely to hit upon this method. The discovery of the drugs' effect was made by Dr. Charles Bradley at the Emma Pendleton Bradley Hospital in Rhode Island in 1937, when he gave Benzedrine to 30 children who had a variety of behavior disorders. The stimulant calmed those who were hyperkinetic, and also improved their school performance. But Bradley's pioneering work was virtually ignored for almost 20 years, mainly perhaps because it seemed absurd to give stimulants to overactive children. Exactly how the drugs exert these effects is not yet clear. As they grow older--usually by the age of 15--most affected youngsters outgrow their hyperkinesis, perhaps because the brain chemistry matures with the arrival of adolescence. But it would be unwise to leave the children untreated and wait for nature to correct the problem. By adolescence, abnormal patterns of behavior would be so fixed and learning so far below average that normal development thereafter would be impossible.

Since 1957, many pediatric psychiatrists have espoused drug treatment for other learning disabilities. Anaheim's Dr. Adler is consultant for seven Orange County school districts in which he helps to screen children and to recommend treatment. He treats 2,000 children in his private practice. Not all respond to drugs as dramatically as Jeremy did, he cautions, but most of them do so much better than before that he keeps them on Ritalin or an equivalent drug throughout the school year. After about two years, Adler arbitrarily decreases the dosage during the summer vacation, hoping that new habit patterns will have formed by fall, enabling the child to carry on. "If he is successful then, when for so long he has been a failure, it's like a shot in the arm, and he's motivated to try harder," says Adler. Most of the children must take their medicine for at least two or three years, and some for ten years or more.

Much of the significant research on psychotropic drugs for children is still done where it began, at Rhode Island's Bradley Hospital, which is now headed by Dr. Maurice Laufer, an authority on brain disorders in the young. "In many cases," he says, "if you get to the child early, before the secondary emotional problems set in--the family's reaction to the hyperkinesis and the pat tern of failing in school--this is all they need."

A hundred Bradley Hospital graduates have been studied intensively by Drs. Leon Eisenberg and C. Keith Conners of Massachusetts General Hospital. "There is not a single case of a child becoming a drug addict of any kind," says Eisenberg. The stimulants that produce a high in an adult do not have this effect in a child, Eisenberg says. It may be that the child's body metabolizes the drug differently from an adult's.

Side Effects. There is some opposition to the use of mood drugs for children. Traditionalist Freudian psychiatrists believe that behavior and learning problems are psychological, not physical or chemical in origin. Dr. Eric Denhoff, who runs two schools for handicapped children in Providence, concedes that frequently drugs alone are not enough. Counseling and special classes are necessary for many patients.

Like all other drugs, the stimulant pills for children have undesirable side effects in some cases. The commonest is a tendency to insomnia if the medication is taken late in the day. Amphetamines usually depress the appetite, and Ritalin occasionally does. No one believes that the pills are a final answer to the problem of the problem child. Says Adler: "If we could figure out how to turn kids on in a more meaningful way, then I would be the first to say Throw out the drugs!' But we have to use them as tools to help keep these kids from going down the drain."

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