In December 1999, Yolanda DuPerret received a phone call from the principal at her son's preschool. Three-year-old Nicolas was "acting up," and "disrupting class." The principal, Cindy Oberdier, wanted the DuPerrets to come in for a meeting because she suspected that Nicolas had attention deficit hyperactivity disorder (ADHD). "He really stuck out like a sore thumb," said Oberdier. "His approach was to bombard everyone with his presence."
Nicolas's father, Cyrille DuPerret, is from France, where children are rarely diagnosed with mental disorders. It didn't occur to him that there was anything wrong with his son. "He's just a boy and he's very active and ... we didn't think much of it," said Cyrille.
After discussing their son's situation with the school, the DuPerrets met with psychologist Ed Cable, an ADHD specialist. At first, Dr. Cable thought Nicolas might be attending the wrong school. But after he saw a videotape of Nicolas in the classroom, he said, "It was pretty apparent that he was below average in his ability to just stay in one place." In order to determine if Nicolas had ADHD, Dr. Cable proposed using a standard diagnostic tool--the Conners Rating Scale, a checklist of 28 behaviors like "restless in the squirmy sense," "overly sensitive to criticism," "childish and immature," and impulsive.
The DuPerrets chose not to formally test Nicolas for ADHD. "The psychologist suggested he might be ADD or ADHD, which were new acronyms for us. And then he suggested also the use of medication. For us, it was like a cold shower," said Cyrille. "He's a handful," said Yolanda. "He is more intense. He is more active. ... I could never understand how that would translate into my son having something wrong with his brain."
The DuPerrets chose not to medicate Nicolas. Instead, Cyrille and Yolanda are trying to spend more time with their son. They decided it would be best if they did not both work full-time, so for six months, Cyrille stayed home to take care of Nicolas and his baby brother.
In "Medicating Kids," FRONTLINE examines the dramatic increase in the prescription of behavior-modifying drugs for children. Are these medications really necessary--and safe--for young children, or merely a harried nation's quick fix for annoying, yet age-appropriate, behavior? FRONTLINE follows four Denver, Colo., families over the course of one year. From school complaints of disruptive behavior and parent-teacher conferences through multiple doctors, medications, and dosages, "Medicating Kids" offers an intimate portrait of how American families grapple with the decision to medicate their children and the stress such decisions place on the family. Viewers meet Nicolas DuPerret
, barely three years old, whose doctor suspected he might have ADHD; Noelle Demo
, 13, whose fidgeting and disruptive behavior resulted in poor grades and school suspensions; Alex McCarty
, 12, whose ADHD was compounded by severe depression; and Robin Day
, 16, who has endured multiple diagnoses, one hospitalization, and ultimately his parents' divorce.
Interwoven with these stories are examinations of the role of doctors, advocacy groups, and pharmaceutical companies in advancing the medication trend, as well as a look at the strong anti-medication movement that has filed lawsuits charging that drug companies and doctors have conspired to exaggerate the number of ADHD cases in an attempt to boost drug sales. "You can't ignore the fact that there is a lot of over-diagnosis of ADHD," says FRONTLINE producer Martin Smith. "But we've tried to look at both sides of the issue. There are no easy answers here." Indeed, the case of each child profiled in the documentary is unique. Despite school complaints and the psychologist's opinion, for example, Nicolas DuPerret's parents decided not to put Nicolas on medication, viewing their son's behavior as "intense," but normal. "[Medication is] just a quick fix," says Nicolas's father, Cyrille. "We would never do that."
But for other families, medication appears to be a godsend. Before taking Ritalin and later Adderall, Noelle Demo was getting Ds and Fs on her report card. She had also been suspended twice for fighting with another student. Her teachers urged medication. Soon thereafter, the Ds and Fs turned into As and Bs, while her improved concentration had a positive impact on her gymnastics performance. The medical community, however, still is unable to explain why these medications help relieve ADHD symptoms in many children.
"We still don't really know much about how Ritalin or Dexedrine or Adderall work," Dr. Xavier Castellanos tells FRONTLINE. The head of ADHD research at the National Institute of Mental Health, Castellanos freely admits that much remains unknown about the nature and cause of ADHD. "The problem is," he says, "we're searching in the dark and don't know where that clue is going to be." This lack of basic understanding about the nature of ADHD concerns some parents. Others are concerned about the role played by pharmaceutical companies, which have not only provided financial support to ADHD advocacy groups such as CHADD (Children and Adults with Attention Deficit Disorder) but also paid physicians to make speaking appearances to raise awareness of ADHD. Such support, critics claim, is an attempt to boost diagnoses of ADHD--and thereby drug sales. For parents, meanwhile, the decision to place their child on medication remains a difficult one. In "Medicating Kids," even the parents who credit medication with "saving" their children admit wrestling long and hard with the decision. "Of course I'd not want [Alex] to take medication if he didn't have to," Diane McCarty says. "But for Alex it's working ... and I know in my heart I've gone the distance and I'm helping my son."