TESTIMONY OF
E. CLARKE ROSS, D.P.A.
CHIEF EXECUTIVE OFFICER
CHILDREN & ADULTS WITH ATTENTION DEFICIT/HYPERACTIVITY DISORDER (CHADD)
LANDOVER, MARYLAND

Before the
Joint Informational Hearing of the
Senate Health and Human Services Committee
and
Business and Professions Committee
and the
Senate Select Committee On Development Disabilities And Mental Health

February 13, 2002

The Critical Role Teacher & Physicians Play in the Treatment of AD/HD

As the treatment of AD/HD (attention-deficit/hyperactivity disorder) continues to raise discussion across the country, several state legislatures have begun considering legislation designed to restrict the role that physicians and teachers can play in advising families about the use of medication for the treatment of AD/HD.

CHADD believes that all families should have access to the best, evidence-based science in the diagnosis and treatment of AD/HD. We are therefore concerned when legislation is proposed which undermines this critical access. Likewise, CHADD is appalled when children are inappropriately prescribed medication that they do not need. This is of particular concern when small subsets of children suffer significant side effects.

The Surgeon General of the United States and the National Institute of Mental Health , as well as leading medical societies such as the American Academy of Pediatrics (AAP), American Psychiatric Association (APA), and the American Academy of Child and Adolescent Psychiatry (AACAP), recognize that medication, under the prescription of a treating medical professional and when taken as prescribed-along with other non-medication interventions-provide an effective foundation for the treatment of AD/HD. This is called multi-modal treatment.

Multi-modal treatment is a long-term management plan that combines medication with a variety of other treatment interventions designed to produce the best results. Such interventions include individualized education plans, special education resources when needed, behavioral therapy, family training and counseling. CHADD endorses a multi-modal approach to the treatment of AD/HD.

CHADD's Position on Legislative Efforts Designed to Restrict Physicians' Roles

CHADD believes that legislation must not limit or undermine the ability of a medical professional, within their scope of practice, from treating AD/HD based on the most widely accepted evidence-based medicine. CHADD encourages all families and physicians to follow best practice assessment and treatment guidelines being uniformly implemented throughout the nation, specifically the current AAP and AACAP guidelines. Using the force of law and agencies of government&emdash;particularly criminal penalties&emdash;to monitor and enforce best practice treatment guidelines is an ineffective approach at best and disastrous approach at worst. Instead, ongoing training and education in the diagnosis and treatment of AD/HD should be encouraged among all physicians.

CHADD's Position on Teacher Involvement in Recognizing AD/HD

The above principles also apply to teachers, given the critical role they play in assisting children and their families when AD/HD is suspected. Teachers are frequently the first to recognize learning, functioning, and behavioral problems in the school setting and therefore should be able to advise parents of such observations. CHADD believes that professionals should act within their professional scope of practice; thus, school personnel should not recommend the use of medication. Medication assessment and prescription is the role of physician. However, teachers should be able to recommend a comprehensive and complete medical assessment by persons licensed to perform such evaluations. Because students spend a significant portion of their day in the classroom, the vital role teachers play in providing observations to the diagnosing professionals cannot be underestimated. Effective communication among teachers, professionals and parents is essential and strongly encouraged.

SUMMARY OF LEGISLATIVE ACTIONS

Legislation Restricting Physician Practice, 2002

California, SB 119: This legislation would criminalize decision-making by physicians and families if statutory procedures were not followed when a physician prescribes a psychiatric medication to a legal minor. The legislation makes it a crime for a physician to prescribe a psychiatric medication to a legal minor until the physician has received a physical exam by a pediatrician and had all physical conditions treated prior to prescribing the medication, has fully explained all possible side effects to the parents, and has obtained a written informed consent from the parents. There are additional physician reporting requirements to the pharmacist and state Board of Pharmacy.

Mississippi, HB 221: Any physician or pharmacist that prescribes Ritalin or fills a prescription for Ritalin shall be subject to suspension of their license to practice and may be fined up to $5,000.

Wisconsin, AB 672: Any physician who diagnoses a child with AD/HD must provide the parents with an explanation of the method used to diagnose, including the results of tests and evaluations; information on alternative treatments; and any potential risks of any medication prescribed for AD/HD. The state is required to prepare materials which all physicians must give parents of children with AD/HD including how using medication may affect health insurance costs and how use of medication may affect a person's future eligibility to serve in the U.S. armed forces. The state must also distribute such information to school officials.

Legislation Restricting Teachers Giving Advice, 2002

Michigan, HB 5085: The legislation would prohibit teachers from diagnosing AD/HD and recommending the use of medication, but could discuss with parents optional treatments for AD/HD, which could include medication. Teachers could discuss behavioral, learning, or emotional problems of children with the parents and could recommend professional assessments.

Utah, HB 123: This bill would make teachers criminally liable for referring a student's behavioral problems to anyone outside the school other than the parent. Any statement to the parent must be in writing. The school would continue to serve the child even if the parent refused to have a psychiatric, psychological, or behavioral assessment of the child's behavioral problems. Unless conveyed in a letter, teachers would be prohibited from recommending a professional behavioral assessment or recommending that the parents contact physicians, psychologists, or any other health specialist.

Vermont: Legislation would stipulate that schools might not require students with behavioral problems to take psychiatric medication as a condition of staying in schools.

Related Legislative Actions of 2000-2001

California, SB 2098: Requires the state to adopt standards for the administration of psychotropic medications for children under the jurisdiction of the state department of youth. This legislation was enacted.

Connecticut, H 5701: Requires that each local and regional board of education shall adopt and implement policies prohibiting any school personnel from recommending the use of psychotropic drugs for any child. The provisions of this section shall not prohibit school medical staff from recommending that an appropriate medical practitioner evaluate a child, or prohibit school personnel from consulting with a practitioner with the consent of the parents or guardian of the child.

