Race for perfection: children's rights and enhancement drugs.

• Author: Powers, Therese

1. INTRODUCTION

   Today's society places a strong emphasis on perfection. Everyone strives to be the best, and often we want to become the best in the quickest way possible. Parents are no different in demanding the best from and for their children. Every parent is happy with a healthy child, but at the same time every parent wants his or her child to be as successful as possible. This success may come in the form of academic, athletic, or cosmetic excellence. Parents, however, often find themselves too caught up in this race for perfection and the children are left behind. Who represents the child's rights when a parent becomes too attached to the situation to recognize any problem?

   Often, we find ourselves looking for the short cut to a solution. For example, a child may have behavioral problems and may not be performing well in school. Rather than take the time to address the problem, Ritalin may be given to the child so that he or she will just "sit still" and the stigma that the child is a "problem" will be removed. Also, a boy may be perfectly healthy; but may simply be excessively short. Rather than encourage the boy's self-esteem and accept him for who he is, Human Growth Hormone may be given to the boy to "enhance" his height.

   This Note will address the question of what are a child's rights when the child's views differ from his or her parents regarding the child's use or refusal of enhancement drugs such as Ritalin and Human Growth Hormone. This Note will begin with a description of Ritalin and Human Growth Hormone along with the uses and abuses of each drug. It will then discuss the evolution of children's rights dealing with situations such as civil commitment, abortion, and medical treatment over religious objection. Furthermore, it will draw comparisons from the case law in these situations to a child's right to refuse or have access to enhancement drugs. Finally; this Note will discuss the possibility of creating a statutory right to provide children with procedural due process rights with regard to enhancement medication.

   This statutory right will give children greater access to courts and, as a result, will enhance their ability to protect their personal autonomy. This Note proposes an administrative hearing be held to determine what is truly in the best interest of the child when conflicts of interest arise. The difficulties of such a hearing will also be addressed. An administrative hearing will be difficult to implement because of the obvious obstacles: (1) intrusion on parental rights and family autonomy; (2) expenses involved in administrative hearings; and (3) the procedural difficulties associated with conducting such a hearing.

2. OVERVIEW OF RITALIN AND HUMAN GROWTH HORMONE

   1. Ritalin

      Estimates show that between four and ten percent of all school age children currently suffer from Attention Deficit-Hyperactivity Disorder (ADHD).(1) Children with ADHD may exhibit symptoms such as inattention, distractibility, and impulsiveness, usually associated with excessive motor activity or hyperactivity.(2) The children who suffer from this disorder quickly frustrate teachers in the classroom because they are unable to conform to the classroom environment and thus, are often labeled as "learning disabled."(3) As a result of the teacher's frustration with this behavior, school administrators and parents react by demanding special education services or medical treatment.

      The symptoms of ADHD are difficult to detect and the standards related to ADHD are considered by many to be too vague.(4) Often it is difficult to determine whether a child truly suffers from ADHD or whether teachers and parents are instead dealing with an undisciplined, difficult child.(5) Guidelines have been established for each of the three major symptoms to aid in the diagnosis of ADHD.(6) These typical characteristics are variable symptoms which may not be visible to a clinician and therefore must be observed by teachers and parents.(7)

      A child's "hyperactivity can be distinguished from ordinary over-activity in that hyperactivity tends to be haphazard, poorly organized, and not goal directed...."(8) The overall social atmosphere in which the child lives is also important in determining the degree of a child's hyperactivity. It may become impossible to differentiate ADHD from symptoms of a child's social environment when a child is subjected to inadequate, disorganized, or chaotic environments.(9) Symptoms appearing to resemble ADHD may be fostered by abusive home environments.(10) Conversely, home environments which are supportive may minimize symptoms of ADHD.(11)

      The characteristics of ADHD have broad social and medical implications. A child's learning difficulties and a child's ultimate self-esteem both play a large role when the child enters the adult world. A child's ultimate self-esteem will be based on characteristics and personal feelings such as vulnerability; inability, and inadequacy.(12) Likewise, a young adult's self-esteem will suffer if she finds herself easily confused, unable to become organized, or incapable of completing tasks.(13)

