Tonight on Rock Center NBC aired a special documentary on Adderall abuse at Columbia University in New York City. Students refer to the addictive drug as “academic steroids.” A Columbia student who became addicted to Adderall, and ended up dealing the drug on campus before he was arrested in a narcotics raid and expelled from the University, tells his story to NBC: http://rockcenter.nbcnews.com/_news/2012/10/16/14455856-adhd-drugs-become-popular-dangerous-study-solution-for-students?lite
Earlier in October 2012 I reported:
The following typical but fictional ADHD story represents my own opinion. I wrote it after reading an article in the October 11th 2012 online issue of The New York Times. The Times article follows my essay.
I am forever grateful that as a high IQ kid, I was re-directed by smart observant teachers during my K12 years into higher intellectual activities, and not doped by my community because I was really bright, really creative and a little bit bored in class. I really dodged a bullet there. If parents imagine their children are “mental ill” or have a “personality disorder” when they act out now and then, or if parents think there is something wrong with their bright and creative children simply because they occasionally actually behave like children, I’d like to suggest that these “pro-doping” parents visit a psychiatric ward in their local community and spend an afternoon observing the genuinely genetically and pathologically mentally ill. I think that would be an eye-opener for misguided parents who want to label every little childish outburst in their kid as a sign of mental illness.
BACKGROUND: Little Johnny is nine years old. He loves to learn. He also loves to run and around and play. He likes horseplay. He’s a little boy who like to rough and tumble once in a while. Little Johnny has an IQ of around 139 but no one knows that yet. He hasn’t been tested. Little Johnny is also a naturally biological alpha male child, so he rather likes to take charge. It’s a genetic trait that for more than 200,000 years of evolution has helped the human species to survive and thrive. Biology has provided for natural leaders to bubble up in the human gene pool in each generation of newborns and little Johnny is one of those natural biological leaders. One could even say he was “born this way.”
Funding cuts in his school district have eliminated most of the physical education programs. Johnny and his friends used to be able to run and play supervised games outdoors for a half hour after lunch each day, along with another 20 minute recess later in the day. But they don’t have a physical education program anymore at Johnny’s school. The school can’t afford it. The school can barely afford books and supplies. Now Johnny sits, sits, sits for eight long hours in the classroom. Johnny is expected to sit still, be quiet all day long, and focus on his studies without moving around. Johnny, like any NORMAL nine year old boy, needs to run and exercise and be active and do physical activity. His brain and body are developing and he literally needs to move to stabilize his body’s growth patterns and work and stretch growing bone and muscle tissue. Johnny is really restless. Johnny doesn’t really get enough outdoor exercise during the school day. So Johnny jumps up and down in the back of the room at school and makes hooting noises after about four hours of sitting because he wants to go outside and play. The teacher gets mad. Johnny doesn’t like to sit still for eight hours. So now Johnny is also a little bit mad. No one really “gets” Johnny.
The teacher and the school system want Johnny to sit. All day. Every day. Johny doesn’t want to. Johnny gets restless. Everyone gets together to have a big important meeting about Johnny. Maybe something is wrong with Johnny. Maybe Johnny is mentally ill. Maybe they will all need to do something about Johnny’s mental illness of not wanting to sit still all day. Maybe they can call this mental illness they have decided Johnny has A.D.H.D.
Johnny doesn’t have A.D.H.D., the fictitious attention deficit hyperactivity disorder that many American psychiatrists and physicians openly admit is a fraudulent make-believe disorder. But the school system, Johnny’s parents, his school appointed psychiatrist and the school principle have all conferred about the problem of Johnny hopping up and down in class all day, and the decision has been made to DOPE Johnny into submission in the classroom. No one thought to examine Johnny’s diet or his sugar intake. Sugar is a strong drug but everybody ignores that fact.
Johnny’s parents are ALL ON BOARD with this plan, as they think it might make Johnny a little bit more manageable at home after school as well. Johnny doesn’t have a chance in hell. No one in this scenario is advocating for Johnny to grow up drug free in a clean healthy body that’s not affected and bent by psychotropic and / or anti-psychotic medications.
