Posted Feb 14, 2013

The furor began in October when Dr. Michael Anderson, a pediatrician who treats mostly children from low-income families in Georgia, said that he routinely prescribed ADHD medications for kids struggling in school.

Red flags went up more recently when the Centers for Disease Control and Prevention released data last month that said Missouri is second only to Mississippi in the percentage of kids who are prescribed medication for attention deficit hyperactivity disorder diagnosis.

The study indicated that Missouri doctors also may be making the ADHD diagnosis too frequently. The data show that nearly 9 percent of children in Missouri have been diagnosed with ADHD, and that 80 percent of them take prescription drugs for the behavioral disorder.

Dr. Ramesh Raghavan, a child mental-health services researcher at Washington University and an expert in prescription drug use among low-income children, said there are circumstances in which prescribing medication is a doctor’s only recourse to help a child struggling in school.

But he added that society should not force doctors into those situations, and should make available other methods to improve school environments and help families and children who are finding it difficult to thrive academically.

Dr. Raghavan said drugs are the first line of treatment for a reliable ADHD diagnosis, but making the diagnosis can be difficult. Frequently a child will have an underlying problem — such as a reading disorder or a learning problem — that looks like ADHD but isn’t, he added.

In such cases, the stimulants prescribed for ADHD will not help the child and may result in the child not being treated for the real problem.

Adequate treatment for behavioral disorders and learning difficulties, including easy access to mental health care, is critical, Dr. Raghavan said. Availability should not depend on geography or income, he added.

“It’s really immoral. We absolutely should be making investments in our kids. They should be able to have early and rapid treatment, and it should be sustained through childhood and adolescence,” he said. “It is unfair that a child in poor circumstances does not have the same access to treatment as a child in better circumstances. Where you live should not determine the care you get.”

Dr. Anderson, the Georgia pediatrician, explained that he diagnosed kids with ADHD so he could give them the medicine. But he said the real problem is bad schools and a culture that refuses to spend the money needed to fix them.

“I don’t have a whole lot of choice,” Dr. Anderson told the New York Times. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.”

His comments were picked up and circulated by education journals, people in the medical community, social workers and children’s advocates.

Dr. Raghavan was interviewed and quoted in the story that featured Dr. Anderson. He said that society’s unwillingness to invest in effective nonpharmaceutical interventions for poor children and their families has forced local community psychiatrists to use medication to help boost academic performance.

Giving drugs to kids who may not need them sounds horrible. But when you hear Dr. Anderson’s explanation, it makes an odd sort of sense. Still, it does not address the societal problems that have fostered an environment in which kids attend poor schools, demonstrate bad behavior and fail to thrive academically.

Dr. Anderson said that prescribing stimulants to low-income students who are struggling in school levels the playing field a bit. For families that cannot afford the time or expense of such behavior-based therapies as tutoring and family counseling, drugs are a reliable and pragmatic way to help kids become more successful students.

But then there are the horror stories that flood the media. The tales of affluent kids who are using ADHD drugs to achieve an academic edge. Kids who don’t have prescriptions getting pills from friends who do.

According to the reports, college kids long have used the drugs as study aids. But now high school students seeking a competitive advantage as they apply to colleges are dipping into the same pharmaceutical stash.

ADHD meds are dangerous and highly addictive. Side effects include disturbed sleep patterns, mood swings, increased blood pressure, growth suppression and elevated body temperature. In extreme cases they can cause psychiatric side effects, including paranoia, hallucinations, aggression, suicidal thoughts and psychotic behavior.

Finding and treating the causes of bad school performance is cheaper to society in the long run than misdiagnosing and looking for the quick fix with a pill. Again, research points to the need to spend money on the front end to spare the anguish and expense that comes from ignoring or mistreating the problems.

©2013 St. Louis Post-Dispatch

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