Dr. Nancy Rappaport has written a terrific piece outlining why it’s important that kids not be given ADHD medications just because they’re not doing well in school or are behaving badly. That is, without a real diagnosis of ADHD, by someone who believes it’s a real thing.

She is responding to the piece that ran last week in the New York Times, in which a Georgia pediatrician describes prescribing the ADHD medication for kids who go to lousy schools as a form of “social justice.” We can’t fix the schools, he said, so we “fix” the kids.

It’s a particularly bad idea, she writes, to use ADHD meds to manage distracted or disruptive kids in poor schools without an actual diagnosis because there are a lot of other reasons why those kids may be distracted or disruptive, and if they’re not addressed, those problems aren’t going to go away with a prescription for Adderall. In fact they might very well get worse.

For example, a child who has experienced trauma has many of the same symptoms as ADHD—”the hyperactivity, the disorganized approach, the distraction, the frequent mood changes, the anger, the reactivity,” explains Dr. Rappaport, a Harvard professor of psychiatry who focuses on kids’ mental health and schools. Undiagnosed learning disorders may cause a child to tune out, or to act out in frustration. These kids need a very different kind of help to do well in school—and life.

It’s troubling to acknowledge that we have to put the word “real” in front of diagnosis, to distinguish between a knee-jerk prescription and a serious assessment of a child’s behavior. Dr. Harold Koplewicz makes this point, and explains the difference, on a roundtable video on Huffpost Live. He also makes the point that the majority of kids who have behavior problems in school don’t have ADHD, and the one-pill-fits-all approach does a serious disservice to those who really do have the disorder, and do need the medication.