Your Child's Education & Prescription Drugs?

Leave it to Colbert to turn me onto some interesting information. While watching tonight's episode (there's nothing else on, may as well catch up on the satires) I learned about the following article. Thoughts?

Attention Disorder or Not, Pills to Help in School
By ALAN SCHWARZ

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.

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.

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 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.”

http://www.nytimes.com/2012/10/09/health/attention-disorder-or-not-children-prescribed-pills-to-help-in-school.html?pagewanted=all

“We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

This all too easily sums up the world today and it seems absolutely ridiculous to me, personally. "If something isn't working, don't bother trying to figure out the real cause, just throw a pill at it and hope it goes away." :blink: :huh:

OH wait, the problem is, kids are kids. Oh and cut out the damn sugar. You know how hyperglycemia can cause bipolar like symptoms?

Even if they say my kids have ADD or ADHD, I will never put them on meds like that.

Asopo wrote: I will never put them on meds like that.

Neither would I, but parents see their children slipping behind and that has implications for the children. If they are making these diagnosis from the childrens behaviour then it sounds like the wrong treatment. I'd have thought a test showing some imbalance would be required before messing with kids brain chemistry.

It sounds like its basically the drug that my mates called speed. If I had that at 15 I think I would have done better at school as well, but if society is going to use it to improve poor students results, then make it legal and pharmacy dispensed so everyone can get the same benefit..... unless its unhealthy in which case you shouldn't be giving it to kids.

alright, let me try to give the 'other side' rebuttal.

i have adhd. i have bipolar disorder. i am on pills that, if i dont take them, i would not be able to function in normal society.

in school, i was a straight A student. but Very easily distractable. this is still the case, i have just learned to adapt to it. it was not 'poor academic performance', or my parents wanting to drug me into submission. without it, i would have continued to get in trouble in class, bother other children, talk out of turn. its not that i was malicious, i just ... couldnt help it. and my grades would have slipped at some point as well...well, they did anyway, but thats a nother story.

so i took adhd meds for a few years. i used them as a bridge(?) to the point i was mature enough, self controlled enough that i could function without them, it wuold just be more difficult.

now my son has been diagnosed as well with adhd. i hoped that he would be spared some of my genetic maladies, but i guess not. which is to be expected as he is right near my clone anyway.

i am not going to hit you guys with the 'yall just dont understand!' line, even tho its true. i just ask that, for those of us who need this little bit extra, this stability, to allow it. think that, there but for the grace of god, go i. its hard most days. very hard. judgmentalism, scorn, ridicule...these are just some of the things i deal with. i know, i know, we all do. but its simply unnecessary. it doesnt help anyone, least of all me.

I don't agree with the use of meds for ADD/ADHD unless it's an extreme, provable circumstance.

That said, I REALLY disagree with this doctor's approach to using it for education in kids that don't even get the label of ADD/ADHD.

I'm sure there are some instances where it could be beneficial, everybody’s body chemistry is different, but I think there are a lot of kids that get misdiagnosed. Kids are hyper, it's who they are...for the moment. I don't think that drugs are inherently bad, but I don't think they're usually necessary. A lot of societies medical troubles could be cured by changing one's diet and activity level. It's just too easy to be lazy...I know I'm overly guilty of it.

I think if cutting the sugar and smacking kids worked the pills wouldn't be issues. I want to give the parents at least a passing nod simply because they cared enough to get involved in their children's life. Some of you who haven't gone to lower income schools or seen this junk first hand might be surprised by how often that isn't the case.

I think modern entertainment culture has a lot to do with ADD though. You create a world in which a child from the age of nothing through eighteen sits in front of a box or computer all day and has highly entertaining images flash quickly in front of then and wonder why real life can't compare. Are you kidding me? Throw that shit out the window! (And the sugar;) )

The thing to keep in mind with studies (Not the article but related material) like this is its easy to say, "When I was a kid XYZ/When my parents were kids XYZ" This is not 19xx anymore. Our tools for diagnosis and our idea of what to diagnose have changed radically in the last thirty years.

That being said, I do agree its an over diagnosed condition, and many parents are incredibly lazy.

Hmmm....response:

I do not allow my son to have (much) sugar, and no caffeine. I 'make' him exercise everytime I have him. We have preffered trails in the nearby wildlife refuge, even.

As this is the South, and I am old school in that regard (as my parents before me), if the boy needs a spanking, he gets a spanking. A couple of times, his mother even called me over to her house solely for that purpose. Each time I explain to him that when he can understand logic and reason, and not do something bad based solely on that, he will not be spanked. He's a smart boy. They are getting fewer and fewer, not one in months.

Modern culture, yeah. But what are ya gonna do? *i* like modern culture. I game. I watch some cartoons with him. I'm a smartphone right the crap now. So....

One thing I should have mentioned; I work in the mental health field. There is a copy of DSM 4 on my desk, and I eagerly await DSM 5. Trust me when I say I have done my homework on this condition (among many others, mostly mood disorders, naturally), and while I agree that it is probably overdiagnosed, there are cases where it most certainly is not, and the parents have done all in their power Before resorting to this. But something must be done, according to his teacher, principal, councilor, doctor. So something was, and he is so much better now.

I am glad this subject came up because it is very personal to me, and (unfortunately) I have much firsthand experience with it. I urge you to consider what I say because this is what shaped much of my life.

I am not a parent, nor will I ever be; but I have experienced ritalin firsthand. I consider it the modern version of the lobotomy. Growing up in the 90's, teachers were "diagnosing" every less-than-perfect student with ADD/ADHD, and pediatricians were giving out ritalin and similar drugs like candy, often without a psychologist or psychiatrist ever being involved. That was the case with me. I began taking ritalin when I was 8 and stayed on it well into 8th grade (age 13). Let's put it this way: I, as a grown man, am only slightly taller than I was at 13, and at 160 lbs, I am average weight; when I was 13, I weighed 80 lbs. I had hallucinations, I was always feeling sick, always tired. The effects are lasting. Confusion, occasional hallucinations, strange dreams, depression, and anxiety have stayed with me and will stay with me. This is a proven long-term effect of heavy and prolonged ritalin use. Also, it turns out there is now a larger number of people with Asperger's than ever before. While doctors are doing their usual stupid method of making something complicated out of it, I realize what it probably is: a side effect of giving ritalin to several generations. It's been considered a possibility that ritalin can cause Asperger's, and according to a few tests, this is probably the case with me.

I normally would not tell my business, but I feel people need to know this. I'm not bitching or asking for sympathy, so save it. I just hope I convince at least one person not to let a doctor (see: Nazi) pump their kid full of poison. Me, personally, I don't go to doctors at all, but I'll let you all make up your own minds on that.