Hyperactive Diagnosing

November 12th, 2007

Teachers are putting more kids on drugs

By Emily Stoner

On March 21, 2000, a 14-year-old boy named Matthew Smith of Marion, Va. died of heart failure. His death certificate read, “Death caused from long term use of Methylphenidate (Ritalin).” It was Matthew’s school that suggested he be put on Ritalin in first grade. His parents disagreed, but the school threatened to charge his parents with neglect and said that Social Services would come and take their son away if they refused. The Smiths, like many families, could not afford to spend hundreds of dollars for a private evaluation, so they complied and started Matthew on Ritalin.

Matthew’s story is just one example of the potential dangers of prescribing amphetamine-like drugs to children. His case also raises questions about the place of schools in diagnosing and treating attention deficit hyperactivity disorder. Today, with more children being diagnosed with ADHD than ever before, some are beginning to wonder if tighter regulations are needed to protect children from misdiagnosis and needless medication.

The diagnosis and medication of ADHD are often viewed as controversial, both because ADHD is a relatively new disorder and because some children have been medicated unnecessarily. While hyperactive children have been treated with stimulants since 1937, the term attention deficit disorder was not added to the Diagnostic and Statistical Manual of Mental Disorders until 1980, and attention deficit hyperactivity disorder was added in 1987. This classification led to the standardization of diagnosing and treating these disorders.

Over the past decade, diagnosis and treatment of ADHD has increased dramatically. Between 2000 and 2003, the use of attention deficit hyperactivity drugs among 5- to 9-year-olds increased 85 percent. For preschoolers, use of these drugs went up 49 percent. Today, more than 2.5 million children are being medicated for ADHD, which is over half of the 4.4 million children diagnosed with the disorder.

Some of these diagnoses are being made not in doctors’ offices, but in classrooms. Organizations like Parents for Label and Drug Free Education and the National Alliance against Mandated Mental Health Screening and Psychiatric Drugging of Children say this is inappropriate and can be dangerous. In elementary schools some teachers try to force medication on students that are disruptive, unfocused, or that stray from the ‘perfect student’ model in any way, they say. Critics say that because the medications are so dangerous and controversial, teachers have no business pushing them.

Of course, the diagnosis and medication of ADHD can be beneficial. In 2007, two Mayo Clinic centers released the first population-based, long-term studies to investigate links between ADHD, medication and school performance. Results showed that by age 13, stimulant use was correlated with improved reading achievement scores and decreased absenteeism, and children with ADHD treated with stimulants were 1.8 times less likely to fail a grade than non-medicated children with ADHD.

Still, high-profile complications from ADHD medications and concerns about rampant misdiagnosis have caused some governments to step in. Due to the sudden deaths, heart-related deaths and strokes in children taking the recommended dose of amphetamine-based ADHD medication, Canada suspended the sale of Adderall XR in 2005. Recently, the suspension has been abolished, but the drug now has to have a warning label stating the risks of heart problems and the hazards of amphetamines.

In the United States, the Parent Consent Act of 2007 was introduced in the House of Representatives banning the use of federal funds for the use of any universal or mandatory health-screening program at schools. The act, which is in committee, stated that attention deficit hyperactivity disorder has not been firmly established as a brain disorder – yet children as young as 18 months old are being medicated for it.

Many schools do not want to give up their influence in diagnosing ADHD. Connie McCrary, the school psychologist for Cayuga Heights Elementary in Ithaca, feels that teachers and other school staff members play integral roles in diagnosing children with ADHD and other disorders.

But even McCrary, who supports schools that have an active role in student diagnosis, feels there is a limit. “I think that we need to be very careful when we diagnose; make sure it’s appropriate,” she says. Schools should play a role in diagnoses but shouldn’t threaten that children will be kicked out of school or taken away from their parents if not given medication, she said.

Emily Stoner is a freshman journalism major who is against Adderall except when it helps her cram. Email her at estoner1[at]ithaca.edu.

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