One of pediatric psychiatry's most vocal and enduring critics is Peter R. Breggin, M.D. The former NIMH advisor served as medical consultant in a series of class action suits filed in Texas, California and New Jersey against Ritalin manufacturer Novartis, the APA and advocacy group Children and Adults with Attention Deficit Hyperactivity Disorder that alleged Ritalin's makers "directly affected and caused the APA to make every effort possible to support and confirm a new medical 'diagnosis' for which a stated treatment would be methylphenidate, i.e. Ritalin." The suits were eventually dropped, but ten years-post trial Breggin still has no love for the DSM.

"There is no percentage of the patient population accurately diagnosed (for ADHD). There is no diagnosis," he says. "It's fake, made-up to justify drugging. Everybody who works in the diagnostic panel over the years has been in favor of drugging the kids. That's the whole purpose of it. Impulsivity, inattention and hyperactivity are just categories of what could be normal childhood behavior, or something that reflects anything from a bored kid to a kid who's had a head injury. It's nonspecific. It's meaningless. It's not a diagnosis, and it should never be used as such."

One of Breggin's concerns is the rise and consequences of pediatric polypharmacy - the use of multiple medications to treat mental illness. A 'cocktail' of medications may be assembled to target specific brain chemistry when a single medication is ineffective, or to counteract the effects of other medications. While there are no current clinical trials that demonstrate the efficacy of this approach when it comes to pediatric psychopharmacology, its success in treating certain cancers and HIV/AIDS serves as anecdotal evidence that the idea has merit.

Breggin views polypharmacy as a cause rather than a cure. "Increasingly now I'm seeing children on multiple psychiatric drugs. That's partly because they get adverse reactions to the stimulants. Let's say they have trouble sleeping, so they're put on some form of drug that sedates them, and then when they start to get a little weird on the combination of drugs they're put on an antidepressant or some other medication," he posits. "By the time I get to see them they're on antipsychotics and the parents have forgotten what wonderful kids they were and it all began because he wasn't happy with his kindergarten teacher. Now we've got a kid who's been labeled as psychotic. And he's being labeled with bipolar disorder but he's actually having a manic reaction to antidepressants."

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