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JUSTICE AS A DRUG

We must be off our medication again, because otherwise we're sure we'd understand the logic of the Albany County Family Court judge who told Jill and Michael Carroll to keep dosing their son Kyle with Ritalin despite their concerns over the drug's effects. If they don't stop being so concerned, they could lose custody of their boy on charges of child neglect.

Of course, we may not be off our medications for long, because the consent order signed by Judge Gerard E. Maney stands at the brink of a long and slippery slope involving mandated behavior-altering drugs.

Ritalin isn't a drug that cures a medical condition, or a psychological one. It changes behavior, but only for as long as it's taken. Its use, now under attack as too widespread, calms a child with attention deficit/hyperactivity disorder but has not been shown to produce any long-term changes.

In a yearlong dispute with their local school district, the Carrolls have tried to end what was supposed to be a pediatrician-prescribed trial run of Ritalin. After three years of that "trial," they argue, Kyle -- now 7 -- is turning into a sickly, staring insomniac and his personality has changed.

The case is fundamentally different from courtroom intervention when parents bar medical treatment for their children. That intervention is based on concern for the child's physical health and involves a balancing of rights within the family. It's also different from court intervention in mental health matters under Kendra's Law, which allows a judge to mandate treatment, upon petition by relatives or others, for unwilling adults with a history of abandoning medication and either institutionalization or violence.

Ritalin treats behavior, not disease, and it matches the child against the school district's need to control disruptive behavior in the classroom.

It's that "control disruptive behavior" part that's troubling. Unlike even mandated childhood immunizations designed to prevent the school-based spread of disease, Ritalin is a drug aimed at control. Its defenders argue that it allows a child to concentrate; opponents argue that attention deficit/hyperactivity disorder, ADHD, may not even be a valid diagnosis, and that drug-induced behavior alterations are simply cheap and easy substitutes for the hard work that's really needed to help a child take charge of his or her own behavior and learn to cope, longterm, with the world.

There is evidence, including a successful summer camp run here by the ADHD program of the University at Buffalo, that positive reinforcement and other techniques that work with children, instead of against them, have longer-lasting benefits even if they aren't as "easy" as a prescription.

To be fair, the judge in Albany County is not trying to practice medicine. The consent order to which the Carrolls agreed tells them to keep giving Kyle Ritalin until they come up with an alternative from a court-approved physician, and they haven't yet found a doctor who will recommend taking him off the drug.

But the intrusion of the court into what should be a family-based decision has drawn criticism from scholars, the American Psychiatric Association and the National Coalition for Child Protection Reform. With 1 million to 2 million children on Ritalin nationwide, the chance that it's just a "quick fix" also has convinced the Clinton administration to launch a five-year, $6 million study of its effects.

At worst -- and assuming their school district properly complied with all the legislated requirements for accommodation of such students -- the Carrolls should have faced a choice between continued public school with the drug or other alternatives without it. The choice they got was much more draconian -- drug your child, or risk losing him.

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