Drugging Poor Kids to Boost Grades in Failing Schools: One Doc Says Yes

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Why are so many poor kids taking risky psychiatric medications? A front-page story in Tuesday’s New York Times offers one surprising answer: some pediatricians are prescribing drugs — medications to treat ADHD — to try to boost kids’ grades and give the most disadvantaged students an edge in school.

Unfortunately, however, while well-intentioned, such prescribing may ultimately do more harm than good, as the Times’ Alan Schwarz illustrates in his story about Dr. Michael Anderson, a Georgia pediatrician, and some of his young patients.

Writes Schwarz:

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.”

While taking amphetamine-like drugs to improve academic performance is typically seen as a vice in richer children, Anderson considers it a virtue for poor kids, helping level the playing field. And there is little disagreement among child psychiatrists that lack of funding and resources means that giving drugs is often seen as the only option to help many children, even in cases where the evidence shows that talk therapies are not only safer but more effective.

(MORE: Antipsychotic Prescriptions in Children Have Skyrocketed: Study)

But the story of some of Anderson’s patients should give pause to those who promote this approach. Schwarz interviewed the Rocafort family in Ball Ground, Ga., whose four children have received prescriptions for medication from Anderson. Quintn, 11, experienced harrowing side effects from the amphetamine Adderall, which he was prescribed starting around age 6 because of his disruptive behavior at school.

As Schwarz puts it:

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 [the antipsychotic medication] Risperdal.

Yet despite this extremely severe and dangerous turn of events — a previously healthy child winding up in a psychiatric hospital hallucinating and feeling suicidal — the Rocaforts continued to medicate Quintn and the rest of their children. Quintn’s twin brother is taking Risperdal, too, and despite Quintn’s experience with Adderall, the Rocaforts give it to their 12-year-old daughter, Alexis, and 9-year-old son, Ethan, despite insisting that they don’t actually have ADHD (according to Anderson, however, who checked the children’s charts, the Rocaforts had marked a five out of five on nearly every item on a parent questionnaire assessing their children’s severity of behaviors associated with ADHD):

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?”

There are many possible reasons. For one, the side effects of drugs like Adderall include growth suppression, raised blood pressure, possible increases in heart attack and stroke risk and, rarely, psychosis. (In 2005, Canada briefly banned the extended-release form of Adderall because of 20 deaths, 14 of them in children, but it was put back on the market and never pulled in the U.S. because the connection between the deaths and drug was not clear.) The treatment of children with stimulant drugs for ADHD has also raised concerns about risks of later drug misuse and addiction. Although data suggest that it actually reduces or at least doesn’t increase this risk — children with genuine ADHD are already at higher risk of later drug problems — much of this data has been published by researchers with ties to stimulant manufacturers. Indeed, last year the researchers, from Harvard, were sanctioned by the university for failing to disclose large sums of money received from drug companies and for violating the school’s conflict of interest policies.

For children who don’t have ADHD but are taking stimulants simply to improve mood and grades, the risks of later drug abuse would intuitively seem far higher, but there is no data on the question.

(MORE: Top 10 Drug Company Settlements)

As for antipsychotic drugs like Risperdal, the harms are much clearer. Risperdal’s maker, Johnson & Johnson, is involved in a $2 billion settlement with the government for hiding data on the serious harms the drug can cause and for promoting it for children despite lack of evidence of benefit. Data show that the drug typically causes weight gain of 5 lbs. to 13 lbs. and increases the risk of diabetes by 50%. It is linked with increased risk for heart disease, stroke and sudden death. Because of its effects on a hormone called prolactin, it can cause some teenage boys and men to grow breasts.

“I’m almost speechless,” says the normally loquacious Dr. Bruce Perry, a leading expert in child trauma who has spent much of his career working with poor children, regarding the Times story. [Full disclosure: Perry and I have written two books together.]

Perry notes that the potential for stimulants and antipsychotic medications to alter the development of key neural networks — especially those that affect the neurotransmitter dopamine and, therefore, the ability to feel excitement, desire and motivation — in children’s growing brains is “very real.”

