"The Ethics of Informed Parental Cconsent to the
Psychiatric Drugging of Children."

Ethical Human Sciences and Services, 3, 3, 2001.
Breeding, J. & Baughman, Jr, F.
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Abstract

That so many children are taking prescribed psychiatric drugs means that millions of parents have agreed to this recommendation for their children. Most pertinent to this fact is the question whether these parents have been given the opportunity to make their decisions in accordance with the legal standard of informed consent which requires a physician to disclose sufficient information for a patient to make an "informed" decision about a proposed treatment. At the least, such legitimate consent entails an opportunity to evaluate knowledgeably the options available and the risks attendant upon each, without coercion. This article examines the ethics of informed consent in psychiatry, and extant practices in the field, especially in regard to the psychiatric drugging of school age children in the United States. The authors argue that informed consent is systematically violated in this domain, and present a look at what authentic informed consent for parents to decide about psychiatric drugs for their children would entail.

The Ethics of Informed Parental Consent to the Psychiatric Drugging Of Children

There has been a dramatic increase in the numbers of United States children on psychiatric drugs. In 1970, when Ritalin prescription use was around 200,000, our country seemed alarmed enough that a subcommittee of the Committee on Government Operations of the United States Congress held hearings entitled "Federal Involvement in the use of Behavioral Modification Drugs on Grammar School Children." In 1971, the Drug Enforcement Administration (DEA) classified Ritalin and other amphetamines as Schedule II drugs of the United Nations Convention on Psychotropic Substances, a category that indicates significant risk of abuse and limited medical value. Since that time, the explosion in use of psychiatric drugs with children in this country has been phenomenal, as has been amply documented. Today, an estimated 8,000,000 school-age children in this country take psychiatric drugs (Breeding, 2000a).

That so many children are taking prescribed psychiatric drugs means that millions of parents have agreed to this recommendation for their children. The legal doctrine of informed consent requires a physician to disclose sufficient information for a patient to make an "informed" decision about a proposed treatment. Our nation's courts have explained that, "true consent to what happens to one's self is the informed exercise of choice, and that entails an opportunity to evaluate knowledgeably the options available and the risks attendant upon each" (Baker, 1997, p. 835). In the case of children, this doctrine must be interpreted to mean that parents have a legal right to sufficient information necessary to make a fully informed choice on behalf of their children. This article examines the ethics of informed consent in psychiatry, especially in regard to the psychiatric drugging of school age children in the United States. We argue that informed consent is systematically violated in this domain, and present a look at what authentic informed consent for parents to decide about psychiatric drugs for their children would entail.

Psychiatry and Informed Consent

In the modern practice of medicine, the doctrine of informed consent is fundamental. Issues of physician responsibility and malpractice are major forces shaping the delivery and cost of health care services in the United States. As Baker (1997) shows in his legal review of malpractice issues regarding tardive dyskinesia (TD) caused by antipsychotic drugs, at least one court has written that "every person has a right to determine and control what is to be done to his or her body; and a surgeon who performs an operation without his patient's consent commits (a battery) for which he is liable to damages" (p. 835). Baker believes that a patient might allege battery in the context of unconsented antipsychotic drug administration, and this view would apply to other psychiatric drugs. The failure to disclose potential harmful effects of stimulant or antidepressant drugs prescribed for children must be equally tantamount to treatment without consent as is the failure to tell patients about the risks of TD due to antipsychotic drugs.

While the pharmacological arena is much broader and less controlled than the domain of surgery, issues of responsibility and malpractice are highly significant. Drug company liability is an ongoing concern, as these corporations defend themselves against lawsuits by complainants who attest to harm suffered by a drug. The Food And Drug Administration is under scrutiny as many allege that this agency has become coopted by the pharmaceutical industry, resulting in a drug review process heavily weighted in favor of drug approval (Willman, 2001). The majority of the pharmaceutical research is, in fact, funded by the very drug companies who want their products promptly on the market (e.g., Duncan et al, 2000).

