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.