For example, research in rats has shown that exposure to the ADHD medication Ritalin during adolescence not only reduces the enjoyment the animals derive from cocaine, but also lessens pleasure from sex and sugar. It is not known whether the same changes would occur in humans or, if so, whether such alterations would be large enough to cause the pleasurelessness and amotivation that often accompany depression. But the possibility alone suggests the wisdom of restricting use of the drugs only to the most severe cases in which other approaches have failed.

(MORE: Psychiatrist Contends the Field Is ‘Committing Professional Suicide’)

Further, Perry says, there’s little reason to support the use of the antipsychotic Risperdal in children with ADHD at all. “Quality data about the use of Risperdal for these problems is scant to nonexistent, while the known adverse effects of all of these medications are significant,” he says. “The balance between potential benefits versus potential risks does not seem to be in favor of this cavalier form of prescribing.

“It is sad that our field has deteriorated to the point where clinicians would essentially give up on therapeutic efforts that are enduring and much more likely to cause meaningful changes in the brains of developing children and retreat to the use of non-specific and questionable psychopharmacology,” Perry adds.

Poor children need better schools and less chaotic neighborhoods and homes. Perhaps the money from the $2 billion settlement with J&J can be directed toward providing the education, parenting training and therapy that could really make a difference. If drug companies are going to profit by fraudulently selling medications for use on vulnerable children, shouldn’t they be made to pay for treatment that would actually help them?

Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland’s Facebook page and on Twitter at @TIMEHealthland.

19 comments
GinaPera
GinaPera

To Time magazine editor:

Why is Maia Szalavitz writing on this topic? With every other sentence, she betrays a shocking ignorance about ADHD and everything associated with it.

She flatters and quotes her book co-author ad nauseam. He is not an expert on ADHD. He is trying to insinuate himself in an area where he has absolutely no qualifications. His fearmongering is straight from the anti-psychiatry playbook.

Who funds his "Child Trauma Academy" where he is the "senior fellow"?  The website is not transparent in the least.

He seems to be selling courses, and perhaps profiting from his "fellow" status.

How can a person be a fellow in his own for-profit not-for-profit

In short, Time editors -- please hire people with actual knowledge of neuroscience instead of the most amateur pretensions to such.

SteveMcCrea
SteveMcCrea

It is particularly foolish to give kids stimulants to improve their school performance, because there is no evidence that it does that, except for the very short term. It might help a little to give some stimulants shortly before the exam, or perhaps to help stay alert while doing some last-minute cramming. But in the long term, it's never been shown that stimulants improve academic performance. "ADHD" kids who don't take stimulants do just as well as those who do. 


It's scary that doctors would consider prescribing for such a purpose, even if it did work. Something is very wrong with our society when we're willing to give our kids dangerous drugs just so they can get better grades in a school that doesn't meet their needs. There has to be a better way!


---- Steve

KimZolciak
KimZolciak

The purpose wasn't set up drug worked, however the proven fact that parents, doctors and educators are putting children's health in danger by prescribing a pointless medication rather than actually doing what must be completed to improve schools as well as their environments.

I'm able to only think that schools were somehow better? I am inclined to think society generally must is becoming very selfish and foolish through the years if can't spend precisely what it takes to correctly educate our kids.

Know more about health facts here:
http://www.medstorerx.com

ILUVMEDICINE
ILUVMEDICINE

The 6 year old child was disruptive in class ...really what do you expect from a six year old child ...we should medicate children for being children... 

I remember my little brother was in kindergarten and the teacher was sending notes every week saying he was talking in class with friends, getting up without permission even got my mom thinking this was some kind of a terrible thing .... until my dad put it in perspective for her he was like yes he acts just like a kid....but we spoke to him anyway we encouraged him and had hundreds of talks over and over again about importance of paying attention in class and the appropriate times for socializing with your friends is during recess and later he was over it ... his new teacher now says he is great enthusiastic child who is interested in everything even calls him a happy apple because he is often smiling and is in a good mood. 