Disease or Not Disease

The application of informed consent in psychiatry raises a unique set of problems related to the existence of fundamental differences between the concepts of physical and mental illness. The practice of medicine has developed hand in hand with clarification of and allegiance to the scientific method. Simply put, there is a process whereby medical scientists posit the existence of a disease entity, then confirm the presence of a physical or chemical abnormality which is a marker for the disease. By this marker, physicians can know and demonstrate to patients the presence of a specific disease, and can make a specific disease/no disease differentiation between those who have the disease and those who do not. Treatments for a disease are relevant only when the disease is verified, and are judged accordingly on a risk/benefit analysis relevant to the health of the patient with or without the treatment. If the physician is unable to verify the existence of a disease by confirming the established marker for a disease, then he cannot, properly speaking, be said to treat a disease.

The process whereby a psychiatrist responds to so-called mental illness, however much the trappings of a doctor's office or hospital may emulate those of physical medicine, is remarkably different. No problem routinely seen by psychiatrists has been demonstrated, according to the simple criteria above, to be a legitimate medical disease. There is no objective marker for any psychiatric illness. (One may exclude exceptions where psychiatric symptoms are part of diseases diagnosable by objective markers, such as organic brain syndrome, Parkinson's disease, thyroid malfunction or dementia). To test this, ask a psychiatrist to show you the article or articles in the scientific journals that prove the existence of a physical or chemical abnormality by which a disease/no disease differentiation can be made for an alleged psychiatric illness. There are none for any diagnosis, including those we constantly hear are proven to be genetic or biological in nature, such as schizophrenia, depression, and bipolar disorder.

The fact that psychiatrists treat unproven illnesses may be their most distinguishing difference relative to colleagues in other branches of medicine. Imagine that the practice of oncology involved oncologists offering an assortment of chemotherapies based on their observations and opinions of a patient's behavior and language, and the observations and opinions of those around the patient. Clearly, most of an oncologist's patients are willing to undergo the adverse effects of chemotherapy just because the doctor has shown them the physical evidence of cancer, and their analysis of the cost/benefit issues leads them to conclude that taking the toxic chemicals is their best option to live longer. Surely, most cancer patients would balk at taking the drugs if their doctors could not show any physical evidence of disease.

How Psychiatry Abrogates Informed Consent

In order to profitably continue to exist without being able to demonstrate to patients the existence of their disease, a branch of medicine has two options. It can abrogate informed consent directly by misleading or withholding information, or simply lying. Or it can work to withdraw the right to choose. While psychiatry is guilty of both, the latter defines the second major difference between psychiatry and other types of medicine. Generally speaking, adults are granted the right and responsibility to accept or refuse medical treatment, even when the existence of a disease is confirmed, and even when that disease – such as AIDS or tuberculosis – may pose a danger to others. Psychiatry, however, operates as an agent of the therapeutic state through the doctrine of parens patriae (Kittrie, 1971). Once an individual is discerned to have a "mental illness" of sufficient severity, that individual is considered to be incapable of independent decision-making, and is effectively considered a dependent of the state.

Involuntary commitment has a long history in this country, and is in full force today, providing justification for the ongoing violation of the civil rights of significant numbers of United States citizens judged to be "mentally ill." Those so labeled are systematically denied their sixth amendment right to a speedy and public trial by an impartial jury when threatened with loss of liberty by incarceration. Szasz, the best-known champion of the long-standing fight to end this practice, summarizes this issue precisely and elegantly: "To be sure, as we might expect in this age of humanitarian inhumanism, we do not refer to this procedure in plain English as imprisonment without trial. We call it psychiatric hospitalization because of unfitness to stand trial"(1988, p.11). Recently, state mental health agency expansion of forced treatment in the form of "outpatient commitment" laws has led to resistance from activist groups in California (Oaks, 2000) and New York (Feld & Darrow, 2000). Forced medication of nondangerous persons clearly violates many human rights, including the right to informed consent.

