Friday, October 12th, 2012
There is much ongoing conversation about an article in the New York Times which featured a pediatrician who reports giving kids who are struggling in school Adderall – which is prescribed for kids with ADHD – without first diagnosing them with ADHD. His rationale is that he does this for kids who are in low-income families who do not get sufficient support for their academic development or for services to help them if they have problems. He notes that this is a short-cut he takes because he knows that society, overall, does not invest nearly enough resources into giving kids the proper social and academic resources they should get. This practice was aptly captured by Stephen Colbert who coined the term “meducation” to refer to this practice of giving pills to kids to improve their school performance.
A lot can be said about this (and much has been already written). I’ll make three points.
First, it’s dangerous practice to give kids medication for anything unless a clinician goes through the proper steps to make a meaningful clinical diagnosis. For ADHD, there is a series of steps which include:
- gathering information from a number of sources, including parents, teachers, and sometimes the kids themselves (because kids with ADHD don’t just show problems in school or in home – the problems should appear across a number of contexts)
- using that information to consider a diagnosis in relation to the standard criteria (it’s not just a subjective impression)
- assessing symptoms of a number of other conditions such as anxiety, sleep problems, and learning problems like dyslexia (because symptoms of ADHD can be seen in kids with a number of other clinical conditions)
Without taking these steps, it’s just not acceptable practice to make a diagnosis. It would be like seeing that a kid is sneezing and has a runny rose and assuming they have the flu. Now it’s acknowledged that we don’t have biological markers that allow us to diagnose ADHD – it’s a behavioral syndrome. But ensuring that a kid meets the criteria that have been established is the best available way of identifying kids who could greatly profit from intervention – and it’s also a way to make sure a kid isn’t just slapped with a label without going through a rigorous diagnostic process.
Second, even when a child is diagnosed with ADHD, it is not a given that they will go on medication. A number of behavioral methods are available and should always be considered (and in my opinion used). And when a decision is made to go on a medication, the dosage, potential side effects, and impact on symptoms needs to be tracked carefully and consistently. Drugs like Adderall can be used safely but only with sufficient monitoring.
Third, giving kids medications to try to solve social problems is just not right. We shouldn’t be messing around with kids’ biology to circumvent the lack of adequate resources, overcrowding of classrooms, and the multitude of other factors that can undermine a kid’s academic progress. These are, without question, very hard problems to solve. But rather than giving kids pills, it’s interesting to note that Paul Tough’s new book begins to explore the utility of giving kids psychological boosts via social initiatives that may turn out to have real educational advantages.
There are kids in the world who have the severe level of symptoms that are consistent with a diagnosis of ADHD. I would guess that it’s about 2% of school-aged kids (prevalence estimates land somewhere around 9%, but estimates of kids with severe levels of symptoms are typically less than 2%). Routinely treating kids who suffer from social disadvantage with a medication that should be reserved for kids with the most severe symptoms is just not the solution anyone is looking for.
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