A parent, not a pill

Given how common the diagnoses of Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder are these days, and the seeming haste with which physicians will prescribe stimulants to treat the disorders, you may find it interesting, as I did, that the Wall Street Journal reported in July that those prescriptions do not improve the academic performance of the children who take them. In fact, they may even have the opposite effect.

According to the article, “Stimulants used to treat ADHD like Ritalin and Adderall are sometimes called ‘cognitive enhancers’ because they have been shown in a number of studies to improve attention, concentration and even certain types of memory in the short-term. Similar drugs were given to World War II soldiers to improve their ability to stay alert while scanning radars for enemy aircraft.”

The study the WSJ was reporting on, however, indicates that over the long run there is really no significant difference in achievement scores, grade point averages or being retained in school among students who take the ADHD medication and the students who do not.

That would be disappointing and even troubling all by itself, but the study went further. Not only do students on the medication not perform any better, but “boys who took ADHD drugs actually performed worse in school than those with a similar number of symptoms who didn’t.” A separate report, a working paper published on the web site of the National Bureau of Economic Research, indicates that girls on the medication report suffering from more emotional problems than girls who do not use the drugs.

Given the number of students taking these medications–2.7 million of them as of 2007–this is serious news. While the prescriptions have been flowing in increasing numbers there have been other voices arguing that the medical community really has no idea what the long term effect of ADHD medication will be on the children who take it. And the belief that these medications help improve focus and academic performance has led to them being popular among students taking important tests or trying to improve their grades–even students who do not have a prescription for them. There is such a demand for these drugs on the “black market” that estimates are that as much as 15% to 20% of all ADHD medication winds up in the hands of someone without a prescription for it.

The WSJ article also points out that what ADHD medications do seem to do effectively is improve classroom behavior. Students on the medication are more likely to sit still and less likely to interrupt the teacher than those students diagnosed with ADHD who do not take the drugs. More specifically, “The medicine may help with focus, but it doesn’t help with deciding what to focus on.” In other words, the ADHD medications are effectively behavioral modification drugs.

I can remember attending an educators’ conference years ago, when ADD diagnoses were just coming into vogue, at which the head of a large educators’ organization suggested that ADD might be more accurately spelled BRAT. The comment received the chuckle the speaker was going for, but in the years since then the diagnosis became so common, and the medication so prevalent, that there was surely a growing number of people who believed that the “disorder” is real and the treatment effective.

I have worked with enough children and talked to enough people to know that there are legitimate cases of chemical imbalances and other challenges that make focusing and remembering difficult, and perhaps there are times when treatment with medication is warranted. At the same time, I can say with just as much conviction that I have worked with enough children and talked to enough people to know that there are times when children who were unsuccessful on the medication become much more successful when they are in environments with structure and discipline, when they are held accountable, and when they have adults who encourage them in their work.

I can recall another professional conference at which I heard an expert in the field of working with troubled youth say that while there may be a case for medication in some instances, the best treatment for children who seem incapable of focusing or applying themselves appropriately is “consistent, loving discipline over time.” I would have to echo that with a hearty amen, since that is what all children need, regardless of whether they have any diagnosis. Not coincidentally, that is exactly what the Bible prescribes for raising children, too.

I am not a mental health professional, and I am not going to jump on a soap box and say all ADHD medications should be eliminated or all children should be taken off of these drugs. I will say this, though: no physician or parent should ever use drugs just to get a child to behave or sit still. There seems to be significant evidence questioning the merit of using these medications in order to accomplish improved academic performance, and that means physicians and parents alike should think long and hard before putting children on these drugs–especially when there seems to be a link between the medication and emotional problems. If a child has trouble focusing, listening, learning or obeying it may not be a medical problem. It may not take a pill, but it will take a parent.