Informed consent is also a focal point of challenge in other specific  struggles to regain basic civil rights for those who lose them to psychiatry. Activists in Texas pushed the Texas legislature to pass an electroshock informed consent law in 1993, Chapter 578 of the Texas Health and Safety code. The New York Assembly, pushed to action by activist driven exposure of an upsurge in incidence of forced electroshock in New York psychiatric facilities, is considering similar legislation requiring more rigorous standards of informed consent.

Lack of informed consent in nursing homes, over 90% of which regularly use psychiatric services (Reichman, Coyne, Borson, Negron, Rovner, Relchat, Sakauye, Katz & Hamer, 1998), is also a cause of great concern. Ilminen (1999) reports that, despite increasing regulations, use of psychoactive drugs in the nation's nursing homes has soared from 26.4% in 1991 to 50.3% in 1999. Given that it is routine to require nursing home residents to sign a blanket consent to recommended medical treatments upon admission to a nursing care facility, the opportunity for genuine informed consent is negated as potential protection against harmful and unnecessary psychiatric treatment. Residents and/or their responsible parties typically do not even know what drugs they are taking, much less their effects. Thanks to the work of Texas activists, the 2001 Texas legislature passed Senate Bill 355, the first of its kind, which requires that current provisions of the Texas mental health code regarding informed consent (that patients be made aware of their diagnosis, the probable course of the alleged disease with and without treatment, the possible effects of the treatment, the probable length of treatment, and why alternatives are rejected) be applied specifically to nursing homes

It is apparent that our society allows for systematic abrogation of human rights in the name of a parens patriae therapeutic state supposedly functioning to care for the mentally ill who are judged to pose a danger to themselves or others. It is accepted that fully informed consent is impossible for the mentally ill because of their irrationality and incompetence. As I have described elsewhere (Breeding, 2000b), using electroshock as an example, even where there exists a pretense of informed consent in psychiatry, its practice is routinely violated. In nursing home care, there currently is not even a pretense. It may be no coincidence that elderly women receive the brunt of psychiatric electroshock (Breggin, 1998), that nursing home residents are a booming industry for psychiatric drugs, and that children are the most rapid current growth market for the psychopharmaceutical industry. Those dispossessed of power are always the victims of oppression. Informed consent is most easily violated with those lacking political and economic power to resist.

Children and Psychiatric Drugs

Undeniably, more and more of our children are taking stronger psychiatric drugs today. As of this writing, it appears that methylphenidate (Ritalin) is still number one, but other stimulants such as Adderall (an amphetamine mixture) represent one third of the children's market (Breeding, 2000a). Adult antidepressants are being used more freely with children. Incredibly, such drugs are frequently given to toddlers (Zito et al, 2000).
Children are powerless to resist this trend, and legally incapable of informed consent. Yet we know it is not the children who decide. Parens patriae plays a big role in children's care in our society. According to Imperio (2000), the Bazelon Center for Mental Health reports that gaining access to mental health "care" for children is so difficult that parents often end up giving up custody to ensure care. The center estimates that approximately 2.1-4.1 million children aged 9-17 years have a serious mental or emotional disorder. In 1999, 23% of parents of children with behavioral disorders were told that they needed to relinquish custody to obtain intensive mental health services for their children, and 20% actually gave up custody.

Coercion of Parents

The therapeutic state has also been known to coerce parents with custody of their children into complying with recommended psychiatric drugging of their children (Thomas, 2000). Two New York families can attest that parents are increasingly being accused of child abuse or neglect and threatened with removal of their child from the home if they refuse to give that child prescribed psychiatric drugs. Jill and Michael Carroll were concerned that their son, Kyle, was sleeping only five hours a night and eating a single meal a day. They told school officials they wanted to take Kyle off the Ritalin for two weeks to see if that helped. This is when they received a call, and then a visit, from a Child Protective Services (CPS) worker, based on a complaint from Kyle's school guidance counselor. The charge was "Child abuse," in the form of "medical neglect." According to the Albany Times Union (May 7, 2000) the Carrolls are now on a statewide list of alleged child abusers, and find themselves "thrust into an Orwellian family court battle to clear their name and ensure their child isn't removed from their home." This February, Tammy Kubiak of Buffalo, New York, lost custody of her 12-year-old son for taking him off three psychiatric drugs which she reports were making him "zombie-like."