I was a kid and I was disruptive in class at times talking with my friends was sometimes very tempting or doing my own thing ....I can not imagine how my life turned if someone was trying to make me believe I was doing those things children do because of some mental illness. Being a little restless, energized used to be a characteristic of a healthy child , people would say well yes of course she was talking in class she is full of energy ...and I am 23 that is not that old ....you take your kid home talk to them , discipline them accordingly but at no point do you give them meds for non existing disorder ...just because it makes your job as a parent easier. What is the point of trying to leave behind the old grading systems that would negatively affect the children abolishing the red pen , making efforts to encourage children to be persistent in the quest for improvement if we are going to put even more difficult problems on their backs and expose them to more pressure .... they would deal with red pen better then the idea that their child like behavior is result of a mental disorder...how do you handle that.  Not to say there are no children who do need actual help ...but being a naughty kid that is not doing well in school should not be enough to prescribe them meds. I wonder how do you get from my child is misbehaving and had bad grades to giving them meds for ADHD even if they do not have it ....is it the panic that makes us confused and vulnerable , suggestive desperate . Does our culture of wanting quick fixes and fast results predisposes us for drawing wrong opinions and therefore wrong answers........and if so do they make a pill for that .... ??? 

Jael James
Jael James

Parents who allow their children to take drugs for conditions that they do not have should not be parents. Period. Read the side effects and then ask why any parent, in their right mind, would willingly and needlessly expose a child to such: http://www.ncbi.nlm.nih.gov/pu... As a parent with a now adult son  who does not have ADHD, but who teachers "suggested" may need treatment (he was restless in class after weeks of having recess taken away for something he did not do and that I was not made aware of), I say that it's past time for people to start parenting again and stop leaving everything up to the so-called experts. My son grew into a happy, well-adjusted adult who graduated high school and attended college without medication. Thank goodness I didn't take the advice of teachers who wanted to medicate instead of doing their jobs...which included notifying parents early of problems in class.

mike anderson
mike anderson

It a shame that this "DR. Anderson" is still in practice. I personally know mothers who use to take their kids to see him and he writes them whatever drugs they want. This man has performed surgeries on almost all of their kids. Most of them deemed medically unnecessary. Almost all of them had MRSA infections right after. He also knocks them out to perform the surgeries. One friend's daughter was so traumatized by him cutting on her vagina for MRSA that she had to seek counseling afterwards. Come to find out she could have easily treated it with antibiotics! Now she has a horrible scar and has to have a second surgery to correct it! Who is this guy and when is Georgia going to wake up that he is a fraud! And they have also told me he keeps his pet dogs in the reception area. One friend saw dog poop in the waiting room!  And he has the nerve to write "poor kids" meds so they have an advantage later in life? Give me a break!

Jens Nordmark
Jens Nordmark

There is no reason to choose between either biomedical or social engineering, the best end result will be obtained by using both.

Ruth Raynor
Ruth Raynor

How about you offer more contraceptives and sex education so half these kids aren't born in the first place instead?

Talendria
Talendria

This article asks us to make a judgment about medicating children who struggle in school but doesn't offer any information about whether the drugs improved the children's performance.  Did their grades go up?  If so, by how much?  Did their behavior improve?  Would they have been kicked out of school if their behavior hadn't improved?

In general, I'm against drugging children, but this article is sloppy reporting.  Time Magazine needs to send its entire staff back to journalism school.

Robert Harvey-Kinsey
Robert Harvey-Kinsey

I have very mixed feelings about this.  True these drugs have risks and it is true that the schools and society should adapt to service these children. The fact is, though, they do not, have not, and will not for decades. Keep in mind before public education, children like this were not placed in school so this is a problem of the modern era that has yet to be adequately addressed.

Articles that inflame emotions like this need to do more to compare the drugs' side effects to real world outcomes without them. Given both the government and most tax payers have refused to fund the changes needed in school to help them, children with ADD/ADHD like problems are often left hopeless with no way to succeed and little hope of living a successful life absent drugs therapy. It is when you compare the level of success of children who take drugs for ADD/ADHD compared to those who don't that you see why parents make this harrowing choice. True many children suffer terrible side effects, but that vast majority do far better than they would have otherwise. Even with the terrible side effects of the drugs when you compare the type of negative outcomes for those not taking them such as drug use, criminal behavior  conduct disorders, and abject poverty; one has to wonder which is really worse.

