Legislature(2001 - 2002)
03/04/2002 01:35 PM Senate HES
| Audio | Topic |
|---|
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SB 230-PSYCHOTROPIC DRUGS FOR CHILDREN
MR. RICHARD BENAVIDES, staff to Senator Bettye Davis, sponsor,
gave the following explanation of the measure.
The use of psychiatric drugs in our nation's schools
has more than doubled in the first half of the last
decade and continues to escalate. While it is
recognized that properly used, these medications have
been shown to improve behavioral patterns of some
children, as well as improve their ability to
concentrate in a classroom, there are documented
incidents of negative consequences from the use of
these drugs. There is also parental concern regarding
the issue of diagnosis and medication and using these
drugs for what are essentially problems of discipline
that may be related to a variety of causes and their
impact on student achievement.
Currently, ten states have laws on the books related to
the use of psychiatric drugs on children and while
there is no hard data on the total number of children
in Alaska on these medications, [indisc.] hope to make
clear the responsibilities of both parents and schools
and the growing debate on the use of these drugs are
requiring school districts to adopt policies
restricting school personnel from recommending that a
student be given psychiatric drugs. It would also
prohibit a child from being considered to be a child in
need of aid simply based on the refusal of the child's
custodian to give psychiatric drugs to the child.
He informed members that several people were available to testify
on different aspects of the bill.
SENATOR LEMAN asked Mr. Benavides if the words psychiatric and
psychotropic are used interchangeably in relation to drugs.
MR. BENAVIDES said, "Some people identify them as psychiatric
drugs, others call them psychotropic drugs. It depends on - the
different drugs - what they - their full term affects on kids
because a variety of drugs are used."
CHAIRWOMAN GREEN called Mr. Maloney to testify and asked him to
touch on what is actually happening in school districts now and
what this bill will require school districts to do regarding
setting policy.
MR. GREG MALONEY, Director of Special Education for the
Department of Education and Early Development (DOEED), made the
following statement.
The use of psychotropic groups with children is an area
of critical importance. Ongoing research on the impact
of such drugs on developing brains and neural networks
mandate that decisions regarding their use must be made
carefully by parents and professionals with the
capacity to make these decisions. SB 230 would put into
law what is already an ethical, professional
requirement, namely that school professionals act only
in their areas of expertise. In other words, there are
individuals in the school setting who are trained to
provide information providing certain diagnoses and
possible interventions, including at times medical
interventions. Such a person would be a school
psychologist. I'm a nationally certified school
psychologist myself. Part of the training is to learn
more and then provide the parents information about the
pros and cons, benefits, consequences of medication.
Alaska's teachers, I must say, do work hard for the
interest of children and this measure would provide
additional guidance to them. The tendency to think that
teachers are providing this maliciously because this is
a way - if the kids are not performing, this is a way
that we can do something about that. However at times,
teachers also may make suggestions regarding medication
out of an attempt to be helpful because they are trying
to help parents come up with options that may be
useful. Again, this points out the need for training in
that area because while the suggestion maybe from good
intentions, it may not have the intended consequences.
SB 230 also requires school staff to communicate
behavioral or emotional concerns to parents. The bill
may be too prescriptive when it requires a letter be
sent to the parent or guardian recommending an
evaluation be conducted by a licensed physician. This
presupposes that a student may need medication and for
purposes other than medication, a physician may not be
the best person suited to conduct that assessment. In
other words, if a student has behavioral or emotional
concerns, part of it may eventually get to the point
where a medical evaluation may need to be considered.
Prior to that, there are a number of kinds of
interventions that are non-medical in nature. One
example that you may be familiar with is called
positive behavior support in which the school
environment within which the student is operating is
changed and positive and negative reinforcements are
provided in order to help the student make better
choices. Interventions other than medication, including
positive behavioral supports, have been shown to have a
positive durable impact.