Such dramatic state intrusion and breaking up of families parallels the violation of the civil rights of "mentally ill" adults. Resistance to psychiatric treatment is handled by declaring patients incompetent due to their "mental illness." Parental resistance to their child's psychiatric treatment is handled by declaring the parents incompetent. Adult psychiatric patients are said to be dangerously neglectful of their treatment needs due to irrationality and denial of their illness; parents are said to be incompetent because of their denial and neglect of their children's medical (psychiatric) treatment needs.

Roe, Lereya, and Fenning (2001) reviewed articles over the last 40 years comparing psychiatric patients' and staff members' attitudes toward treatment. The authors found that patients and staff disagreed on treatment issues in 26 of 28 articles, concluding in an understated way that "The consistency of the disagreement might have more to do with the fundamental difference between being a patient and a staff member rather than a patient's cognitive deficit or pathology" (p. 307). The review clearly suggests that psychiatric determinations of competence are more about power and control than about patients' or clients' capacity for informed consent. CPS removal of children with charges of medical neglect on parents who disagree with recommended psychiatric treatment is nothing short of tyrannical behavior. The calling card of psychiatry today is coercion. In a less dramatic way, parents are routinely pressured by educators and mental health professionals to use drugs with their children.

How Children Typically Receive Psychiatric Drugs

Before elaborating on informed consent in this context, a brief description of the typical process resulting in a child's being placed on psychiatric drugs may be useful. The most common entry point of a child into psychiatry is during the transition from the preschool life into the early elementary school experience. This period is difficult for some children for obvious reasons (Breeding, 1996; Gatto, 2001). Rather than face the tough task of finding why school is not working for a given child, many professionals assume that there is something wrong with the child. Their reasoning seems to be that if a child has a problem, it is not because the system is poorly designed in relationship to the true nature and real needs of children, but because children are defective. Hence, psychiatry is playing an ever-increasing role in the schools.

Institutional psychiatry and compulsory age-graded competitive education share many things in common, and one of these is a primary value on selection. Millions of young people are being selected based on a judgment that their behavior is unacceptable. Parents are then notified that there is a problem, and are typically encouraged to seek a psychiatric evaluation to determine whether their child might have Attention Deficit Hyperactivity Disorder (ADHD) or a related disorder. ADHD is in a class of so-called Disruptive Behavior Disorders (DBDs), all diagnosed according to behavioral criteria listed in the Diagnostic and Statistical Manual (DSM-IV, 1994) of the American Psychiatric Association.
A child is selected and referred to a psychiatrist or psychologist for an evaluation to determine a diagnosis and decide whether the child has a psychiatric disorder. Once a child is selected, a thoroughly predictable process with thoroughly predictable results is set in motion. It is extremely rare for a child referred to a psychiatrist or psychologist for evaluation of a disruptive behavior disorder (DBD) to be given no diagnosis. These professionals are in the business of giving diagnoses. As Szasz (1993) made clear, psychiatric diagnosis is not descriptive, but prescriptive. Just as referral almost inevitably leads to diagnosis, diagnosis means treatment. When a child is selected as manifesting a behavior problem, he or she is being chosen for treatment and special services.  Biopsychiatry assumes that these behavior problems are diseases caused by biological and genetic defects in the sick child. The treatment of choice is pharmacological (drugs).

The Real World of Informed Parental Consent

Despite the reality of our therapeutic state in action, our society in principle considers parents legally and morally responsible for medical treatment decisions for their children. While there is an alarming increase in state coercion of parents who resist psychiatric drugging of their children, via the agencies of Child Protective Services, it is more often the case that parents are granted the right, albeit with pressure and disapproval, to say no to the psychiatric drugging of their children. Yet more and more are saying yes. For the purposes of this discussion, the question that remains is whether this "yes" is a fully informed consent.

