The New York Times has a provocative and compelling story on the front page today about the use of ADHD medications. It will be widely shared—and widely misinterpreted.
The story is about the growing use of ADHD medications to help kids struggling in school—kids, that is, who don’t have ADHD. A lot has been written about middle class kids cribbing Adderall to help them score better on tests, or scoring their own prescriptions to enhance their chances of making it into an Ivy League college. But this is about a different set of kids: those whose schools are underfunded and whose parents can’t afford the non-pharmaceutical support they need to enhance their school performance.
In the story we hear a lot from Dr. Michael Anderson, a well-meaning pediatrician near Atlanta who routinely prescribes ADHD meds to kids essentially because they’re struggling in school. “I don’t have a whole lot of choice,” he tells the Times reporter. “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 sees it as an issue of social justice, of “evening the scales a little bit” for these kids who would otherwise almost surely be failing in school—in schools, that is, that he perceives as clearly failing them.
Whoa. We need to establish some facts here. Kids who are failing in or behaving badly in school don’t necessarily have ADHD. It does a serious disservice to both kids who do have ADHD and kids who don’t to prescribe it as a fix for bad schools.
ADHD isn’t a disorder that just happens in school—to qualify for a diagnosis, a child must exhibit extreme inattention, hyperactivity and impulsivity in several settings, not just the classroom. It’s what we call a global impairment, and it’s not responsible or competent to see stimulant meds simply as a tool to improve school performance—or to compensate for a lousy school.
We know it happens, and we worry that it happens much more to kids whose families don’t have the resources to get other kinds of support they might really need—tutoring, behavioral therapy, smaller classrooms, better-trained teachers, consistent structure.
We worry along with one school superintendent who speculates that what’s happening is 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 ADHD, let’s give this a try.’ ”
This story also fuels the myth that ADHD medication is dangerous. The unsubstantiated suggestion that these meds can lead to lifelong addiction is irresponsible. There is a clear body of evidence that taking ADHD meds in childhood and adolescence does not increase the risk of addiction or abuse, and in fact they are among the safest, most effective, best-studied, and least easy-to-abuse psychotropic medications we have.
So what we have here is a sympathetic pediatrician arguing that when a kid is struggling in school, trying ADHD meds might be the most cost-effective thing he can do to help. “I am the doctor for the patient, not for society.” It may be cost-effective, but we’d argue that it’s not good either for the patient or the society.