GEORGE LATHROP BRADLEY
AND THE WAR OVER RITALIN

HENRY H. WORK

One parent’s concern for his child has meant help
for several million children a century later

The Cosmos Club has always had an illustrious roster of members. One of its distinguished early members was George Lathrop Bradley (CC 1883-1906), a well-respected mining engineer with interests in various enterprises throughout the country. A friend of Alexander Graham Bell, he was an officer of the company in the early days of the AT&T. He amassed considerable wealth through his activities and accumulated a large library. Upon his death, some valuable documents were given to the Library of Congress, but most of his library was bequeathed to the Cosmos Club.

In 1880, the Bradleys were excited by the birth of Emma Pendleton Bradley, their only child. Reared with all the care possible by loving parents and relatives, she became, in her seventh year, a victim of encephalitis, which left her with severe behavior symptoms as well as epilepsy and cerebral palsy. From that point on, both parents devoted their attention to her care and to a search for cures for her disorder. Neuropsychiatry in that era was still in its infancy, and services for children were totally lacking. In despair, the parents set up a small hospital in their home in Pomfret, Connecticut, staffed by a full-time doctor and round-the-clock nurses.

George Lathrop Bradley (CC 1883–1906) Photographs courtesy of Emma P. Bradley Hospital, Levy Library Archives

Bradley died in March 1906. His daughter, age 27, died a year later, her mental state largely unimproved since the initial illness. The Bradley family’s experiences, however, were to have long-lasting implications for the care of many children with behavioral and neurological problems. In his will, Bradley provided funds to set up a children’s home in Providence, Rhode Island, his birthplace. The will stipulated that the home was to serve poor children afflicted as Emma had been, as well as to support and foster research to improve the health of such children. Construction was not to be considered until after the death of Mrs. Bradley, who died in 1919. By the late 1920s, the Rhode Island Hospital Trust, which managed the estate, decided that sufficient funds had accumulated and proceeded to build the Emma P. Bradley Home (now Hospital), which opened in 1931.

Arthur Ruggles, M.D., of the Butler Hospital in Providence was its first superintendent. He was followed in the mid-1930s by Charles Bradley, M.D., a distant cousin of George Bradley. Charles was a pediatrician who had studied neurology in Philadelphia, and he developed a strong medical program. Under his direction, extensive brain studies were undertaken of all the children referred to the Emma P. Bradley Home. As some of the tests left the children with headaches, the drug benzedrine was prescribed to ease their pain. This drug was a derivative of amphetamine, a known stimulant for adults. The children called the medication “arithmetic pills” because they seemed to be able to sit still and concentrate on their studies.

Subsequently, Charles Bradley expanded the use of these amphetamines to other children with behavior problems. Bradley’s studies were first reported in 1937 in an article entitled “The Behavior of Children Receiving Benzedrine.” The article provoked relatively little discussion at the time, despite the fact that it described the paradox that a stimulant when taken by an adult was somehow capable of calming children down.

Emma Pendleton Bradley Photographs courtesy of Emma P. Bradley Hospital, Levy Library Archives

FAST FORWARD:
ATTENTION DEFICIT DISORDER

While the effect of benzedrine in children was a subject that remained dormant for a decade or more, the study of children’s behavior problems was progressing quickly. It was obvious in the 1940s and 1950s that many children, primarily boys, were afflicted with very active behavior that interfered with their daily activities, especially in school. They seemed unable to sit still, plan ahead, or finish their tasks. One parent described them as existing “in a whirlwind of disorganized or frenzied activity,” a description shared by many other parents and teachers. And the number of these hyperkinetic or hyperactive children seemed to be on the rise.

As neurological studies focused on various forms of “brain damage,” it became evident that the defects lay in the sensory system. For reasons not entirely understood, these children were unable to filter out information and focus their attention on the specific tasks. Gradually, the diagnosis shifted from Minimal Brain Dysfunction (MBD) to Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD). ADD/ADHD is now generally considered to have a strong biological base, and recent studies at Harvard Medical School have looked at a defect in the DNA of afflicted individuals. In the 1950s, however, the war over the diagnosis of these disorders and the recommended treatments was about to begin.

Concurrent with the changes in diagnosis, there was also an increase in drug use (and abuse) in American culture. One therapeutic drug, Ritalin (methylphenidate), a drug related to the benzedrine used by Charles Bradley, came on the market in 1955, in response to a heightened concern about children’s behavior both at home and in school. The concern reflected a sense that the fidgety, restless, distracting activity of many children could be viewed as abnormal, affecting both the child and his or her peers. Parents, teachers, and physicians rushed to suggest the use of Ritalin—a rush that has not abated. It is important to note that child psychiatrists, fearing that prescription drug use might lead to later drug dependence or abuse, were more loath than pediatricians to use such drugs on children. Child psychiatrists today continue to stress the need to include a full range of therapies, especially individual and family counseling, in the treatment of children with ADD/ADHD.