In an earlier article on electroshock and informed consent, Breeding (2000b) discussed four ways in which informed consent is violated. We will now cover these same four areas in the context of parents' decisions to give their children psychiatric drugs. As Breggin (1999a, 1999b) and McCubbin & Cohen (1999) discussed the use of psychostimulants with children in the pages of this journal, the following is a brief review.

Denial and Minimization of Harmful Effects

The first violation involves denial and minimization of harmful effects of the drugs. Parents are typically told that Ritalin, for example, is a "mild stimulant," "proven safe and effective in the treatment of ADHD." They may be warned about a small number of the common physical effects, such as that it sometimes affects appetite or sleep, and that dosages sometimes need adjustment. They are almost never given or strongly encouraged to obtain a pharmacy insert or to otherwise thoroughly research the drug. Virtually everything else is usually not disclosed. Parents are usually told nothing at all about the likelihood of growth suppression and brain atrophy with long-term stimulant drug use. They are not told that it affects virtually every organ system of the body (Eberstadt, 1999), or that some children die; 160 Ritalin-related deaths were reported to the FDA between 1990 and 1997, mostly cardiovascular in nature. Keep in mind that experts such as Brian Strom, chairman of epidemiology at the University of Pennsylvania, believe these reports represent as few as 1 to 10 percent of all such events. This means that the 160 above-mentioned reported Ritalin-related deaths may actually represent several thousand deaths.

Parents are also usually not told that methylphenidate is classified as a controlled substance by the DEA, or that experts may disagree on basic attributes of this drug. For example, an esteemed behavioral pediatrician testifying at a special hearing of the Texas State board of Education in November 2000, stated his assurance to the board that methylphenidate was "not addictive," and that children prescribed psychiatric drugs used them exactly as prescribed. He was followed shortly after by Gretchen Feussner, a DEA pharmacologist, who assured the Board that it was a substance controlled and monitored by her agency prescisely because of its proven "addictive" potential. Fuessner also presented data showing that up to 20% of young people with psychiatric prescriptions misuse their prescribed. Parents may never be told that research has repeatedly demonstrated that neither animals nor humans can tell the difference between cocaine, amphetamine, or methylphenidate when they are administered in the same dosage and form; their effects are nearly identical (Woodworth, 2000).

We have personally witnessed many times the increasingly frequent  progression from being prescribed a relatively small dose of Ritalin to a higher dose of Ritalin to a longer-lasting amphetamine such as Dexedrine to an adult antidepressant such as Prozac or Wellbutrin to some form of polypharmacological cocktail by teenage years. In fact, this dangerous  psychiatric practice of so-called polypharmacy  is not limited to our older children. Clinical Psychiatric News (July, 1998) reported that a number of Michigan preschoolers were "treated" with more than one psychotropic medication.  Twenty-two different psychiatric drugs were prescribed.  Ritalin and Tenex (also known as Catapres) were prescribed most often.  Others were Dexedrine, Prozac, Pamelor, Aventyl ,  Effexor,  Wellbutrin, Zyban, Lithobid, Lithostat, Risperdal, and Restoril.  More than 33% of medicated children received two or more drugs.  Parents, however, are not told about they and children becoming dependent on using drugs and about this trend in psychiatric prescribing practices. They are not told about the dangers of polypharmacy. They are also not told about the challenges and dangers of drug withdrawal. Regrettably, it is customary practice for doctors and other adults to interpret behavior of a child coming off psychiatric drugs not as the withdrawal symptoms that are inevitably present, but as evidence that the child still needs the "medication;" in other words, as the progression of the child's alleged and untreated disease (Breggin & Cohen, 1999; Breeding, 2000c; Tracy, 1994).

The psychological effects of stimulants are also notable; issues like shame and stigmatization, and character and responsibility are crucially important (Breeding, 1996; Breggin, 1998). Parents are not likely to be informed of various political, social and economic considerations for their child. These include consequences of a psychiatric label and history following the child through his or her education and life. For example, use of prescription psychiatric drugs normally excludes a child from service in the armed forces of the United States.

Finally, we have yet to find a parent told by their prescribing doctor that there is negligible evidence that stimulant drugs have any positive long-term effects in any important area of a child's life: in learning, behavior or social relationships (NIH, 1998).

