In a shocking--but somehow sadly unsurprising--sign of the times, doctors are prescribing low-income children powerful stimulants like Ritalin and Adderall simply to help them focus at school. Nothing is necessarily wrong with these kids, but family physicians are increasingly handing out ADHD diagnoses to underprivileged children to help give them an academic boost.
“We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid,” the New York Times quotes Dr. Michael Anderson, a pediatrician for many poor families north of Atlanta, who routinely prescribes Adderall to healthy patients struggling in elementary school. “I don’t have a whole lot of choice.”
Of course wealthier kids have been receiving academic boosts--both pharmaceutical and otherwise--for years, and college-aged students have been known to pop the occasional pill for a marathon study session. But now the Times reports that the impulse has moved down a few grades and income brackets. Poorer parents eager to see their kids excel despite an inadequate scholastic infrastructure are making the Faustian bargain. There are, after all, potential side effects and a murky understanding of how these powerful psychotropic drugs may alter developing brains.
"We as a society have been unwilling to invest in very effective nonpharmaceutical interventions for these children and their families," 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, told the Times. "We are effectively forcing local community psychiatrists to use the only tool at their disposal, which is psychotropic medications."
The milder side effects of these drugs include sleep disruption, slowed growth and dependence. On the scarier end of the spectrum, the Times interviews 11-year-old Quintn Rocafort, who was made psychotic by his Adderall.
"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 Times reports. "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."
Still, even the physicians who find that these prescriptions have genuine classroom benefits are ambivalent. Ideally parents would be able to afford tutors and better schools for their kids. But Medicaid covers Ritalin, Adderall and their ilk, and under close monitoring many lower income students have improved their grades and generally performed better in school. In some respects, this does seem to level playing field.
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. He did tell the Times, however, that the rising use of stimulants in this manner can threaten what he called “the authenticity of development.”
What would you do? If you couldn't afford better schooling and a prescription to one of these stimulants would help your child focus and perform in school, would you opt for the prescription?