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Published: Sunday, 10/14/2012

Better schools, not drugs

Perhaps only in over-medicated America would prescription drugs substitute for education reform. Physicians are giving growing numbers of struggling, low-income elementary school students powerful stimulants such as Adderall to boost their focus and academic performance.

The use of such psychotropic medications, covered by Medicaid, to improve impulse control, listening, and study habits has yielded some positive results. Another generation of poor children who attend inadequate schools should not have to leave school with little prospect for prosperity, just because they live in a society that doesn't fully recognize the value of investing in their futures.

Still, the less-than-discriminate use of psychotropic drugs for children carries troubling physical and psychological risks, including addiction, higher blood pressure, stunted growth, and, rarely, psychotic episodes.

At the least, the federal government should monitor the administration of stimulants such as Adderall pills and Concerta, and, if necessary, more closely regulate their medical use. One Atlanta-area pediatrician acknowledges using trumped-up diagnoses of attention deficit-hyperactivity disorder (ADHD) as an excuse to prescribe drugs such as Adderall to treat a more general problem: poor academic performance in lousy, cash-starved schools.

Doctor must ensure that parents know the risks. They should closely monitor side effects and make judgments based on guidelines of the American Academy of Pediatrics, not gut feelings. African Americans, especially, may be wary of medical efforts to modify behavior, given the lingering effects of the infamous Tuskegee syphilis experiment.

Doctors prescribe stimulants such as Adderall to control the effects of ADHD, which is characterized by extreme inattention, as well as impulsive, often disruptive, behavior. ADHD has become a common psychiatric diagnosis for Americans ages 4 to 17; nearly 10 percent, or 5.4 million children, are estimated to have it. Affluent students often use, and abuse, stimulants to raise already-good grades in colleges and high schools.

A broader and equally troubling question is whether more pediatricians have concluded, not unreasonably, that other intervention strategies — including tutoring, family counseling, better nutrition, prep classes, and expanded Head Start — are no longer realistic options for poor children. It may not be coincidental that diagnoses for ADHD have gone up as school funding has gone down.

In that regard, give Dr. Michael Anderson, an Atlanta-area pediatrician who serves poor families, high marks for candor in arguing that he has no real choice but to prescribe stimulants.

"We've decided as a society that it's too expensive to modify the kid's environment," he said. "So we have to modify the kid."

Dr. Anderson's remarks are a call not only for closer scrutiny of Adderall and other drugs, but also for investments in strapped school districts the nation has too long ignored.



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