Violation of Guidelines For Drug Approval and Administration  

Guidelines for the approval and administration of psychiatric drugs with children are routinely and systematically violated. Breggin (1998) reviews the history Ritalin, first approved by the FDA under lenient standards in 1955. Despite widespread methylphenidate abuse and addiction, it was only in 1969 that these problems were indicated in its label. In a re-evaluation of Ritalin, the FDA reported in 1970 that the longest study of efficacy and adverse effects in children was 6 weeks in duration. Breggin defines the bottom line: "History indicates that Ciba is as honest in its claims as the FDA forces it to be. Even if the FDA had the requisite political courage, the agency does not have the resources to keep on top of the drug companies to ensure their honesty in promoting their products" (p. 228).

The quality and quantity of safety reporting in drug trials is "largely inadequate," according Ioannidis and Lau (2001). These authors evaluated seven medical areas and found that researchers who publish their results in medical journals often devote more ink to their academic affiliations than they do to explaining the nature and severity of a drug's side effects. The compromised nature of clinical psychopharmacology research is increasingly well known (Jacobs, 1996; Duncan, Miller, & Sparks, 2000).

There are, of course, many other psychiatric drugs besides Ritalin now being prescribed to children. The story on FDA approval and monitoring of Prozac (and its family of related so-called SSRIs such as Paxil, Zoloft, Luvox and Effexor) reveals a lax and highly suspect approval process (Breggin & Breggin, 1994). Tracy (1999) reports that the latest FDA figures show Prozac has about 44,000 adverse reports, including 2500 deaths with the large majority of them linked to suicide or violence. Despite this disturbing evidence, the number of antidepressant prescriptions for children continues to soar, reaching 1,664,000 in 1998 (Huffington, 1999).

That psychiatric drugs were never tested on children is not really the issue. As Breggin (2000) reports, our National Institute of Mental Health (NIMH), in collaboration with the drug companies, is all too eager to jump into clinical drug studies for children. The breaking news that large numbers of small children receive these drugs does not raise a cry of alarm from psychiatry's best, only a cry for more research funding of these practices. The NIMH Preschool ADHD Treatment Study (PATS), designed to give amphetamines-Ritalin included- to children 2 years old has just begun.  In a letter to the editor of Science (1-26-01), Baughman responds to PATS this way:  "Should the NIMH go forth with the drugging of normal infants, toddlers and preschoolers, existing laws should be invoked and criminal charges should be brought" (p. 595).

False Information About The Condition To Be Treated

The legal obligation under informed consent is to provide the patient with all the information relevant to their decision-making--not just about the treatment in question, but also about their condition. It is our opinion that to say or even imply that what the patient has is biologic and a disease when there is no such proof (as in all psychiatric "diseases") is conscious deception which abrogates informed consent.  That this has become the "standard of practice" in psychiatry does not excuse it.  The abrogation of informed consent still constitutes de facto medical malpractice.

Psychiatric patients are never told that their alleged disease is theoretical or metaphorical. This is true of all standard psychiatric diagnoses of children. Regarding the most popular diagnosis, the final statement of the NIH ADHD Consensus Conference Panel (November 18, 1998) read: " ...we do not have an independent, valid test for ADHD, and there are no data to indicate that ADHD is due to a brain malfunction" (p. 2).

That a child conforms to the strictly behavioral DSM-IV criteria in no way proves that ADHD is a disease. Furthermore, ADHD "symptoms" are not even reliable as behavioral observations (Mota & Schachar, 2000). To be reliable, people must agree that a child has "ADHD." Typically, different observers, such as peers, parents, teachers, and mental health professionals disagree on whether children exhibit ADHD "symptoms." This means that research done to support the identification and treatment of ADHD that uses the DSM-IV definition rests on invalid support. It also means that no medical person "correctly" diagnoses ADHD. ADD and ADHD remain politically manufactured concepts, created by committees of the American Psychiatric Association. ADD was created in 1980, ADHD in 1987. The plain truth is that they are not real diseases in any legitimate scientific meaning of the term disease. To declare otherwise is not medicine; it is fraud.

