Adderall isn’t just for kids struggling with ADHD anymore. Kids all over the country are quietly being prescribed Ritalin, Adderall and other ADHD medications for a disorder that wouldn’t normally be dealt with in a doctor’s office at all: underperforming schools.
Doctors are giving their low-income patients these powerful prescription drugs to help them fit in and focus at school, not because they think there’s anything wrong with the kids, but because they’re powerless to improve the schools these children attend. Struggling students are being handed flimsy ADHD diagnoses and a bottle of pills to make up for the poverty that hobbles their home and school lives.
The New York Times reports on this phenomenon, talking to doctors who practice it and researchers who are thinking about it and families who’ve done it.
Here’s how one doctor describes this practice:
“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.”
While those prescribing these meds are acting out of a concern for children’s well-being and a social justice motivatio, there are obvious issues with this approach. Side effects of these medications are rare, but can occur. The NYT article includes an interview with a child who was made psychotic by his Adderall; his doctor switched him to a different pill. Less severe symptoms and side effects can affect even kids who have relatively good experiences with the meds. Sleep disruption, slowed growth and dependence are all concerns.
It’s not a simple equation. The challenges facing these kids are real. They are, as one doctor says, square pegs in round holes. Schools don’t have the resources to accomodate different needs and learning styles; the meds make these kids more like the other kids in their classrooms. They really do help them succeed. But at what cost? One doctor worries about disrupting the normal rhythm of a child’s development:
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.”
Now, normally I love ADHD meds. I take Ritalin every day. I rely on its effects to work, to stay focused with my kids, to keep track of details like when my deadlines are and what household bills are due. Without it I miss appointments and space out on simple things like getting my daughter a glass of water. I’ll make it to the kitchen with no idea what I went there for.
So I’m far from a detractor for medicating people with ADHD. Both of my kids appear to be neurotypical, but if either of them did show signs of having inherited my attention problems I’d readily turn to medication as part of a holistic plan for treating the disorder.
But I’m not comfortable with the notion of medicating neurotypical children to make up for gaps in the school’s ability to teach them. On the one hand, I see the argument for it from a parent’s perspective. Why not use every available tool to help your child succeed? Why should a pill be a less worthy boost to a kid than a tutor or an after-school program?
But from a social and public health stance, this seems like a red flag. We shouldn’t be medicating otherwise healthy children to correct for a broken system. We should be correcting the system to care for these kids.
What do you think? Would you give your kid Ritalin, even if she didn’t have ADHD, if you thought it would help her in school?