      The symptoms and characteristics of ADHD are often associated with, and eventually lead to, other problems and disorders. A child's impulsiveness and distractibility may interfere with academic performance. ADHD is often present with other developmental disorders, including language disorders such as dyslexia, as well as more pervasive language disabilities.(14) In addition, learning disabilities are a characteristic frequently linked to juvenile delinquency.(15)

      The overall relationship of how ADHD affects a child's adult existence depends in large part on what actions are taken at the early stages of the child's education.(16) The therapy chosen to treat the symptoms of ADHD, whether counseling or drug therapy, will play a large role in the remainder of the child's life.

      One of the most prominent, effective methods of treating a hyperactive child is stimulant drug therapy.(17) Stimulant drug treatment is preferred because it is inexpensive and produces almost immediate results.(18) Methylphenadine hydrochloride, better known as Ritalin, is the most widely prescribed stimulant drug for treating hyperactivity.(19) Ritalin, combined with counseling and special education can be an effective treatment for truly hyperactive children.(20)

      Insomnia and nervousness are the most common side effects of Ritalin.(21) In addition, many children suffer from loss of appetite, abdominal pain, weight loss, and dermatological disturbances during periods of prolonged therapy.(22) More severe side effects such as allergic reactions, extensive bruising, and abnormally low red and white blood cell counts may also result from the use of Ritalin.(23) Ritalin has also been characterized as having the "potential for serious psychological dependence."(24) Most minor side effects usually disappear as the child becomes tolerant of the drug. The long term side effects of stimulant drugs on a growing child's brain are still not completely known.(25)

   2. Human Growth Hormone

      In 1985, the FDA approved the marketing of Synthetic Human Growth Hormone (HGH) for children with growth hormone deficiency.(26) Since its approval, the drug has become the forty-third largest selling pharmaceutical in the United States.(27) Human Growth Hormone can help increase the height of children who suffer growth retardation because of such disorders as growth hormone deficiency; chronic renal failure, and Turner's Syndrome.(28)

      Despite its FDA approval for growth-deficient children, HGH is increasingly being used for children for whom it was never intended.(29) Recent medical studies have indicated that HGH may cosmetically enhance short, but otherwise healthy children.(30) Approximately 7,000 children in the United States suffer from classic human growth deficiency; however, HGH is now being used by approximately 20,000-25,000 children.(31)

      A study conducted by Dr. Raymond Hintz, a pediatric endocrinologist from Stanford University, announced that treatment of extremely short children with HGH "yielded average heights two to three inches taller than heights predicted at the beginning of the study".(32) Overall, however, the study cautioned that while HGH may add a couple of inches to a healthy child, scientists are not able to predict which children will benefit from treatment.(33)

      The side effects, if any, of HGH will not be known for a number of years. Some commentators have compared HGH and anabolic steroids and have raised the possibility that HGH may be addictive because the desire to take the medication is driven by the same social motivation as steroid users.(34) In addition, there may be emotional and psychological problems associated with a child's use of HGH. There may be situations in which a child may actually want HGH because the child feels psychologically handicapped by his or her short stature.(35) The attention needed to administer the drug up to three times a week may; in itself, be a psychological burden.(36) In addition, children, as well as parents, may be disappointed if they have unrealistic expectations or there is no response to treatment.(37) A short, otherwise normal and healthy child, who receives constant injections to promote growth may be stigmatized by the implication that his or her body is unacceptable in the eyes of his or her parents.(38) The use of HGH on healthy children sends the message that being short is a problem and that the child is not good enough by his or her parents standards.

   3. Competing Interests in Administering Ritalin & HGH

      While there are many children who need and rely on Ritalin and HGH, there are also many children who are currently taking these medications for the wrong reasons. There are many children who really do have a difficult time with school as well as many children who suffer from severe growth deficiency. There are, however, children who become left...