By the 1960s, Ritalin and other stimulants were becoming a fixture in American culture. Pharmacologically, the drug seemed to work by modifying the sensory pathways in the brain. The lay literature suggested that the number of children taking Ritalin was in the hundreds of thousands: pupils lined up in schools to receive their pills from the school nurse. The more the behavior of such children was seen as pathological, rather than the result of the child’s willfulness or the parents’ inability to teach him/her to behave in a civil manner, the greater the tendency to treat the child with problematic behavior with Ritalin or similar drugs. Physicians were not the only ones on the front lines of the Ritalin wave. Schools, increasingly, pushed for the use of Ritalin to help with hard-to-handle pupils throughout the country, even as special classes were created for them.

But all this activity stimulated a backlash. As the diagnosis of ADD/ADHD became more firm and the disorders were incorporated in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association, opponents of drug therapy began to speak out. In the 1980s, charges of “mind control” began to appear in the press and in congressional hearings. One standard, if flippant, claim was that Tom Sawyer and Huck Finn would be diagnosed today as having ADHD, and prescribed Ritalin.

By the 1990s, there was a virtual “war” over the usage of Ritalin. In the lay press, there has been a barrage of articles and books condemning the use of these pills for “healthy, rambunctious boys.” Some parents decry the use of Ritalin as depriving the children of their normal childhood. A few worrisome allegations emerged about permanent brain damage from the use of Ritalin, though there is no scientific evidence of this. Other critics suggested links between Ritalin use and illegal drug use later on, though at least one recent study found that boys being treated with Ritalin for ADHD are far less likely to abuse drugs and alcohol when they are older.

In spite of this barrage of information and misinformation, the lay literature continues to be resoundingly in favor of drug therapy. Medical advertising, coursework, and journal offerings all attest to the popularity of Ritalin as a means of handling hyperactive as well as poorly managed children. Studies by the AMA and others have found little evidence that Ritalin is oversprescribed by physicians, who, for the most part, remain aware of the remedial effects of the drug and feel that it is underused.

No drug is a panacea, of course, and no single drug will prove to be an effective treatment for every child. But pressures from anxious and worried parents call for responses from physicians and schools. If there are problems with the misdiagnosis of ADD/ADHD and the misuse of Ritalin, it is likely because parents and school officials may be looking for a quick diagnosis and a quick solution for children with behavioral or learning problems. In some cases, it may seem easier to medicate a child than to offer the extra educational services he or she needs. Even children, aware of the disruption caused by their behavior, clamor for their daily pills! One author has described this situation as a “social trap” affecting both professionals and families.

As with all medications, Ritalin can have side effects. Early in treatment, it may have a suppressant effect on the appetite; later on, it may cause insomnia. To the harried parents, these are minimal concerns; to the opponents of drug treatment, they are horrendous. Concomitant with the increased use of the drug “because it works,” there has been a lessening of the use of psychotherapy for these restless, “bothersome” children.

The Emma P. Bradley Hospital, with additions built over the years, now serves over 3,000 children each year.

HEIGHTENING THE ATTACK

A critical point in the debate over the use of Ritalin was reached last year when three lawsuits were filed in California, Texas, and New Jersey on behalf of children allegedly injured as a result of having taken Ritalin. The suits, basically identical except for the names of the children involved, allege that the American Psychiatric Association (APA) and Ciba/Novartis, the manufacturer of Ritalin, “planned, conspired, and colluded to create, develop, promote, and confirm the diagnoses of ADD and ADHD in a highly successful effort to increase the market for its product Ritalin.” The suit also named the organization CHADD, a lay advocacy group for children and adults with ADD/ADHD, as a third defendant in the case. Two similar suits, most likely “copycat” maneuvers, also were filed in Florida and Puerto Rico.

The official response from the APA, which defended itself vigorously, states that “the allegations are not only groundless but are part of an opportunistic attack on the scientific process that underlies this effort.” Earlier this year, two federal courts, one in California and one in Texas, dismissed the suits filed in those states against the APA, Novartis, and CHADD. The Texas court pointed out that there were serious defects in the preparation of the suits and the defendants’ failure to provide any concrete statements to document their claims. A similar ruling was made in the California courts, which dismissed the case and ordered the plaintiffs to pay the defendants’ legal fees. Recently, the plaintiffs in Florida and Puerto Rico withdrew their suits before the courts had an opportunity to rule. The case is still pending in New Jersey.

In my view, these troubling legal challenges are a threat to the long legacy of George Lathrop Bradley and the Emma Pendleton Bradley Home. A century ago, when George Lathrop Bradley and his wife searched in vain for a diagnosis and treatment for their daughter’s affliction, medical science simply had no answers. Thanks in no small part to Bradley’s vision, modern diagnosis and treatment methods for many types of brain dysfunction, including ADD/ADHD, allow many children to become calm, productive members of society. When Bradley provided for the establishment of the Emma P. Bradley Home, he did so out of a generous and personal concern for the ills of children. For many in the field of child psychiatry, these legal attacks certainly do not foster advances in the field, and do little to serve the needs of the children George L. Bradley wanted to help.

Henry H. Work (CC ’73) is a physician certified in both pediatrics and child psychiatry. He completed a residency at the E. P. Bradley Home in 1940 and has been a close observer of the therapeutic use of Ritalin and other treatments for behavioral problems for over 50 years.

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