Rich Kid, Poor Kid

Are mental steroids a fair way to play the game?

Posted Mar 01, 2014

ADHD medications to help kids do better at school are like athletes using steroids to enhance their performance in sports. So say the authors of a new book on ADHD, The ADHD Explosion, in an interview with the Los Angeles Times on February 25, 2014.

"So if this is a smart pill, and it helps people who can afford it, why not? Part of me says yes," says co-author Richard Scheffler. But part of him says "no" as well. He asks: If it's the right thing to use steroids, why does our society think that it's not a fair way to play the game?

Co-auther Stephen Hinshaw, reflecting on the same issue, says that for a long time he thought that performance enhancement with stimulants was simply a personal choice. If stimulants improve kids' academic performance and adults' work performance, what's the problem? But now he questions his earlier view.

How rich kids get an ADHD diagnosis

One factor that Hinshaw finds significant is that college kids who start taking stimulants to boost their grades have a 15% liklihood of getting addicted to the drugs, which college students have traditionally called "speed". He concludes that it's O.K. for college kids who have been diagnosed with ADHD to take speed because their treatment is carefully monitored. Unfortunately, however, an ADHD diagnosis is easily come by if the student can afford to spend twenty minutes with a psychiatrist and knows what to say.

David Berry, a professor and researcher at the University of Kentucky is a co-author of a 2010 study that compared two groups of college students — those with diagnoses of A.D.H.D. and others who were asked to fake symptoms — to see whether standard symptom questionnaires could tell them apart. They were indistinguishable. “With college students,” Dr. Berry said in an interview, “it’s clear that it doesn’t take much information for someone who wants to feign A.D.H.D. to do so.”

So the playing field is tilted in favor of richer college students who can afford to see a doctor and get a diagnosis and a prescription for mental steroids. Various studies have estimated that 8 percent to 35 percent of college students take stimulant pills to enhance their academic performance.

How poor kids get an ADHD diagnosis

For younger children to get an ADHD diagnosis and stimulants, it actually helps to be poor and to live in a poor state. After George W. Bush signed the "No Child Left Behind Act" into law in 2003, ADHD rates started to rise among poor kids. By 2007, there was a 59% increase of the ADHD diagnosis among the poorest kids in public schools in the poorest states that got "accountability" under "No Child Left Behind." Accountability means that the schools' financing was attached to the school's standardized test scores. More ADHD diagnoses "helped" these schools because the test scores of kids with an ADHD diagnosis could be ommited from the school's scores. Moreover, kids with an ADHD diagnosis got special accomodations, such as a longer time to take standardized tests. So the school's scores improve one way or another with more kids having an ADHD diagnosis, and Medicaid pays the bill. There was no comparable rise in private schools in those same states, since private schools were not subject to the new rules of "No Child Left Behind."

I wrote about this shameful situation in a previous blog post, "No Child left Unmedicated." If a child is poor and lives in a relatively poor state, his chances of being drugged for an ADHD diagnosis is higher than that of a middle class or rich kid in the same state. I'm pleased that the authors of The ADHD Explosion noticed this as well. Medicating healthy but poor kids to make schools look good is a societal scandal. In my view, the more authors who are aware of this issue and bring it to the attention of policy makers the better.

A federally-funded preschool program that linked funding to test performance could potentially have tragic consequences. It would lead to scores of even younger children being diagdosed with ADHD. Since the American Academy of Pediatrics lowered the age at which a child can be diagnosed and medicated with ADHD to four (previously it was age six), preschool children are now eligible for the diagnosis.

Perhaps we should learn from Finland, a country with one of the best schools systems in the world, and do away with standarized testing altogether. Another solution is to dissolve the relationship between standardized test scores and financial rewards for schools (accountability).These measures could at least prevent healthy children from being unnecessarily drugged with speed because they are poor and come from less eduacated families.

Are ADHD Drugs Safe?

I do not agree with Hinshaw and Scheffler on everything they say. For one thing, I don't agree with their opinion that stimulants are among the "safest drugs" that psychiatry uses. They don't mention the inconvenient fact that stimulants are schedule 2 controlled substances, in the same category as cocaine and morphine. As population care expert Brad Stulberg said in a recent Huffington Post article, the medications used to treat ADHD carry "significant side affects" for children who take them. Examples he gives are insomnia, appetite loss, and hallucinations. Stunted growth and other psychotic symptoms are other potential side affects of stimulant drugs in young children. There is also the psychological danger of addiction.

Even Edward Hallowell--who is famous, or infamous, for saying that the stimulants he prescribed to thousands of children were "as safe as aspirin"-- told the New York Times recently that he regrets saying these words. Now he says he is much more cautious about diagnosing and prescribing stimulants for kids. Hallowell added: "I think now's the time to call attention to the dangers that can be associated with making the diagnosis in slipshod fashion...That we have kids out there getting these drugs to use them as mental steroids--that's dangerous, and I hate to think I have a hand in creating that problem."

Although I disagree on a number of issues with the authors of The ADHD Explosion, they do discuss an  important topic in our society that bears reflection. Why do we stand by while doctors prscribe speed to millions of healthy children, and is this the kind of society that we really want?

Copyright © Marilyn Wedge, Ph.D. 

Marilyn Wedge is the author of Pills are not for Pre-Schoolers: A Drug-free Approach for Troubled Kids and a forthcoming book that offers a new paradigm for the understanding and treatment of  ADHD.