A 15-year-old girl and her parents recently came in for a chat with Dr. James Perrin, a Boston pediatrician, because they were concerned about the girl's grades. Previously an A student, she was slipping to B's, and the family was convinced attention deficit hyperactivity disorder was at fault — and that a prescription for Ritalin would boost her brainpower.
After examining the girl, Perrin determined she didn't have ADHD. The parents, who had come in demanding a prescription, left empty-handed.
Perrin, a professor of pediatrics at Harvard Medical School and spokesperson for the American Academy of Pediatrics, and other physicians say this is an increasingly common scenario in doctors' offices around the country, though there are no hard statistics on it.
Parents want their kids to excel in school, and they've heard about the illegal use of stimulants such as Ritalin and Adderall for "academic doping." Hoping to obtain the drugs legally, they pressure pediatricians for them. Some even request the drugs after openly admitting they don't believe their child has ADHD.
“I spoke with [some] colleagues the other day and they mentioned three cases recently where parents blatantly asked for the medication so that their children would perform better in school, yet there were no other indications that the child had ADHD,” says Dr. Nick Yates, a pediatrician and director of medical ethics for Mercy Hospital in Buffalo, N.Y.
“I’m very concerned that there’s a fair amount — and we don’t know how much — [of ADHD drugs] being prescribed and used for off-label purposes," says Yates.
Academic doping — using these stimulant prescriptions in an effort to enhance focus, concentration and mental stamina — first started on college campuses, especially Ivy League and exclusive, competitive schools. Now, the problem is filtering down to secondary schools, Yates says, and more parents are playing a role in obtaining prescription ADHD medication for their teenagers.
Yates isn't entirely surprised that parents ask for it. He believes that most families simply have a heartfelt — if shockingly misdirected — desire for their children to do their best.
Parents can be overly eager to blame poor grades on a medical condition rather than looking for other explanations, says Dr. Michael Rater, medical director of the Adolescent and Residential Treatment Program at McLean Hospital in Belmont, Mass. “It’s usually that parents are just trying to understand their children’s struggles in a narrative that makes sense to them,” he says.
Yet some parents will do whatever it takes to keep opportunities from slipping through a child's fingers — even outright lying to doctors to get the drugs, says Rater.
And some pill-eager parents aren't just seeking to level the playing field, they're trying to make their kids superstars, says Dr. Martin Stein, a professor of clinical pediatrics at University of California, San Diego.
“I see patients who come from privileged backgrounds and lower-level economic backgrounds and there’s a tremendous difference in parental expectations,” Stein says.
Privileged kids tend to have parents who will push them to be the academic cream of the crop and when they aren’t, they’ll start looking for reasons why, he says. “I tell them that honor roll, a merit scholarship or acceptance in an Ivy League school is not the end point. That would be poor medicine.”
The concerns with academic doping aren't just ethical.
"The medications in general have a long safety record for people who need them but when you use a drug for off-label purposes, there are additional safety concerns,” says Yates.
Although doctors generally agree that side effects from the medications are minimal for most kids, there is an extensive, and sometimes frightening, list of possibilities.
Commonly reported side effects include difficulty sleeping, loss of appetite, irritability, stomachaches, headaches, blurry vision, nausea, dizziness, drowsiness and tics and tremors. There have been concerns that ADHD medication temporarily delays growth, and one study found that up to 5 percent of children experience tactile hallucinations, often involving a sensation that bugs or snakes are crawling on their bodies. The FDA recently announced that certain ADHD drugs should caution users about the risks of serious heart problems and psychotic behavior.
A 2004 rat study conducted by the National Institutes of Health and McLean Hospital/Harvard Medical School suggested that children who take prescription drugs for ADHD but do not have the disorder may be at higher risk for developing depressive symptoms in adulthood. The study was particularly looking at the issue of misdiagnosis but it raises obvious concerns for the future of young people who are electing to take the medicine for no other reason than to do well in school.
In addition, Yates says that possible dependency issues, either psychological or physical, could occur when the drugs are being misused. It’s widely acknowledged that some kids abuse the drugs to get high. The pills are often crushed and snorted or even injected.
Searching out other explanations
While ADHD drugs aren't a quick fix for a lackluster report card, Stein says that poor academic performance is cause for investigation — sometimes for ADHD but also for a host of other problems. “If it was brought to my attention that someone’s grades were going down even to B's I would start looking at the whole picture," he says.
Stein says there are a variety of learning disabilities and myriad situations that are not medical but still may have an impact on a child’s academic performance.
“It could also be something situational like a divorce or a relationship with another person this kid is having," he says. "It could be that a parent has lost a job and there’s financial stress in the family.”
Depression, anxiety and other mental disorders might also be at work.
“ADHD is only one of the possibilities, and I make a point to put that at the end,” says Stein.
Perrin says he’s particularly skeptical when he’s treated a patient for many years and attention problems are only brought up once the child reaches high school. The 15-year-old girl in question, for example, had been his patient for more than a decade. He concluded that she was just a normal teen experiencing the distractions — sports, boys, friends — that teens experience.
He said that even if he had ultimately determined that the girl had ADHD, medication would not have been a speedy remedy. “True ADHD is not something that is dealt with quickly,” he says.
Scrupulous doctors, Perrin says, will take numerous office visits and much investigation before diagnosing the problem. And, if ADHD is diagnosed, they will not just prescribe medication. They’ll also prescribe behavioral therapy (sometimes for the entire family) and recommend fairly significant changes in the child’s home and learning environment.
Furthermore, doctors warn that if a kid doesn’t have ADHD, the benefit from taking the drugs is unpredictable and, despite the lore, most likely extremely modest. Parents of unmotivated kids may be particularly disappointed.
“One of the biggest problems in adolescent mental health is motivation,” says Rater. “And this medication doesn’t effect motivation. If a kid is not all that motivated, it’s really not going to help.”
Victoria Clayton is a freelance writer based in California and co-author of "Fearless Pregnancy: Wisdom and Reassurance from a Doctor, a Midwife and a Mom," published by Fair Winds Press.