Yes, it is the fault of society that we medicate these children, but do not blame the parents for making what for most is the only viable choice to let their children have a chance of living a normal life.  Parents are choosing the lesser of two evils. It is the government and tax payers who vote against helping these children who are the guilty parties.

Mark Hinds
Mark Hinds

No doubt they're working on that - just be patient :-) BTW, why do you suppose there are so many antidepressants prescribed?

On a serious note I see people here complaining about some lack info - Yes, from the article one could/should conclude that these drugs do improve academic outcomes. For me that is not a sufficient excuse to inflict these drugs on children. It seems to me that we have simply become lazy and cheap as a society and this is just one more symptom of that greater malaise.

GinaPera
GinaPera

@Talendria Thank you for noticing the shoddy journalism. I won't even call it that. It's closer to blogging with a personal agenda.

It's horribly reported, and with a flaming agenda.  The author of this piece is the co-author with Bruce Perry of two books. She shows immense unprofessionalism (and her editors do as well) in allowing her to quote him as an expert on the topic of ADHD when he is an absolute non-expert.

He also has his own "academy" from which he peddles courses.

He is spouting a rogue view, and seemingly making money from it.

The author of this piece inaccurately explains the publishe research on ADHD.

Jael James
Jael James

The point was not whether or not the drug worked, but the fact that parents, doctors and educators are putting children's health at risk by prescribing an unnecessary medication instead of actually doing what needs to be done to improve schools and their environments. Perhaps you should write a better article. In it, maybe you can explain why someone who is against drugging children would even wonder whether or not an unnecessary drug with devastating side effects actually improves academic performance. So what if it does? Your point?

GinaPera
GinaPera

@Robert Harvey-Kinsey This author absolutely set out to flame emotions by starting with the incredibly sensationally reported story by Alan Schwartz at the New York Times.

The dirty little secret is that half-baked "journalists" see ADHD as an easy way to draw readers, controversy, and comments.

That they do this on the back of children and adults who have enough problems tells us all we need to know about these people.

SteveMcCrea
SteveMcCrea

@Robert Harvey-Kinsey Actually, they don't. Years of studies have not shown any long-term benefits in the aggregate for medicated ADHD children vs. non-medicated. There have been reviews in 1978, 1993, and 2001 that have verified this. There were big studies done in the US and in Australia, both of which show the same result: medication does not improve academic outcomes, or any other outcomes, for ADHD-diagnosed kids. I know popular culture and the drug companies will tell you differently, but that's the scientific consensus.


---- Steve

Mark Hinds
Mark Hinds

I'm not sure what the notion of the old days before public schools has to do with this. I'm 54, I never heard of such things (behavior control drugs) when I was in school. We were in fact pretty damn crazy (boys) and I got my bottom paddled more than once, yet somehow my generation and its predecessor did manage to get educated and accomplish a few things - without these drugs. I can only assume that schools were somehow better? I tend to think society in general must has become very selfish and foolish over the years if can't spend what is needed to properly educate our children.

Talendria
Talendria

You can't judge whether the drug was unnecessary until you have more information about the child's disciplinary record and grades. If a child is at risk of being expelled from school because he can't control himself or if an otherwise intelligent child is failing his classes because he can't sit down and focus, then I would probably medicate the child at least long enough for him to gain an understanding of what normal behavior constitutes. While I prefer organic methods, some children have such severe problems that you simply can't wait six months for a new routine to improve his attitude.

In general I don't like editorials masquerading as news. Journalists are supposed to present all the pertinent facts so we the readers can make up our own minds. http://www.spj.org/ethicscode....

GinaPera
GinaPera

@SteveMcCrea Why are you so invested in promoting the idea that medication does not help kids with ADHD?  You distort the studies you cite, and you in no way speak for the scientific consensus.  One wonders what dog you have in this fight.