Another issue that some of you may be familiar with is
that under the Individuals with Disabilities Education
Act as amended in 1997, referred to as IDEA 97,
districts are expected to pay for medical evaluations
that are suggested as part of a student referral for
special education services. In other words, if, as part
of the evaluation, it's been noted that the school
district has some concerns related to a student's
medical needs or the need for an evaluation, quite
likely the school district would be required to pay for
that evaluation so that may have some fiscal impact on
the school district.
I suggest that the language be changed to require
school districts to notify parents or guardians of
emotional or behavioral concerns. This may occur in the
form of a letter, a telephone call, or during an
intervention team meeting. One of the really nice
things that has been developing in the last few years
is a focus on pre-referral - in other words, prior to
the referral of a student for special education
services, a team meeting made up of interdisciplinary
professionals. So, in other words, you may have a
teacher, an administrator, a speech pathologist, a
special education teacher coming together - not to talk
about whether the student is eligible for special
education, but what kinds of things can be done prior
to the referral for special education that would enable
the student to continue to make progress in the regular
classroom and not require either medication or special
education services.
On a final note, I also do not read this legislation to
be limiting the legitimate role of trained school
personnel, such as a school psychologist or school
nurse, to provide important information to parents
concerning potential benefits and consequences of
medical interventions. And so one other possible
suggestion would be to consider, instead of using the
term school personnel, regarding who this is referring
to - it may be teachers. Some state laws that have
other states that have enacted laws have specified
teachers rather than school personnel precisely because
of the issue that it may limit unintentionally the
services provided by a school psychologist or a school
nurse. The difference we see is that it is one of the
advocacy - a school psychologist or school nurse may
provide information, however that is not necessarily
advocating for the use of medication - but it is
important that parents have quality information as they
go about making this decision.
MR. MALONEY offered to answer questions.
SENATOR DAVIS commented that regarding a special education
student, a school district is already required to pay for an
evaluation and SB 230 would not change that. She pointed out that
SB 230 will affect students who are not in special education. She
said she does not have a problem with limiting what is in the
letter, but she doesn't understand why this will cause a great
expense to school districts. She also noted she does not want
this bill to apply to teachers only because too many children
have been placed in special education and put on medication
because they have behavioral problems. She added that nurses have
estimated that 800 students in the Anchorage School District are
given psychotropic drugs.
MR. MALONEY said, in regard to his statement that a referral to a
physician could require an additional expense, if a teacher
believes a student should have a medical evaluation independent
of this larger, more informed process, it could mean the district
would have to pay for it even though the special education team
may not have recommended one.
SENATOR DAVIS noted that IEPs are done for all special education
students but other students are put on medication yet do not go
through that process. She wants to make sure they do not slip
between the cracks. She pointed out that some children have been
denied the right to come to school. SB 230 prohibits a school
district from keeping a child out of school because the parent
does not want the child to take psychotropic drugs.
CHAIRWOMAN GREEN took public testimony.
MR. RICHARD WARNER, President of the Citizens Commission on Human
Rights of Seattle, said SB 230 represents an important first step
toward establishing some clear limitations on the ability of
state agencies to force parents to give normal children
psychotropic drugs. By way of background, one reason some states
are addressing this issue right now is that the use of
psychiatric drugs by children is skyrocketing. These drugs, with
the exception of Paxil and Ritalin, have never been approved for
use on children by the FDA. Paxil and Ritalin are not approved
for use by children under the age of six. The findings of a
February 2000 study in the Journal of the American Medical
Association warned that the use of stimulants on preschoolers
tripled during the 1990s. Another survey by INS Health, which
tracks pharmaceutical usage for the pharmaceutical industry,
found the use of newer anti-depressants, like Prozac and Zoloft,
on children older than six increased 580 percent between 1995 and
1999.
MR. WARNER indicated DOEED includes these children in a category
entitled, "Other Health Impaired." He was able to determine a
200 percent increase in the number of children in that category
between December of 1995 and December of 2000. During that same
time period, total school enrollment increased by 7 percent.