The decision is made and now Johnny sits in a chemical straightjacket through his classes all day. His grades go up a little bit. Everyone is thrilled about Johnny’s progress. But Johnny is now addicted to his meds and he acts out violently when he misses a dose. Sometimes he just acts out violently anyway. No one really knows why. The supervising psychiatrist [ Did Johnny ever need a psychiatrist in the first place? Does a highly energetic active little boy who is completely normal really need a psychiatrist just because he wants to move?] now decides that Johnny is a little bit “too amped up” and will also need a sleep med to calm down at the end of the day and be able to sleep. A night time sleep aid is prescribed. Like the day med, it’s habit forming. Johnny passes out at 10 O’clock every night on his sleep med. Each morning he gets his day med and each night he gets his sleep med. Johnny is not ten years old yet. Johnny is a junkie now.
By the time Johnny is fourteen years old, adolescence will kick in and he will crave other stimulants to supplant and enhance the ones his parents give him every day. He will start to experiment. Since drugs are everywhere all over the house, and everywhere all over the neighborhood in his home town he figures it’s fine to do this. It’s no different than how he has grown up so far.
The problem is, Johnny is still emotionally about nine years old. He never really moved forward in his emotional development because the day meds and the night meds changed all that. Everything just slowed down to a crawl. Now Johnny never really feels like he understands what is going on around him, but his body is tall, strong and full of strange new urges. Johnny needs more drugs or Johnny is going to act out again on the girl next door.
Johnny doesn’t know it yet but he is headed to juvenile court and then onto prison in about two more years. And the entire community surrounding Johnny helped this all to happen, including his own parents. It took a village to turn Johnny into a junkie. This is parenting in the new world order. This is another part of the “new normal” they are selling us. The lack of outrage by parents against what was done to Johnny is part of the new world order too. It was easier to raise Johnny when Johnny went on the day and night meds. No one had to work very hard at parenting. But now the whole family will pay the price. Johnny is going to be in and out of courtrooms and prisons all of his life. Everyone in the family, his schools and the courts will pretend they don’t know what went wrong with Johnny. They will all take their own meds and go back to their seats and open their books then bury their faces in denial. Johnny will disappear onto the streets and into the criminal justice system. Johnny never had a chance in hell. Bye Johnny.
I found one small bright spot in this horrific tale of what the system wants to do to Johnny to make it easier for his teachers and his parents to get through the day. Two of the comments under this article below showed signs of intelligent life. So I have included them.
“Stephen Colbert had a word of the day several years ago: psychopharma-parenting. Parents want the meds to do their parenting for them, whether it’s because they have to work two jobs or have four other kids, or even just because they’re lazy parents (shocking idea, I know.) Medications are not benign interventions; it’s not like we’re giving them a few days’ worth of antibiotics. As demonstrated by the little boy’s psychotic episode, there are serious problems that can happen. And if ADHD medications aren’t entirely benign, then antipsychotic medications *certainly* aren’t. My response to a psychotic episode due to medication is not to prescribe an antipsychotic: it’s to stop the medication that started it in the first place. Period.”
New York Times, October 11th 2012:
Attention Disorder or Not, Pills to Help in School
Bryan Meltz for The New York Times
Amanda Rocafort and her son Quintn in Woodstock, Ga. Quintn takes the medication Risperdal. More Photos »
Published: October 9, 2012 728 Comments
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.”
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A version of this article appeared in print on October 9, 2012, on page A1 of the New York edition with the headline: Attention Disorder or Not, Pills to Help in School.
I’m a pediatrician and a child psychiatrist, and I deal with ADHD on a daily basis. I get where this physician is coming from. It’s beyond frustrating, trying to get schools and parents to alter the child’s environment to make it more learning-friendly. They either can’t or won’t put in the time and money (for the schools, it’s more won’t), so what are we left with? However, using these medications as a crutch is beyond dangerous. I have never prescribed ADHD medications to a child who didn’t meet the criteria for it. The concerns for dependence are valid, as are the dangers of illegal diversion, particularly in low-income areas where drug problems tend to be worse.
Stephen Colbert had a word of the day several years ago: psychopharmaparenting. Parents want the meds to do their parenting for them, whether it’s because they have to work two jobs or have four other kids, or even just because they’re lazy parents (shocking idea, I know.) Medications are not benign interventions; it’s not like we’re giving them a few days’ worth of antibiotics. As demonstrated by the little boy’s psychotic episode, there are serious problems that can happen. And if ADHD medications aren’t entirely benign, then antipsychotic medications *certainly* aren’t. My response to a psychotic episode due to medication is not to prescribe an antipsychotic: it’s to stop the medication that started it in the first place. Period.
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