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Attention Disorder or Not, Pills to Help in School

CANTON, Ga. — When Dr. Michael Anderson hears about his low-income patients struggling in elementary school, he usually gives them a taste of some powerful medicine: Adderall.
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The pills boost focus and impulse control in children with attention deficit hyperactivity disorder. Although A.D.H.D is the diagnosis Dr. Anderson makes, he calls the disorder “made up” and “an excuse” to prescribe the pills to treat what he considers the children’s true ill — poor academic performance in inadequate schools.

“I don’t have a whole lot of choice,” said Dr. Anderson, a pediatrician for many poor families in Cherokee County, north of Atlanta. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

Dr. Anderson is one of the more outspoken proponents of an idea that is gaining interest among some physicians. They are prescribing stimulants to struggling students in schools starved of extra money — not to treat A.D.H.D., necessarily, but to boost their academic performance.

It is not yet clear whether Dr. Anderson is representative of a widening trend. But some experts note that as wealthy students abuse stimulants to raise already-good grades in colleges and high schools, the medications are being used on low-income elementary school children with faltering grades and parents eager to see them succeed.

“We as a society have been unwilling to invest in very effective nonpharmaceutical interventions for these children and their families,” said Dr. Ramesh Raghavan, a child mental-health services researcher at Washington University in St. Louis and an expert in prescription drug use among low-income children. “We are effectively forcing local community psychiatrists to use the only tool at their disposal, which is psychotropic medications.”

Dr. Nancy Rappaport, a child psychiatrist in Cambridge, Mass., who works primarily with lower-income children and their schools, added: “We are seeing this more and more. We are using a chemical straitjacket instead of doing things that are just as important to also do, sometimes more.”

Dr. Anderson’s instinct, he said, is that of a “social justice thinker” who is “evening the scales a little bit.” He said that the children he sees with academic problems are essentially “mismatched with their environment” — square pegs chafing the round holes of public education. Because their families can rarely afford behavior-based therapies like tutoring and family counseling, he said, medication becomes the most reliable and pragmatic way to redirect the student toward success.

“People who are getting A’s and B’s, I won’t give it to them,” he said. For some parents the pills provide great relief. Jacqueline Williams said she can’t thank Dr. Anderson enough for diagnosing A.D.H.D. in her children — Eric, 15; Chekiara, 14; and Shamya, 11 — and prescribing Concerta, a long-acting stimulant, for them all. She said each was having trouble listening to instructions and concentrating on schoolwork.

“My kids don’t want to take it, but I told them, ‘These are your grades when you’re taking it, this is when you don’t,’ and they understood,” Ms. Williams said, noting that Medicaid covers almost every penny of her doctor and prescription costs.

Some experts see little harm in a responsible physician using A.D.H.D. medications to help a struggling student. Others — even among the many like Dr. Rappaport who praise the use of stimulants as treatment for classic A.D.H.D. — fear that doctors are exposing children to unwarranted physical and psychological risks. Reported side effects of the drugs have included growth suppression, increased blood pressure and, in rare cases, psychotic episodes.

The disorder, which is characterized by severe inattention and impulsivity, is an increasingly common psychiatric diagnosis among American youth: about 9.5 percent of Americans ages 4 to 17 were judged to have it in 2007, or about 5.4 million children, according to the Centers for Disease Control and Prevention.

The reported prevalence of the disorder has risen steadily for more than a decade, with some doctors gratified by its widening recognition but others fearful that the diagnosis, and the drugs to treat it, are handed out too loosely and at the exclusion of nonpharmaceutical therapies.

http://www.nytimes.com/2012/10/09/health/attention-disorder-or-not-children-prescribed-pills-to-help-in-school.html?hp&_r=0&pagewanted=all
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Avatar universal
The Drug Enforcement Administration classifies these medications as Schedule II Controlled Substances because they are particularly addictive. Long-term effects of extended use are not well understood, said many medical experts. Some of them worry that children can become dependent on the medication well into adulthood, long after any A.D.H.D. symptoms can dissipate.

According to guidelines published last year by the American Academy of Pediatrics, physicians should use one of several behavior rating scales, some of which feature dozens of categories, to make sure that a child not only fits criteria for A.D.H.D., but also has no related condition like dyslexia or oppositional defiant disorder, in which intense anger is directed toward authority figures. However, a 2010 study in the Journal of Attention Disorders suggested that at least 20 percent of doctors said they did not follow this protocol when making their A.D.H.D. diagnoses, with many of them following personal instinct.

On the Rocafort family’s kitchen shelf in Ball Ground, Ga., next to the peanut butter and chicken broth, sits a wire basket brimming with bottles of the children’s medications, prescribed by Dr. Anderson: Adderall for Alexis, 12; and Ethan, 9; Risperdal (an antipsychotic for mood stabilization) for Quintn and Perry, both 11; and Clonidine (a sleep aid to counteract the other medications) for all four, taken nightly.

