Give 'em amphetamines: Part Two

I wanted to add some statistics to yesterday's post about giving kids stimulants to help them through their long days.

A steady rise in prescribed stimulants and ADHD diagnoses in school-age children has been underway for well over a decade. For instance:

PULLMAN, Wash. [1999]--A new study by Washington State University researchers reveals physician office visits for the treatment of attention-deficit/hyperactivity disorder (ADHD) more than doubled between 1990 and 1995. The study also shows that stimulant prescriptions for drugs that treat the disorder, such as Ritalin, nearly tripled among children 5-18 years old.

A 2001 PBS Frontline program found that:

[T]he vast majority of prescriptions for amphetamine and methylphenidate are for children diagnosed with ADHD. Methylphenidate [Ritalin] prescriptions rose dramatically in the early 1990s and have since leveled off at approximately 11 million per year. In comparison, amphetamine prescriptions, primarily Adderall, have increased dramatically recently, from 1.3 million in 1996 to nearly 6 million in 1999.

The Frontline program suggested that a typical US classroom includes 2 to 3 kids taking behavior-modifying drugs, usually a stimulant for ADHD.

These drugs are often taken for a number of years. Ritalin may not be dangerous in the short term, but in the long term, it may damage heart muscle, as apparently occurred in one 14-year-old boy who died of heart failure as a result of long-term use. (That's the pathologist's opinion, not mine.)

Adderall, the new fashionable choice in ADHD medications, is another story:

(February 10, 2005) -- US drug regulators will continue to allow the sale of Adderall to treat hyperactive children and attention deficit disorder, although Canada has halted sales amid concerns about its safety. Health Canada ordered the once-a-day treatment for attention deficit hyperactivity disorder off the market after learning the drug has been linked to 20 sudden deaths and 12 strokes, including among children....

And it's amazing what we do not know about how these stimulants may affect brain development. We're still experimenting with rats to answer that question. One study found that rats given Ritalin as juveniles were more likely to exhibit "learned helplessness," analogous to depression, as adults. Another study found that rats given Ritalin as juveniles were less responsive to rewarding stimuli and more sensitive to stress.

I alluded to abuse of stimulants in yesterday's post. Here is some specific information on Ritalin abuse in middle and high school:

Among the findings from a soon-to-be-published Massachusetts Department of Public Health survey: 13 percent of 6,000 high-school students and 4 percent of middle-school students admitted to an "illicit, unprescribed use" of Ritalin in anonymous, written surveys....

Three years ago, high-school students in a focus group told Clark that the stimulant was "great for studying." Teens who crush and snort it liken the drug, intended for the treatment of ADHD, to cocaine. Also known as methylphenidate, Ritalin ranks on the Drug Enforcement Administration's Top 10 list of most-often stolen prescription drugs.

"In our research, prescription drugs were number two after marijuana in terms of drugs kids said they used most readily," adds Clark. "Girls especially felt prescription drugs were cleaner and safer because they'd been manufactured in controlled conditions."

And a bit about prescribed stimulant abuse in college:

[S]ome students are succumbing to the combined pressures of a heavy workload and active social life, turning to prescription stimulants to help them juggle responsibilities.

A Loyola College junior, who wished to remain anonymous, has had four midterms and two 10-page papers due in the past two weeks. With these demands and trying to maintain a social life, this student often turns to Adderall to keep up with work and to reduce the desire for sleep.

"I'm not sure just how prevalent Adderall is on this campus compared to others but it definitely exists, and the pressures of college are the reason," this student said....

The amphetamines Ritalin and Adderall are used illegally to enhance studying by as many as 20 percent of college students nationwide, according to a study published in The Johns Hopkins News-Letter in November 2002.

Why not misuse these drugs to enhance academic performance? They're prescribed in part to enhance academic performance. The US Dept of Education produced a document titled "Identifying and Treating ADHD, A Resource for School and Home," and under the section on Educational Evaluation, they say:

An educational evaluation also includes an assessment of the child’s productivity in completing classwork and other academic assignments. It is important to collect information about both the percentage of work completed as well as the accuracy of the work.

It's not just whether they're learning, the question is are they doing their work? Thinking back to the push for machine-like efficiency and productivity in the early 20th century (see The management culture), the phrase "child's productivity" sends a bit of a chill down my spine. Nothing like amphetamines for improving productivity! If only Henry Ford had had access to today's modern stimulants!

There is other evidence that ADHD diagnoses are originating in the schools:

Part of the reason that attention deficit is usually diagnosed in school age children (e.g., first to third grade) is attributable to the demands placed on the child when beginning school (American Psychiatric Association [APA], 2000). The structure at school differs from that in the home or preschool environment.

And apparently the fault lies with the individual, not the structure at school, even if the individual has no difficulties outside of school.

The American School Counselor Association has one of the highest incidence estimates for ADHD that I've seen, and places the blame squarely on the student:

ADHD is one of the most prevalent childhood and adolescence disorders, affecting from 5 percent to 10 percent of all school-age children, who may be genetically predisposed to the disorder.

Genetically predisposed, eh? Gosh, where were all these twitchy, inattentive kids in previous decades?

The boy I mentioned earlier who died from long-term Ritalin use was placed on medication after a school counselor threatened his parents, saying they would be charged with neglect if they did not medicate their son.

Doctors seem to give considerable weight to the school's opinion as well, as in this "expert advice" Q & A column:

Since teachers work with children for many hours in a day, they have a perspective about a child's behavior that is very important. Teachers are trained to observe, record, and analyze a child's behavior....

Teachers have the opportunity and the professional obligation to note behaviors that may signal underlying learning, attentional, or behavioral difficulties, including ADHD. This information is a critical part of any decision about what kinds of interventions are best for a child....

Pediatricians, psychopharmacologists, and neurologists (those professionals who are responsible for formally diagnosing ADHD and for prescribing and monitoring medications), must rely on the objective observations of teachers and others in the school to help them make their decisions about the diagnosis, and about starting, continuing, and modifying medication.

Observe, record, and analyze a child's behavior? Do they not even realize how Orwellian that sounds?

In the future, the influence of teachers and school counselors in medicating children will be formalized:

Nov 15, 2004 - Funding for a controversial Bush administration plan to submit the nation's school children to mental health testing and drug treatment may end up reaching the Senate floor this week, as GOP congressional leaders look to clear the legislative slate in order to set the table for George W. Bush's second term.

The plan, called the New Freedom Initiative (NFI), is the keystone of a package of initiatives by the President's New Freedom Commission on Mental Health, a group of doctors and mental health care professionals established by the Bush Administration in 2002.

As previously reported by The NewStandard, the Initiative’s critics, ranging from grassroots mental health advocacy organizations to government whistleblowers, have said the NFI's proposals do little else but establish state-mandated markets for the psychiatric pharmaceutical industry.

In 2003, the Commission published a report recommending states encourage more mental health testing and treatment for Americans and suggested public schools were an ideal place to access students and begin to root out undiagnosed and "severely disruptive" mental health issues.

The NFI plan, said [Allen] Jones, [a former investigator for the Office of the Inspector General], does not "have the Orwellian goal of drugging the populace for a political purpose." Instead, "it's the Orwellian goal of drugging the populace for an economic purpose."

I think Mr. Jones meant the economic purpose of selling more drugs. But when I consider the workload of the kids in my neighborhood-- on the bus at 8am, off at 4pm, and hours of homework in the higher grades-- I have to assume that a good part of the economic purpose of medicating children is increased productivity.