Pragmatics and Power

In the final analysis, it remains that parents, teachers, and children must respond to various stressful demands, and feel these most acutely when things seem to go awry. Teachers are under pressure to manage their classrooms and to produce results. Parents are under economic pressures, and their self-esteem is at risk when their children are seen as a problem. They feel the pressure, overt or covert, to do something about their child. It is currently common practice to query resistant parents with, "If your child had diabetes, you would give them insulin, wouldn't you?"

Children feel enormous pressure and shame when they are labeled as a problem. Everyone is vulnerable, and at vulnerable times, individuals desperately need to trust and rely on others for help. Parents often feel like their only hope is to trust the wisdom and guidance of the professionals to whom they turn for help. It is all too easy for everyone involved to grab onto the idea that a child has a medical illness that explains his or her problems and can be treated with "medicine." This absolves everyone of responsibility, and the possible anguish of felt guilt and blame. Underlying this veneer of medical benevolence is the harsh reality that it often appears easier for adults to suppress a child with drugs, rather than face the challenging task of transforming themselves and their institutions in a way that really meets the need of that child. 

Conclusion

Psychiatry and psychopharmacology do not rest on rigorous research and valid findings. The mental health system, rooted in coercion and guided by a pseudoscientific biological model, does not address the real needs of those it is intended to serve (Breeding, 1996, 2000c; Breggin, 1991; Colbert, 1996). Authentic informed consent is one key necessary prerequisite to genuine help. Cohen & Jacobs (2000) offer a wonderfully informative model consent form for psychiatric drug treatment, with the caveat that, "We are inclined to think that no one who was so informed would consent." Their model form is highly recommended for its direct and comprehensive description of psychiatric drug use. This article concludes with a model form in the spirit of Cohen and Jacobs; it is merely a summary of the plain truth about psychiatric drugs and children.

A Condensed Model Consent Form
  1. I understand that my child has been assigned a DSM-IV diagnostic label, based on my doctor's (and perhaps others') subjective observation of my child's behavior. I am aware that there is no medical evidence that my child has a medical problem, and no biological test that confirms the DSM-IV diagnostic label of the illness which my child is said to have.
  2. I am aware that I will never be able to remove this diagnostic label or any other from my child's medical record, and that this record may interfere with possible educational and vocational directions of my child.
  3. I have been informed that the drug or drugs my doctor is prescribing for my child cannot cure whatever "illness" or "chemical imbalance" this doctor may believe my child to have, but can only affect "symptoms." I understand that psychiatric drugs have not been demonstrated to have long-term positive effects on any measure of learning, behavior or social development in children.
  4. I understand that the review and approval process of psychoactive drugs by the FDA is both controversial and complicated, and that, therefore, all psychiatric drugs must be considered experimental. I have been informed of all the known effects of any recommended drug, and I have a copy of the current information listed on these drugs in the Physicians Desk Reference. I also am aware of the up-to-date accumulation of FDA adverse reaction reports of any prescribed drug; I understand that it is necessary to multiply the number of reported reactions by up to 100 to estimate the actual incidence of these reactions. I understand that stimulant drugs are generally considered to be addictive and to create dependency, and that drug withdrawal can pose serious problems.
  5. I understand that taking psychiatric drugs may cause severe pain and discomfort to my child, worsen my child's condition, or even cause my child permanent damage or death. I also understand that no body of research clearly shows that the problems indicated by my child's diagnosis require or respond more favorably to drug treatment than to one or more forms of nondrug treatment.
  6. I understand that this brief statement is only the "tip of the iceberg" regarding psychiatric diagnosis and drug treatment of my child, and that it is my responsibility to take the necessary time and trouble to fully research the relevant necessary information in order to make an informed decision on behalf of my child.
  7. I understand that since psychiatric diagnosis and drug treatment of children is considered customary and usual medical practice, doctors are generally not held liable for harm resulting from such treatment. Therefore, I understand that the effects of such treatment are, practically speaking, my complete responsibility as a parent.

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