Quintn began taking Adderall for A.D.H.D. about five years ago, when his disruptive school behavior led to calls home and in-school suspensions. He immediately settled down and became a more earnest, attentive student — a little bit more like Perry, who also took Adderall for his A.D.H.D.

When puberty’s chemical maelstrom began at about 10, though, Quintn got into fights at school because, he said, other children were insulting his mother. The problem was, they were not; Quintn was seeing people and hearing voices that were not there, a rare but recognized side effect of Adderall. After Quintn admitted to being suicidal, Dr. Anderson prescribed a week in a local psychiatric hospital, and a switch to Risperdal.

While telling this story, the Rocaforts called Quintn into the kitchen and asked him to describe why he was had been given Adderall.

“To help me focus on my school work, my homework, listening to Mom and Dad, and not doing what I used to do to my teachers, to make them mad,” he said. He described the week in the hospital and the effects of Risperdal: “If I don’t take my medicine I’d be having attitudes. I’d be disrespecting my parents. I wouldn’t be like this.”

Despite Quintn’s experience with Adderall, the Rocaforts decided to use it with their 12-year-old daughter, Alexis, and 9-year-old son, Ethan. These children don’t have A.D.H.D., their parents said. The Adderall is merely to help their grades, and because Alexis was, in her father’s words, “a little blah.”

”We’ve seen both sides of the spectrum: we’ve seen positive, we’ve seen negative,” the father, Rocky Rocafort, said. Acknowledging that Alexis’s use of Adderall is “cosmetic,” he added, “If they’re feeling positive, happy, socializing more, and it’s helping them, why wouldn’t you? Why not?”

Dr. William Graf, a pediatrician and child neurologist who serves many poor families in New Haven, said that a family should be able to choose for itself whether Adderall can benefit its non-A.D.H.D. child, and that a physician can ethically prescribe a trial as long as side effects are closely monitored. He expressed concern, however, that the rising use of stimulants in this manner can threaten what he called “the authenticity of development.”

“These children are still in the developmental phase, and we still don’t know how these drugs biologically affect the developing brain,” he said. “There’s an obligation for parents, doctors and teachers to respect the authenticity issue, and I’m not sure that’s always happening.”

Dr. Anderson said that every child he treats with A.D.H.D. medication has met qualifications. But he also railed against those criteria, saying they were codified only to “make something completely subjective look objective.” He added that teacher reports almost invariably come back as citing the behaviors that would warrant a diagnosis, a decision he called more economic than medical.

“The school said if they had other ideas they would,” Dr. Anderson said. “But the other ideas cost money and resources compared to meds.”

Dr. Anderson cited William G. Hasty Elementary School here in Canton as one school he deals with often. Izell McGruder, the school’s principal, did not respond to several messages seeking comment.

Several educators contacted for this article considered the subject of A.D.H.D. so controversial — the diagnosis was misused at times, they said, but for many children it is a serious learning disability — that they declined to comment. The superintendent of one major school district in California, who spoke on the condition of anonymity, noted that diagnosis rates of A.D.H.D. have risen as sharply as school funding has declined.

“It’s scary to think that this is what we’ve come to; how not funding public education to meet the needs of all kids has led to this,” said the superintendent, referring to the use of stimulants in children without classic A.D.H.D. “I don’t know, but it could be happening right here. Maybe not as knowingly, but it could be a consequence of a doctor who sees a kid failing in overcrowded classes with 42 other kids and the frustrated parents asking what they can do. The doctor says, ‘Maybe it’s A.D.H.D., let’s give this a try.’ ”

When told that the Rocaforts insist that their two children on Adderall do not have A.D.H.D. and never did, Dr. Anderson said he was surprised. He consulted their charts and found the parent questionnaire. Every category, which assessed the severity of behaviors associated with A.D.H.D., received a five out of five except one, which was a four.

“This is my whole angst about the thing,” Dr. Anderson said. “We put a label on something that isn’t binary — you have it or you don’t. We won’t just say that there is a student who has problems in school, problems at home, and probably, according to the doctor with agreement of the parents, will try medical treatment.”

He added, “We might not know the long-term effects, but we do know the short-term costs of school failure, which are real. I am looking to the individual person and where they are right now. I am the doctor for the patient, not for society.”
973741 tn?1342346373
Almost criminal in my opinion.  Not every child does well in school.  And things like this make it awful for the kids that have true diagnosable add/adhd.  

You give chilren the resources they need to live up to their potential. This does not include, in my opinion, drugs when they've not been diagnosed with a disorder that requires them.  

Avatar universal
I've got mixed emotions on the subject.  I do think that there are kids that honestly can and do benefit from medication, but at the same time, I think we are often too quick to medicate.  The reason behind that was mentioned in the article.... it's easier and more cost effective to "modify" the kid than it is to modify his/her surroundings.