Legislation recently passed the Utah House of Representatives
that prohibits teachers from recommending or requiring
psychotropic drugs for a child or recommending psychiatric
treatment or evaluation. It also provides that the Division of
Family and Youth Services may not remove a child from the home
because the parents refuse to drug their child. Mr. Warner said
the state should not intervene in parental decisions regarding
medical treatment for their children when there is no clear
consensus regarding the effectiveness of the treatment or the
risk of the proposed treatment. In the case of ADD and ADHD, the
drugs have been proven to have serious side effects and the
diagnosis itself is in question, so it is more important to state
the limits of state intervention. Adverse reactions to some of
these drugs include anorexia, nausea, rapid heart beat, cardiac
arrhythmia, weight loss, psychological problems, and
physiological problems, such as liver disorders, blood disorders,
convulsions, gran mal seizures, agitation, hostility, abnormal
thinking, and 20 to 30 percent decrease in blood flow to all
parts of the brain.
MR. WARNER stated support for SB 230 and agreed that a letter
home should only state what a teacher has expertise in, for
example, the observation of specific behaviors or emotional
problems in a child. Sending a letter home requiring a medical
evaluation is tantamount to suggesting the child has a medical
disorder. He pointed out that a national consensus conference
was held on this issue in 1998. Participants concluded there was
no independent valid test for ADHD, and there is no data to
indicate these children have any brain malfunction whatsoever.
There are literally hundreds of conditions that can produce
similar symptoms so it is dangerous to use a blanket diagnosis of
ADHD for children who could have one of hundreds of things going
on.
MR. JOHN BREEDING, Director of Texans for Safe Education and a
psychologist, asked committee members to consider the statistics
provided by previous speakers. He sees this issue as one of
informed consent regarding accurate information and free choice.
SB 230 is, to some extent, an anti-coercion bill. He recommended
expanding Section 9 to say that school personnel not recommend,
suggest, or pressure. He agreed with Mr. Warner that language be
included in the bill to restrict schools from requiring the use
of psychiatric drugs as a condition of school attendance because
parents are being threatened with expulsion of their children in
many places. Regarding Section 3, he recommends including
language to prevent children from being removed from their homes
if parents refuse to medicate them, because that has been
occurring in other states.
TAPE 02-16, SIDE A
MR. BREEDING commented that not only is it proper for school
personnel to provide a comprehensive evaluation for children who
are selected out, he believes it is illegal not to do so. He said
it is proper for the school to do a full behavioral evaluation.
MS. DEBBIE OSSIANDER, legislative chair of the Anchorage School
Board, stated support for the intent of the bill. The board
believes school personnel should not be recommending medications
as that is not their area of expertise or their work. Anchorage
already employs severe prohibitions against doing so. The board
is concerned about the letter recommending a medical or
behavioral health evaluation because of implications for
requiring districts to pay for that evaluation. However, the
board is generally supportive of providing information.
MR. RICHARD RAINERY, Executive Director of the Alaska Mental
Health Board, stated support for the intent of SB 230 but
expressed concern that recommending evaluations by physicians may
impact smaller communities as they may not have the appropriate
personnel. He referred to SB 302 and suggested broadening the
pool of people who can do evaluations.
MR. FRANK TURNEY, testifying via teleconference from Fairbanks,
informed committee members that the North Star Borough School
District has brought in psychiatrists from other states on two
different occasions to give teachers a pep talk on how to
identify children with ADHD in the classroom. During the seminar,
the psychiatrist supported the use of Ritalin and another drug as
part of the treatment plan. Also the school district has had a
long time relationship with Dr. Ferguson (ph) who is a leader in
prescribing Ritalin in Fairbanks. He asked the school board to
have Dr. Ferguson to come in and give an opinion on evaluating a
child for ADHD and psychotropic drugs but they declined. In
addition, he has requested data from the school district three
times to determine how much Ritalin is being dispensed by the
school nurse but the district has not provided that information.
He informed members that the Colorado School Board was the first
in the nation to pass a resolution warning parents about the use
of Ritalin in schools. He stated support for SB 230 and said he
will send proposed amendments to the committee.