States that the refusal of a parent or other person having control of a child to administer or consent to the administration of any psychotropic drug to the child shall not, in and of itself, constitute grounds for the Department of Children and Families to take the child into custody or for any court of competent jurisdiction to order that the child be taken into custody by the department, unless the refusal causes the child to be neglected or abused, as defined in section 46b-120 of the general statues. Enacted 6/28/01.

Florida, S 682: Requires the state to adopt standards for the use of psychotropic medications for children under the jurisdiction of the State Department of Children and Family Services. This legislation was enacted.

Georgia, HR 1079: Creates a Commission on Psychiatric Medication of School-Age Children and requires the commission to investigate the use of such medications. This legislation was signed by the governor.

Hawaii, SCR 92 and SR 70: Both contain the same provisions: Provides that the Department of Health and the Department of Education are jointly requested to increase efforts to educate parents, the school community, and other interested parties with regard to the diagnosis and treatment of children with "attention deficit disorder" or "attention-deficit/hyperactivity disorder" and to study the use and effectiveness of medication utilized to improve the child's educational opportunities, as well as research, examine, and recommend non-medication and other appropriate alternatives.

Requires that the departments submit a report of their findings and recommendations to the Governor and the Legislature no later than twenty days prior to the convening of the Regular Session of 2002. Adopted 4/23/01.

Idaho, H 213: Requires that any pharmacy licensed by the Board of Pharmacists that dispenses the stimulant methylphenidate, commonly known as Ritalin, shall disclose, at the least, the following information:

(a) Known side effects of prescriptive use of the drug include tachycardia, dizziness, insomnia, depression, abdominal pain, anorexia, loss of appetite, dry mouth and suppression of growth associated with long-term use;
(b) Ingesting the tablet by any means other than swallowing can result in severe reactions or complications such as blood clots, skin and circulatory problems, and even death;
(c) No person who takes Ritalin after the age of twelve (12) years is eligible for military service; and
(d) Distribution of the medication to any other person is a felony offense in Idaho and is also a federal offense.

Specifies that the board is authorized and directed to promulgate rules to ensure that the information in this section is provided by the licensed dispensing pharmacy to each person who takes possession of a Ritalin prescription. Passed House 3/5/01. Regular session adjourned, no carry over to 2002.

Indiana, S 471: Requires that the controlled substances advisory committee shall review the records maintained by the central repository for controlled substances designated by the state police department regarding the prescribing of psychotropic medications to children. Requires that no later than December 1, 2001, the advisory committee shall submit a report to the legislative council, the governor, and the medical licensing board regarding this review. The report required must include the following:

(1) A comparison of the number of prescriptions written for psychotropic medications for children (A) participating in Medicaid or the children's heath insurance program; and (B) not participating in a program described in clause (A). (2) A statement by the advisory committee regarding whether the information provided indicates that psychotropic medications are being disproportionately prescribed for children described in subdivision (1)(A). (3) Identification of any pattern of prescribing of psychotropic medications for children contrary to the most recent guidelines adopted by the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry. Vetoed by governor 5/11/01.

Maryland, S 742: Creates an advisory council on AD/HD to facilitate communication between educators, families, and physicians and to promote needed reform and training to better serve children with AD/HD, including research into the relationship between AD/HD and learning disabilities. This legislation was enacted.

Minnesota, S 750: A bill for an act relating to education; raising awareness of issues related to student use of sympathomimetic medication; clarifying neglect to indicate that a parent's refusal to provide sympathomimetic medications does not constitute educational neglect; and providing for a study to examine student's Ritalin use.

North Carolina, S 542: Requires that the Department of Health and Human Services and the Department of Juvenile Justice and Delinquency Prevention shall review the feasibility of establishing and maintaining a statewide database containing information on the prescription and administration of psychotropic medications to children who receive State services. Enacted 5/25/01.

New York, A 3162: Amends the mental hygiene law, the social services law and the education law by adding to each, new sections which establish the rights of children in residential care. Included in these enumerated rights is the right to safe medication prescribing practices, including provisions for information about medications and consent for psychotropic medications from the parent or guardian and the right to be free from physical restraint and seclusion, except as otherwise authorized by law or regulation, provided, however, no mechanical restraint or seclusion may be used if the child is under twelve years of age. Passed Assembly 4/2/01.

Oklahoma, H 1965: Authorized the state's courts to order children under court order to take medication as prescribed by the court. This legislation was enacted.

Utah, H 170: Amends the definition of substantiated child abuse to exclude the failure to administer prescribed medication or course of treatment if the parent or legal guardian has not been notified of the opportunity to obtain a physical examination of the minor by a health care professional.

The bill does not specify or define what types of medication. It is intended to be broader that the introduced version of the bill which specified and defined "psychiatric medication." Enacted 3/15/01.

Virginia, HJR 660: That a joint subcommittee be established to study the effects of attention deficit disorder and attention deficit hyperactivity disorder on student academic performance and on public education programs and services. Adopted 2/24/01.

Washington, H 2912: Requires the state to report on children in out-of-home care for longer than 90 days who take psychotropic medication. This legislation was enacted.

With over 22,000 members and 200 affiliates nationwide, CHADD works to improve the lives of people affected by AD/HD through collaborative leadership, advocacy, research, education and support: CHADD CARES. For additional information about AD/HD or CHADD, please contact the CHADD National Call Center at 1-800-233-4050, or visit the CHADD website at www.chadd.org.

For Further Information on this Issue: Members of the media should contact Peg Nichols, Director of Communications and Media Relations, at 301-306-7070, extension 102. Legislative staff should contact Stephen Spector, Director of Public Policy, at 301-306-7070, extension 109.

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