Not only with ADHD, but I think we medicate for any number of reasons where perhaps therapy or behavior modification might be a better option.

Obviously, some kids do benefit from a proper diagnosis and medication while as other kids are simply dragged down.  And as special mom said, not every kid does well in school.  It is that simple and medication is not going to make these kids better students... its just not.

I grew up with 2 kids in the neighborhood whose parents were junkies.  Their grandmother ended up raising both kids as the parents were simply not fit to do so.  There were other things wrong with these 2 kids, but both got a diagnosis of ADHD and were treated with medication.  Mike was may age, and even with the medication, this kid was a handful!  Literally bouncing off the ceilings and you could tell when he was off his meds.  His sister on the other had was totally the opposite.  The medicine completely made her a zombie.... she basically was withdrawn and was enrolled in a lot of special education classes because of this.

It's been a problem for a long time, but it seems far more prevalent these days.... its a travesty.

Avatar universal
I have a grandson who is diagnosed with asbergers syndrome and his doctor has put him on an antidepressant and another med to calm him down as without it he is litterally jumping out of his skin and this is the only way the parents can work with him.

Another daughter has a son that was diagnosed with ADHD and is on adderal.

Then I have a son, who has two children on meds and he came to visit not long ago and said that is the only way to keep her under control as she had been expelled from two pre schools so far. He admitted that he asked the doc for meds because "it was against the law to spank" or try to control her and time outs never have worked.

I agree that some kids need this stuff but I am seeing that every time you take a child to the doctor for hyper or behavior problems, they throw em on meds.

I wonder what the long term affect will be of using meds to control a behavior. What damage will this do to the body for starters and at some point if you try to take the meds away, you will still have to deal with the behavior.

I have even seen moms that dont want to deal with their kids and give them meds so they will sleep.

When mine were little, the doctors would under no circumstances put kids on meds unless they absolutely could find no other way. It seems we have gone from one extreme to the other.

It seems that nowadays, if a teacher tells a parent they cannot control their child in the classroom, the kid is on meds to control his or her behavior.

I dont know, like specialmom said, its getting to where the ones that actually need it will not get the help they need and be overlooked as to just having behavioral problems.

Im on the fence with this one, Im not sure I know what to think anymore.
1310633 tn?1430227691
So if I understand this (what I just read):

Bad grades = prescribe Adderall
Good grades = don't prescribe Adderall

Whether the child has been "officially" (clinically) diagnosed with ADHD or not, they'll prescribe Adderall if grades are poor, assuming that ADHD is the cause of the poor grades.

Is that about the long and the short of it?

973741 tn?1342346373
I am in complete support of a family who has had their child diagnosed with a disorder to treat it medically if their physician thinks it is best.  This article is about ANY kid who has an issue in school being medicated.  That's crazy talk.  There are a lot of reasons why kids struggle in school and not everything is solved by turning them into zombies (which is what happens if a child takes this medication when they do not have the disorder it is supposed to treat.  They turn into a zombie or it acts like speed.  Neither is desirable in a child, in my opinion.)

I believe parents need to advocate for their kids---  if they need medication to function and be successful due to a medical diagnosis, so be it.  But if it is just to get kids to conform to being 'easy' in school---  that is bs.  

My own son has something that looks a lot like add/adhd.  Physical activity is what keeps his system calm.  Maybe if schools stopped taking away recess when a child is acting up and actually gave them some laps to run or something like that, they'd get the same affect as medication.  I'm just saying, a pill is easy.  There are other ways to help some kids stay calm and focused in school.  
973741 tn?1342346373
By the way, I don't think adderall makes kids smarter.  Some kids will always struggle academically due to IQ.  That's life.  
1310633 tn?1430227691
We're raising a generation of addicts.

Get a child used to taking a pill to "solve a problem" at an early age, and they'll parlay that into adolescence and then into adulthood.

Nice work big-pharma!

Maybe I could even STRETCH the blame, and point a finger at the Republican-Right, that's bought and paid for by BIG PHARMA.

That's a stretch, I know, but the incentives doctors get for prescribing meds these days (that they receive from the pharmaceutical companies), is disgusting.

Vacations, cars, time-shares... all for prescribing a particular pill.
Avatar universal
Recess and phys. ed.  They are stripping those two things for more time in the classroom.  Phys. Ed was mandatory through 10th grade when I went to school, and I have to tell ya.... I could have been a nightmare if I didn't have an adequate amount of time to "blow out" during phys. ed or recesses....
Avatar universal
I agree about the activity, children do not play outside anymore and they dont get to play much outside at home either. I hardly ever ever see children out in their yards or even riding bikes like they used to. Maybe that is why we also have obesity in children as well. A lot is just common sense. I also think big pharma has found another clientelle to make money off of, good point el!
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