MS. BETTY ROLLINS stated support for SB 230 and said it is
important to not send a mixed message to students about drug use.
MR. CHARLES ROLLINS stated support for SB 230 and suggested
checking children in state custody to see what medication they
are taking.
MR. BROCK EIDSNESS, and 8 grader from Dzantik'i Heeni Middle
School in Juneau, read the following testimony.
Imagine a society where children are all on
psychotropic drugs. Imagine it is the teachers' fault
because they referred all of the kids - a society where
the drugs are doing more bad than good. That could
happen if someone doesn't take the power away from
teachers to put kids on psychotropic drugs. This could
be a serious problem in the near future. I think you
should pass SB 230 and save our society's children.
SB 230 is trying to limit teachers' influence on
putting kids on psychotropic drugs. Psychotropic drugs
are drugs to calm children down, like Ritalin, or to
treat mental disabilities like depression. Teachers
sometimes recommend these drugs to parents of
disobedient kids for behavioral problems. According to
the Journal of the American Medical Association, from
1991 to 1995 the number of preschoolers on anti-
depressants increased 200 percent and the number of
children ages 2 to 4 taking stimulants more than
doubled. Chemically treating our children at the rate
we are now may lead to problems in our society that
[indisc.] emotional and financial costs to correct.
These medications are being prescribed to children at
increasingly younger ages and I believe this is because
of the school influence.
Ritalin is a commonly used psychotropic drug. There are
some children for whom Ritalin may be their best
option. However there are countless others that are
being drugged unnecessarily. There are some downsides
to Ritalin, like Ritalin is derived from the same
family as cocaine; Ritalin lasts only four hours,
Ritalin treats only some of the symptoms of ADD;
Ritalin provides superficial healing - it does not
treat the root of the problem; Ritalin can cause side
effects such as appetite loss, anxiety, insomnia,
ticks, headaches and stomach aches; Ritalin use is
responsible for causing children to begin a habit of
taking drugs; Ritalin may need to be taken over an
entire life span.
Stimulant drugs were found to have short-term
effectiveness of 60 to 80 percent in reducing the
hyperactivity, distractibility, and impulsiveness of
school age children. Studies began in the 1960s show
that children who took stimulants for hyperactivity
over several years did just as poorly in later life as
a group of hyperactive children who took no medication.
Doctors sharply criticized the lack of a uniform system
for diagnosing and treating ADHD, saying the health
department had largely ignored national health and
medical research recommendations published in 1997. Dr.
Florence Levy from the Sydney Children's Hospital has
expressed concern at the frequency of incorrect
diagnoses before.
The facts are straight: the number of kids on
psychotropic drugs is rising. School influence is
forcing parents to put their kids on psychotropic drugs
by threatening to take them to social services and even
reporting them. Most teachers probably have never been
to medical school and can't diagnose that kind of
disorder. If there is, I'd like to meet them but for
now we need to limit what schools can do.
SENATOR DAVIS stated her intent in bringing SB 230 forward was
not to address what many people have referred to as teachers
making these recommendations. She said if a teacher was making
such recommendations, the teacher would not be the one writing
the letter. Teachers might say something informally during a
parent-teacher conference, but anything official would not come
from a teacher. She said her concern is about how these drugs are
being introduced to children in general, regardless of who is
doing it.
CHAIRWOMAN GREEN asked those participants who have raised
questions to work with Senator Davis and her staff to find
solutions.
SENATOR WARD asked if there is any way to find out the number of
children on Ritalin.
MR. BENAVIDES said there would be no record if a parent
administers the drug before school or if a child takes the
medication on his or her own, however the number of medications
administered by school personnel should be recorded.
SENATOR DAVIS corrected a previous statement she made and said in
the Anchorage School District 480 students were identified by the
school nurse, not 800.
MR. BENAVIDES said it should be possible to get the number of
students receiving medications from school personnel.
| Document Name | Date/Time | Subjects |
|---|